Guided self-help interventions for irritable bowel syndrome: a systematic review and meta-analysis.

OBJECTIVE: Although irritable bowel syndrome (IBS) is highly prevalent and is accompanied by high costs for respective healthcare systems, the data on treatment effectiveness are limited. Current treatment methods have limitations in terms of side effects and availability. Guided self-help (GSH) might be an easily accessible and cost-effective treatment alternative. This study is the first systematic review and meta-analysis of GSH interventions for IBS. METHODS: Using electronic databases (MEDLINE, SCOPUS, PsycINFO, and Web of Science), we performed a systematic search for randomized-controlled trials. Using a random-effect model, we calculated the pooled standardized mean differences (SMDs) of GSH on IBS symptom severity (primary outcome) and quality of life (secondary outcome). We additionally examined the moderating effects of online-based interventions and face-to-face therapist contact by applying mixed models. RESULTS: A systematic literature search identified 10 eligible randomized-controlled trials, including 886 participants. Compared with the control conditions, the effect size was medium for the decrease in IBS symptom severity (SMD=0.72; 95% confidence interval: 0.34-1.08) and large for the increase in patients' quality of life (SMD=0.84; 95% confidence interval: 0.46-1.22). Neither treatment format nor face-to-face contact was a predictor of therapy outcomes in between-group analyses. In contrast, within-group analyses led to the conclusion that online-based interventions are more effective than other self-help formats. CONCLUSION: GSH is an effective alternative for the treatment of IBS. As GSH methods are easy to implement, it seems sensible to integrate GSH into clinical practice. LIMITATIONS: With respect to the high study heterogeneity, the number of studies included was relatively small.

[How burdensome is the treatment of patients with somatoform disorders?]. / Wie belastend ist die Behandlung von Patienten mit somatoformen Störungen?

OBJECTIVES: This study examines the influence of self-perceived emotional stress during the treatment of patients with somatoform disorders. It asks whether emotional stress can be influenced by psychosomatic education. METHODS: Via online questionnaire general practitioners were asked about the prevalence of patients presenting with somatoform disorders and emotional stress during treatment. RESULTS: The prevalence of somatoform disorders in general practices was estimated at around 27.7 %. Practitioners educated in psychosomatic medicine estimate the prevalence of patients with somatoform disorders higher than practitioners without such education (n = 79; r = 0.242; p = 0.032). The treatment of patients presenting with somatoform disorders causes 42.6% more emotional stress among general practitioners compared with the treatment of an average patient (n = 79; t = 16.67; p ≤ 0.001). Doctors with additional education in psychosomatic medicine rate stress 17.2% lower than doctors without such education (n = 79; t = 1.875; p = 0.033). CONCLUSIONS: General practitioners experience the treatment of patients presenting with somatoform disorders as emotionally stressful. This emotional stress is mainly explained by increases in time expenditure, but it can be reduced by additional psychosomatic education.

[Is there adequate care for patients with psychosomatic disorders in Austria? Analysis of the need and a proposal for a model of quality assurance in Austrian psychosomatic medicine]. / Werden in Osterreich Patienten mit psychosomatischen Storungen ausreichend versorgt? Eine Bedarfserhebung mit Losungsvorschlag zur Qualitats-sicherung fur die Psychosomatische Medizin in Osterreich.

INTRODUCTION: Quality assurance in psychosomatic medicine in Austria is currently based on a voluntary continuing medical education programme in psychosocial, psychosomatic and psychotherapeutic medicine. It is questionable whether psychosomatic care can be sufficiently provided in this manner. In addition, a broadly based proposal to create a subspecialty in psychosomatic medicine in order to facilitate quality assurance, is investigated. METHODS: The necessity to reorganize psychosomatic care was explored through semi-structured qualitative interviews with experts. Data-based analyses probed the labour market of the proposed subspecialty, and the literature was reviewed to look into the cost-benefit ratio of psychosomatic treatment. RESULTS: All experts expressed a need to restructure psychosomatic care in Austria. Examples exist for psychosomatic treatment with an efficient cost-benefit relation in diverse medical settings. CONCLUSION: Establishing a subspecialty in Psychosomatic Medicine seems feasible and could contribute to increased quality assurance and the nationwide provision of psychosomatic care.

Health, self-regulation of bodily signals and intelligence: review and hypothesis.

Childhood IQ and adult morbidity and mortality are known to be linked even beyond socioeconomic variables. Yet, their interrelations are insufficiently understood. It has been suggested that bodily sensations play a fundamental role in health-related self-regulation and that intelligence can influence the information processing of these somatic signals. This assumption is supported by reports on the influence of IQ on the exteroceptive (e.g. visual and auditory) and interoceptive (e.g. autonomic nervous system and posture) perception and processing of somatic information. Based on these findings the hypothesis of Psychosomatic Intelligence (PI) is introduced as an additional conceptual framework to probe the link between childhood IQ and adult health status. It implies a specific cognitive ability concerning the perception, interpretation, and self-regulation of bodily sensations. In this model, somatic signals are considered to reflect both intra-individual processes and individual-environment interactions. Based on this hypothesis the influence of intelligence on cognitive efforts to self-regulate somatic phenomena is amenable to systematic testing.

[Evaluation of a two year curriculum in psychosocial and psychosomatic medicine--handling emotions and communicating in a patient centred manner]. / Evaluation eines zweijährigen Curriculums in Psychosozialer und Psychosomatischer Medizin--Umgang mit Emotionen und patientenzentrierter Gesprächsführung.

Psychosomatic Medicine is aiming at a comprehensive understanding of patient's requests. This requires patient-centred communication. During the two-year course for "Psychosomatic Medicine"of the Lower-Austrian Medical Chamber at the Danube-University Krems relevant techniques are trained. This paper reports on the analysis of 120 video-consultations with simulated patients (30 participants, two per participant before and after the training) using a modified version of the Roter Interaction Analysis System (RIAS). Results show a considerable increase in participant's ability to respond to emotional utterances and to use techniques of patient-centred communication: percentage of appropriate utterances related to the sum of all utterances: from 9.78 ± 3.5 to 13.56 ± 4.7 (ANOVA with repeated measures: p<0.001). Furthermore, participants allow patients longer stretches of uninterrupted speech: increase from 1.76 ± 1.4 to 2.47 ± 2.3 utterances (p<0.001) helping them into a narrative style of conversation.