5 A pilot group intervention to treat chronic functional conditions

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Abstract

Objective

To improve affect regulation, increase physical and social functioning, and reduce health care utilisation in patients with functional motor, sensory, and physical disorders, and/or chronic health anxiety.

Method

Following a biopsychosocial assessment at The Persistent Physical Symptoms Clinic, patients were invited* to enrol in a 12 week group therapy programme (the Programme). Designed on principles of CBT and ACT (Acceptance and Commitment Therapy), the Programme combined psycho-education, behavioural experiments, cognitive reframing and Mindfulness. Pre-group and weekly validated measures (EQ-5DL, WEMS, SEPS) were collected, together with data about health care utilisation in the previous year. Patients with Health Anxiety additionally completed the Health Anxiety inventory (HAI).Individuals’ health beliefs and behaviours were recorded, along with historical and recent stressors (childhood/adult trauma, family physical and mental health status, financial worries). Alexithymia – a trait implicated in the impaired development of emotional neural structures, (Kano & Fukudo, 2013; Shibata et al, 2014) – was assessed using the TAS-20. Discussion of individual conditions (including NEAD, Conversion, Movement, Gastro-intestinal, Pain, and Respiratory disorders) was discouraged during the sessions, both to avoid iatrogenic perpetuation through fostering a ‘competitive’ ethos and to keep participants recovery-focused. Expanding psychological flexibility was encouraged in order to enhance acceptance and facilitate change. Learning to identify and name emotions related to their experience of illness helped patients establish links between affect and behaviour (e.g. anger with self, health professionals, and family, lack of exercise, isolation). Role play developed assertiveness skills, whilst experiential exercises – guided-relaxation and compassionate mindfulness – aimed to reduce somatosensory amplification ((Derakshan, Eysenck & Myers, 2007; Edwards & Bhatia, 2012). Patients drew on their own values to design goal-based behavioural experiments for inter-session practice. Dysfunctional cognitive styles implicated in both low mood and the exacerbation of functional conditions – dichotomous thinking, catastrophizing and over-generalising (Lumley, Neely, & Burger, 2007) were challenged, using humour as appropriate. Resilience skills were inter-woven with relapse-prevention techniques. An individual review was offered half-way through the Programme. *Non- English speakers and/or patients currently experiencing psychotic symptoms were excluded.

Results

Participants who completed the group recorded decreases in health utilisation, isolation and anxiety, and an improvement in perceived control over their symptoms, quality of life, and inter-personal skills.

Conclusion

Preliminary results include reduced hyper-vigilance and symptomatology. Narcissistic traits are barriers to progress. OT physiotherapist input would enhance the Programme.

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