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The review article (study 1) is giving an overview about psychotherapeutic approaches, effective dealing and randomized controlled treatment trials for patients with somatoform disorders and shows that powerful interventions are urgently required. Many of those patients seem to lack emotional awareness and show deficits in emotion regulation abilities, but the integration of emotion regulation training have not been assessed so far. The dissertation deals with two subjects for enhancing the treatment of patients with multiple somatoform symptoms (MSS).
First, we developed the treatment manual ENCERT („ENriching CBT with Emotion Regulation Training“), by enriching cognitive behavioral treatment (CBT) with mindfulness based emotion regulation strategies. The objective was to validate the manual in a non-randomized controlled pilot-study (ENCERT: N = 20, CBT: N = 22) and to demonstrate its feasibility (study 2). Patients with MSS improve during ENCERT and CBT with tendentially larger effect sizes for ENCERT, but no group differences.
Second, we experimentally compared short-term effects of acceptance, cognitive reappraisal, compassionate self-support, and distraction on induced somatic symptoms in a group of 48 patients with MSS and 48 matched healthy controls (study 3). The results show that healthy controls benefit from all emotion regulation strategies in reducing the intensity, the impairment and increasing the bearing. Concerning reducing the impairment in patients with MSS, acceptance showed to be significantly superior to compassionate self-support and distraction. However, there were no differences between the emotion regulation strategies regarding intensity and bearing of symptoms.
To conclude, the dissertation provides a treatment manual, which demonstrated comparable effectivity to CBT and good feasibility. Furthermore, the results indicate that differences within effectiveness depend on outcome measures and are different between patients with MSS and healthy controls. In patients with MSS, acceptance showed to be significantly superior to compassionate self-support and distraction, but not to reappraisal. These findings support the integration of mindfulness-based strategies into CBT, but not until experimentally detecting its efficiencies in each patient.