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Group therapy and psychosomatic medicine
114
Symposium abstracts / Journal of Psychosomatic Research 55 (2003) 111–129
parsimonious fit of mental distress perceptions, leaving a total of twenty cross-culturally validated subdomains. Conclusion: A cross-culturally applicable framework of mental distress may be used for cross-cultural research on lay perceptions or help clinicians in multicultural settings to transfer complex lay accounts into smaller more manageable chunks. Limitations of this framework and guidelines towards its, use are discussed.
Depression and somatic symptoms Punjabi and English people visiting their general practitioner Bhui K, Bhugra D, Goldberg D Background: People of South Asian origin are reported to have higher rates of somatic manifestations of mental distress presenting in primary care, often mitigating the detection of mental disorder. Recent studies suggest filters on the passage to specialist care through primary care in the UK, with South Asians being least while detected. Methodology: A two-phase study in primary care of Punjabi Asian and English general practice attendees. Common mental disorder was assessed with a clinical interview schedule. Somatic symptoms were identified with an item on the clinical interview schedule using a Likert rating. General practitioners identified on a Likert rating who had common mental disorders, who had somatic symptoms and/or physical illness. Results: General practitioners have a high threshold for assigning Punjabi Asians a diagnosis of common mental disorder, preferring the diagnosis of somatic symptoms. A detailed analysis of the data shows that somatic symptom prevalence does not differ across cultures. Taking depression as a specific condition, this is more common amongst Punjabi Asians and more common amongst those who are not somatizing. Conclusion: More attention needs to be paid to somatic symptoms as a nosological entity in different cultural groups.
Hearts, guts and minds: the changing face of somatization in the military Jones E Hearts, guts and minds: the changing face of somatization in the military. We sought to identify patterns of somatization in soldiers diagnosed with postcombat syndromes from 1900 to the Gulf conflict. It has been argued that the early part of the twentieth century was dominated by functional somatic disorders linked to the heart. During World War Two, the physical focus was reported to have switched to the stomach and gastro-intestinal disorders. By the time of the Vietnam conflict, it has been suggested, the incidence of somatic disorders had declined as both soldiers and society became more psychologically aware. Hence, post-traumatic stress disorder and other posttrauma illnesses were thought to have taken the place of traditional somatic presentations among the military. Using random samples of UK servicemen with characteristic post-combat disorders, patterns of symptoms were compared. Although changes in the physical focus of these disorders can be identified as new medical priorities arose, our findings suggest that psychiatric presentations have not supplanted conversion disorders. Somatic symptoms were common in the latter part of the twentieth century and are an important feature of Gulf War syndrome, while neuropsychiatric features were found in World War One veterans diagnosed with shell shock. Somatoform disorders have not steadily disappeared from the services as society’s understanding of psychological and medical issues advanced.
15,406 men and women. The associations were particularly strong for angina with and without ECG abnormalities (Men: OR 3.26, 95% CI 2.52 – 4.21; Women: OR 2.89, 95% CI 2.35 – 3.55) (Men: OR 2.68, 95% CI 2.03 – 4.52; Women: OR 2.88, 95% CI 1.89 – 4.39). In longitudinal analyses psychological distress was associated with 5-year all-cause mortality in men in fully adjusted analysis (RR 1.53, 95% CI 1.14 – 2.05) and men free of baseline physical illness (RR 1.67, 95% CI 1.04 – 2.70), and with 5-year CHD mortality (RR 1.64, 95% CI 1.02 – 2.56), (age, sociodemographic and CHD risk factor adjusted), (RR 1.39, 95% CI 0.88 – 2.15) (additionally adjusted for physical illness). Psychological distress was associated with CHD morbidity in men 1.95 (RR 1.95, 95% CI 1.16 – 3.29) in fully adjusted analysis but not women. Conclusion: Psychological distress is associated with an increased 5-year risk of CHD mortality and morbidity in men but not women that is not explained by sociodemographic, traditional CHD risk factors or existing illness.
Group therapy and psychosomatic medicine (Chair) Spiegel D, Abbey S, Gun-Usishkin M Group therapy is an efficacious and cost-effective means of providing psychotherapeutic support. The group model has been applied to an increasingly diverse set of problems, ranging from medical illness to psychiatric inpatients to traumatic stress. The range of group interventions has also grown from a focus on interpersonal process and analysis of here-and-now interactions to supportive/expressive, psychoeducational, and experiential approaches including mindfulness and hypnosis. In this symposium, methods and evidence of efficacy of the application of group intervention to the seriously mentally ill (Dr. Gise), primary breast cancer patients (Dr. Spiegel), the use of mindfulness (Dr. Abbey), and patients with implantable defibrillators will be presented. Special advantages and limitations of the group setting for intervention will be highlighted.
Group therapy for primary breast cancer: a randomized multicenter trial Spiegel D, Classen C, Koopman C, Atkinson A, Dimiceli S, StonischRiggs G, Westendorp J, Morrow G Introduction: This is a prospective, randomized, controlled, multicenter trial. Three hundred and fifty-three women recently diagnosed with primary breast cancer were recruited from 2 academic centers and 9 community oncology practices in the NCI Community Clinical Oncology Program. Participants were randomly assigned to the intervention arm or to the education control arm. The POMS was used at baseline, 3, 6, 12, 18 and 24 months. Results: An intention to treat analysis did not show a statistically significant a decline in POMS scores over time among the entire sample of woman who received group therapy compared with those in the control condition. However, among a subsample of highly distressed participants, intervention patients showed a significantly greater reduction in total mood disturbance on the POMS than did control patients [ F(1,65) = 2.64, P = .05]. Conclusions: Supportive – expressive group therapy is readily transferred to the community setting and is beneficial for distressed women with primary breast cancer. Other studies demonstrate strong effects of group support in reducing distress for patients with metastatic disease, again especially among those with high initial levels of distress. Implications for treatment planning will be discussed.
Somatic symptoms and depression Rasul F, Stansfeld SA, Hart CL, Gillis C, Smith GD The relationship between psychological distress and angina on ECG abnormalities was examined in a cross-sectional community study of
Group cognitive behavioral therapy for depression and anxiety in an ambulatory psychosomatic service (Preliminary report) Rincon HG, Hoyos G, Badiel M
Symposium abstracts / Journal of Psychosomatic Research 55 (2003) 111–129
parsimonious fit of mental distress perceptions, leaving a total of twenty cross-culturally validated subdomains. Conclusion: A cross-culturally applicable framework of mental distress may be used for cross-cultural research on lay perceptions or help clinicians in multicultural settings to transfer complex lay accounts into smaller more manageable chunks. Limitations of this framework and guidelines towards its, use are discussed.
Depression and somatic symptoms Punjabi and English people visiting their general practitioner Bhui K, Bhugra D, Goldberg D Background: People of South Asian origin are reported to have higher rates of somatic manifestations of mental distress presenting in primary care, often mitigating the detection of mental disorder. Recent studies suggest filters on the passage to specialist care through primary care in the UK, with South Asians being least while detected. Methodology: A two-phase study in primary care of Punjabi Asian and English general practice attendees. Common mental disorder was assessed with a clinical interview schedule. Somatic symptoms were identified with an item on the clinical interview schedule using a Likert rating. General practitioners identified on a Likert rating who had common mental disorders, who had somatic symptoms and/or physical illness. Results: General practitioners have a high threshold for assigning Punjabi Asians a diagnosis of common mental disorder, preferring the diagnosis of somatic symptoms. A detailed analysis of the data shows that somatic symptom prevalence does not differ across cultures. Taking depression as a specific condition, this is more common amongst Punjabi Asians and more common amongst those who are not somatizing. Conclusion: More attention needs to be paid to somatic symptoms as a nosological entity in different cultural groups.
Hearts, guts and minds: the changing face of somatization in the military Jones E Hearts, guts and minds: the changing face of somatization in the military. We sought to identify patterns of somatization in soldiers diagnosed with postcombat syndromes from 1900 to the Gulf conflict. It has been argued that the early part of the twentieth century was dominated by functional somatic disorders linked to the heart. During World War Two, the physical focus was reported to have switched to the stomach and gastro-intestinal disorders. By the time of the Vietnam conflict, it has been suggested, the incidence of somatic disorders had declined as both soldiers and society became more psychologically aware. Hence, post-traumatic stress disorder and other posttrauma illnesses were thought to have taken the place of traditional somatic presentations among the military. Using random samples of UK servicemen with characteristic post-combat disorders, patterns of symptoms were compared. Although changes in the physical focus of these disorders can be identified as new medical priorities arose, our findings suggest that psychiatric presentations have not supplanted conversion disorders. Somatic symptoms were common in the latter part of the twentieth century and are an important feature of Gulf War syndrome, while neuropsychiatric features were found in World War One veterans diagnosed with shell shock. Somatoform disorders have not steadily disappeared from the services as society’s understanding of psychological and medical issues advanced.
15,406 men and women. The associations were particularly strong for angina with and without ECG abnormalities (Men: OR 3.26, 95% CI 2.52 – 4.21; Women: OR 2.89, 95% CI 2.35 – 3.55) (Men: OR 2.68, 95% CI 2.03 – 4.52; Women: OR 2.88, 95% CI 1.89 – 4.39). In longitudinal analyses psychological distress was associated with 5-year all-cause mortality in men in fully adjusted analysis (RR 1.53, 95% CI 1.14 – 2.05) and men free of baseline physical illness (RR 1.67, 95% CI 1.04 – 2.70), and with 5-year CHD mortality (RR 1.64, 95% CI 1.02 – 2.56), (age, sociodemographic and CHD risk factor adjusted), (RR 1.39, 95% CI 0.88 – 2.15) (additionally adjusted for physical illness). Psychological distress was associated with CHD morbidity in men 1.95 (RR 1.95, 95% CI 1.16 – 3.29) in fully adjusted analysis but not women. Conclusion: Psychological distress is associated with an increased 5-year risk of CHD mortality and morbidity in men but not women that is not explained by sociodemographic, traditional CHD risk factors or existing illness.
Group therapy and psychosomatic medicine (Chair) Spiegel D, Abbey S, Gun-Usishkin M Group therapy is an efficacious and cost-effective means of providing psychotherapeutic support. The group model has been applied to an increasingly diverse set of problems, ranging from medical illness to psychiatric inpatients to traumatic stress. The range of group interventions has also grown from a focus on interpersonal process and analysis of here-and-now interactions to supportive/expressive, psychoeducational, and experiential approaches including mindfulness and hypnosis. In this symposium, methods and evidence of efficacy of the application of group intervention to the seriously mentally ill (Dr. Gise), primary breast cancer patients (Dr. Spiegel), the use of mindfulness (Dr. Abbey), and patients with implantable defibrillators will be presented. Special advantages and limitations of the group setting for intervention will be highlighted.
Group therapy for primary breast cancer: a randomized multicenter trial Spiegel D, Classen C, Koopman C, Atkinson A, Dimiceli S, StonischRiggs G, Westendorp J, Morrow G Introduction: This is a prospective, randomized, controlled, multicenter trial. Three hundred and fifty-three women recently diagnosed with primary breast cancer were recruited from 2 academic centers and 9 community oncology practices in the NCI Community Clinical Oncology Program. Participants were randomly assigned to the intervention arm or to the education control arm. The POMS was used at baseline, 3, 6, 12, 18 and 24 months. Results: An intention to treat analysis did not show a statistically significant a decline in POMS scores over time among the entire sample of woman who received group therapy compared with those in the control condition. However, among a subsample of highly distressed participants, intervention patients showed a significantly greater reduction in total mood disturbance on the POMS than did control patients [ F(1,65) = 2.64, P = .05]. Conclusions: Supportive – expressive group therapy is readily transferred to the community setting and is beneficial for distressed women with primary breast cancer. Other studies demonstrate strong effects of group support in reducing distress for patients with metastatic disease, again especially among those with high initial levels of distress. Implications for treatment planning will be discussed.
Somatic symptoms and depression Rasul F, Stansfeld SA, Hart CL, Gillis C, Smith GD The relationship between psychological distress and angina on ECG abnormalities was examined in a cross-sectional community study of
Group cognitive behavioral therapy for depression and anxiety in an ambulatory psychosomatic service (Preliminary report) Rincon HG, Hoyos G, Badiel M