Objective

A recent meta-analysis of 17 randomized, controlled trials (RCTs) showed that Short-term Psychodynamic Psychotherapy (STPP) for functional somatic disorders (FSD) reduced somatic symptoms compared to wait list, minimal treatment, and treatment-as-usual controls. A clinically important yet unanswered question is how much improvement patients experience within STPP treatment.

Methods

Following a systematic search, we identified STPP trials presenting data at baseline and post-treatment/follow-up. Meta-analyses determined the magnitude of changes in somatic symptoms and other outcomes from before to after STPP, and analyses examined effect sizes as a function of study, therapy, and patient variables.

Results

We identified 37 trials (22 pre-post studies and 15 RCTs) totaling 2094 patients treated an average of 13.34 sessions for a range of FSD. Across all studies, somatic symptoms improved significantly from pre-treatment to short-term follow-up with a large effect size (SMD = −1.07), which was maintained at long-term follow-up (SMD = −0.90). After excluding two outlier studies, effects at short- and medium-term follow-up remained significant but were somewhat reduced in magnitude (e.g., short-term SMD = −0.73). Secondary outcomes including anxiety, depression, disability, and interpersonal problems had medium to large effects. Effects were larger for studies of STPP that were longer than 12 sessions or used an emotion-focused type of STPP, and for chronic pain or gastrointestinal conditions than for functional neurological disorders.

Conclusions

STPP results in moderate to large improvements in multiple outcome domains that are sustained in long-term follow-up. STPP is an effective treatment option for FSD and should be included in treatment guidelines.

中文翻译：

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功能性躯体障碍的短期心理动力学心理治疗：治疗效果的系统评价和荟萃分析

客观的

最近对 17 项随机对照试验 (RCT) 的荟萃分析表明，与等待名单、最小治疗和常规治疗相比，功能性躯体障碍 (FSD) 的短期心理动力学心理治疗 (STPP) 减少了躯体症状。一个临床上重要但尚未解决的问题是患者在 STPP 治疗中经历了多少改善。

方法

经过系统搜索，我们确定了提供基线和治疗后/随访数据的 STPP 试验。荟萃分析确定了 STPP 前后躯体症状和其他结果的变化幅度，并分析了作为研究、治疗和患者变量的函数的效应大小。

结果

我们确定了 37 项试验（22 项事前研究和 15 项 RCT），共 2094 名患者接受了一系列 FSD 平均 13.34 次治疗。在所有研究中，躯体症状从治疗前到短期随访都有显着改善，具有较大的效应量（SMD = -1.07），并在长期随访中保持（SMD = -0.90）。排除两项异常值研究后，短期和中期随访的影响仍然显着，但幅度有所降低（例如，短期 SMD = -0.73）。包括焦虑、抑郁、残疾和人际关系问题在内的次要结果具有中到大的影响。对于超过 12 个疗程或使用以情绪为重点的 STPP 类型的 STPP 研究，以及慢性疼痛或胃肠道疾病，其效果大于功能性神经系统疾病。

结论

STPP 在长期随访中持续的多个结果领域产生中到大的改善。STPP 是 FSD 的有效治疗选择，应纳入治疗指南。