What Works for Whom? A Critical Review of Psychotherapy Research

Objective Fatigue is prominent across many long term physical health conditions. This scoping review aimed to map the fatigue intervention literature, to ascertain if certain interventions may be effective across conditions, and if novel interventions tested in specific long term conditions may be promising for other conditions. Methods Scoping review methodological frameworks were used. Electronic bibliographic databases were searched (inception to November 2016) for systematic reviews of fatigue interventions in long term conditions. Inclusion criteria were: long term physical health condition; review focus on fatigue management; objective and systematic review process; primary review outcome is fatigue. Articles focussing on surgical interventions or treatments thought to trigger fatigue were excluded. A narrative synthesis was performed. Results Of 115 full texts screened, 52 reviews were included. Interventions were categorised as pharmacological and non-pharmacological (exercise, psychological/behavioural and complementary medicine). Pharmacological interventions did not consistently demonstrate benefit, except for anti-TNFs and methylphenidate which may be effective at reducing fatigue. Non-pharmacological interventions such as graded exercise and fatigue-specific psychological interventions may be effective, but heterogeneous intervention components limit conclusions. 'Complementary medicine' interventions (e.g. Chinese herbal medicines) showed promise, but the possibility of publication bias must be considered. Conclusions Further research is necessary to inform clinical practice. The reported effectiveness of some interventions across inflammatory health conditions, such as anti-TNFs, aerobic exercise, and psychologically based approaches such as CBT, highlights a potential transdiagnostic avenue for fatigue management. More novel strategies that may be worth exploring include expressive writing and mindfulness, although the mechanisms for these in relation to fatigue are unclear. More work is needed to identify transdiagnostic mechanisms of fatigue and to design interventions based on these.

/pdf/fatigue-interventions-in-long-term-physical-health-w910nsc4kn.pdf

Fatigue interventions in long term, physical health conditions: A scoping review of systematic reviews.

Objective: Medically unexplained somatic symptoms (MUSS) represent a frequent complaint in health care services. While psychological treatments have demonstrated some effect in patients with MUSS, ...

Common therapeutic strategies in psychological treatments for medically unexplained somatic symptoms.

Therapeutic change mechanisms in adults with medically unexplained physical symptoms: A systematic review.

Introduction:This study aims to explore the relationships between beliefs about emotions, emotional suppression, distress and global impact (i.e. the extent to which a patient’s symptoms impact the...

Investigating the role of beliefs about emotions, emotional suppression and distress within a pain management programme for fibromyalgia.

Medically unexplained symptoms (MUS) are not only common and distressing, but are also typically poorly managed in general medical settings. Those suffering from these problems tend to incur significantly higher health costs than the general population. There are many effective treatments for different MUS; these are almost entirely based on cognitive-behavioural approaches. However, the wide range of treatment protocols tend to be ‘syndrome specific’. As such, they do not generalise well in terms of training and application, making them expensive and difficult to disseminate, suggesting the desirability of developing a transdiagnostic approach. The general basis of such a CBT grounded transdiagnostic approach is considered, and the particular need to incorporate cognitive elements of both anxiety or health anxiety (threat) and depression (loss) is highlighted. Key empirically grounded and evidence-based processes (both specific and general) previously identified as underpinning the maintenance of MUS are delineated. The way in which these can be combined in a transdiagnostic model that accounts for most MUS presentations is presented and linked to a formulation-driven transdiagnostic treatment strategy, which is described. However, the need to take more syndrome-specific issues into account in treatment is identified, suggesting that the optimum treatment may be a hybrid transdiagnostic/specific approach with formulation, shared understanding, belief change strategies, and behavioural experiments at its heart. The generalisation of such approaches to psychological problems occurring in the context of ‘long-term conditions’ is identified as a further important development that is now within reach.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/4A86818F9198DA2CCA568F6AE2E852BA/S0813483916000085a.pdf/div-class-title-extending-cognitive-behavioural-theory-and-therapy-to-medically-unexplained-symptoms-and-long-term-physical-conditions-a-hybrid-transdiagnostic-problem-specific-approach-div.pdf

Extending Cognitive-Behavioural Theory and Therapy to Medically Unexplained Symptoms and Long-Term Physical Conditions: A Hybrid Transdiagnostic/Problem Specific Approach

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Extending Cognitive-Behavioural Theory and Therapy to Medically Unexplained Symptoms and Long-Term Physical Conditions: A Hybrid Transdiagnostic/Problem Specific Approach