Mindfulness-based cognitive therapy for patients with somatoform disorders
background The daily lives of patients with somatoform disorders are often severely impaired by the symptoms of their illness. Cognitive behavioural therapy has proved to be an effective treatment for somatoform disorders. However, patients with these disorders are often reluctant to consult a psychologist for their physical symptoms. Mindfulness-based cognitive therapy (mbct) might be a useful form of treatment because it gives explicit attention to physical experiences and because it has a strong focus on acceptance of symptoms.
aim To measure the effectiveness and cost-effectiveness of mbct for patients with somatoform disorders and to provide insight into how the therapy can gradually bring about behavioural change.
method In this randomised controlled trial (rct), half of the participants (n=61) received mbct and the other half (n=56) received usual care. Participants belonged to the 10% of patients who visited primary care practitioners the most frequently; they had unexplained medical symptoms for at least six months. The primary outcomes were health status and mental and physical functioning. Measurements were taken at baseline, after 3 months and one year after baseline. In addition, records were kept of the costs involved so that we could obtain insight into health care use. Twelve patients were interviewed extensively at three points in time.
results Although the health status and the physical functioning were almost the same in the two conditions, the mental functioning improved in the patients who had attended mbct with an effect size of 0.3. At three months past baseline vitality and social functioning were significantly higher in the mindfulness condition than in the control condition. There was no significant difference between the total healthcare costs in the two conditions. The use of hospital care was lower in the mbct condition. At the same time, however, greater use was made of mental health care in the mbct condition. The interview study enabled us to establish a process of change. As a result of this process, patients focused less on short-term symptom reduction and more on the acceptance of their symptoms and on self-care.
conclusion With the improvement that occurred in patients’ mental functioning, we conclude that mbct is a meaningful therapy for patients with somatoform disorders. The fact that patients increased their use of mental health care after mbct could indicate that patients with somatoform disorders become more willing to receive mental health care.