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Patients with severe somatoform disorder (in secondary and tertiary care) typically experience functional impairment associated with physical symptoms and mental distress. Although psychotherapy is the preferred treatment, its effectiveness remains to be demonstrated.
To examine the effectiveness of psychotherapy for severe somatoform disorder in secondary and tertiary care compared with treatment as usual (TAU) but not waiting-list conditions.
Main inclusion criteria were presence of a somatoform disorder according to established diagnostic criteria and receiving psychotherapy for somatoform disorder in secondary and tertiary care. Both randomised and non-randomised trials were included. The evaluated outcome domains were physical symptoms, psychological symptoms (depression, anxiety, anger, general symptoms) and functional impairment (health, life satisfaction, interpersonal problems, maladaptive cognitions and behaviour).
Ten randomised and six non-randomised trials were included, comprising 890 patients receiving psychotherapy and 548 patients receiving TAU. Psychotherapy was more effective than TAU for physical symptoms (d = 0.80 v.d = 0.31, P<0.05) and functional impairment (d = 0.45 v.d = 0.15, P<0.01), but not for psychological symptoms (d = 0.75 v.d = 0.51, P = 0.21). These effects were maintained at follow-up.
Overall findings suggest that psychotherapy is effective in severe somatoform disorder. Future randomised controlled studies should examine specific interventions and mechanisms of change.
This study tested various sources of changes in respiratory
sinus arrhythmia (RSA). Twenty-two healthy participants
participated in three experimental conditions (mental stress,
relaxation, and mild physical exercise) that each consisted
of three breathing parts (normal breathing, breathing compressed
room air, and breathing compressed 5% CO2-enriched
air). Independent contributions to changes in RSA were found
for changes in tonic vagal modulation of heart rate, central
respiratory drive (i.e., PaCO2), respiratory depth,
and respiratory frequency. The relative contributions to changes
in RSA differed for mental stress and physical exercise. It
is concluded that uncorrected RSA will suffice to index
within-subject changes in tonic vagal modulation of heart rate
in most situations. However, if the central respiratory drive
is expected to change, RSA should ideally be corrected for changes
in PaCO2, respiratory depth, and respiratory frequency.
The aim of this study was to assess the error made by violating
the assumption of stationarity when using Fourier analysis for
spectral decomposition of heart period power. A comparison was
made between using Fourier and Wavelet analysis (the latter
being a relatively new method without the assumption of
stationarity). Both methods were compared separately for stationary
and nonstationary segments. An ambulatory device was used to
measure the heart period data of 40 young and healthy participants
during a psychological stress task and during periods of rest.
Surprisingly small differences (<1%) were found between the
results of both methods, with differences being slightly larger
for the nonstationary segments. It is concluded that both methods
perform almost identically for computation of heart period power
values. Thus, the Wavelet method is only superior for analyzing
heart period data when additional analyses in the time-frequency
domain are required.
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