J Psychosom Res. 2021 Apr 7;110486. doi: 10.1016/j.jpsychores.2021.110486.Online ahead of print.

Lena Sarter ¹, Jens Heider ², Lukas Kirchner ³, Sandra Schenkel ⁴, Michael Witthöft ⁵, Winfried Rief ⁶, Maria Kleinstäuber ⁷

Author information

• ¹Philipps-University Marburg, Department of Clinical Psychology and Psychotherapy, Marburg, Germany. Electronic address: lena.sarter@staff.uni-marburg.de.
• ²University Koblenz-Landau, Department of Clinical Psychology and Psychotherapy, Landau, Germany. Electronic address: heider@uni-landau.de.
• ³Philipps-University Marburg, Department of Clinical Psychology and Psychotherapy, Marburg, Germany. Electronic address: lukas.kirchner@staff.uni-marburg.de.
• ⁴Johannes Gutenberg-University Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Mainz, Germany. Electronic address: s.schenkel@uni-mainz.de.
• ⁵Johannes Gutenberg-University Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Mainz, Germany. Electronic address: witthoef@uni-mainz.de.
• ⁶Philipps-University Marburg, Department of Clinical Psychology and Psychotherapy, Marburg, Germany. Electronic address: rief@staff.uni-marburg.de.
• ⁷University of Otago, Otago Medical School - Dunedin Campus, Department of Psychological Medicine, Dunedin, New Zealand. Electronic address: maria.kleinstaeuber@otago.ac.nz.

Abstract

Objective: Cognitive behavior therapy (CBT) is the best-evaluated psychological approach to treat patients with medically unexplained symptoms (MUS). We still need a better understanding of what characterizes patients with MUS who benefit more or less from CBT. This systematic review aimed to identify patients' cognitive-emotional characteristics predicting the outcome of CBT for MUS.

Methods: A systematic literature search (PubMed, PsycINFO, Web of Science) revealed 37 eligible studies, 23 of these provided data for meta-analyses. Mean correlation coefficients between predictor variables and the outcomes (symptom intensity, physical or social-emotional functioning) were calculated using a random-effects model. Differences between syndromes of MUS were investigated with moderator analyses.

Results: Meta-analyses showed that patients with a comorbid mood disorder (r = 0.32, p < .01) or anxiety disorder (r = 0.18, p < .01), symptom catastrophizing and worries (r = 0.34, p < .01), tendencies of somatosensory amplification (r = 0.46, p = .04), and low symptom acceptance or self-efficacy (r = 0.25, p < .01) have a less favorable CBT outcome. Moderator analyses revealed that these associations between predictors and treatment outcome are pronounced in patients with chronic fatigue syndrome and irritable bowel syndrome.

Conclusions: Our results show that pre-treatment differences in patients' cognitive-emotional characteristics predict patients' outcome in CBT. Patient-tailored CBT could be a promising approach to address MUS patients' widely varying needs more effectively.

Protocol registration: The protocol of this systematic review and meta-analysis was registered in the PROSPERO registry (CRD 42018098649).