Open Door Review III

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Q2((0<_!H>_!A2#92**_!8>_!ST*&0<_!H>_!SB(#%$0_!'>_!I%B60_!i>_!a)<!>!>!>!H0**$*D60*_!/>![+,-+^>!F%$0:! 1647#)&4*29$7!$*(0%10%6)*2! `#),)(-&N">#+@B&"!&'(A?-)@,#AO&GHH [-^_!g,Egd>!! Q2((0<_!H>_!I$((*0%_!=>_!G!H0**$*D60*_!/>![+,--^>!'$*0!1647#)&4*29$67#E$*(0%10%6)*0<<0!IB%C(#0%21$0!:T%! /2($0*(0*!9$(!9B<($6)92():)%90*!Q(l%B*D![/;QN^!E!/266(!&$06!:T%!2<<0n!~=!3%$0:!1647#)&4*29$7E$*(0%10%6)*2!! N(($_!=>_!ST*&0<_!H>_!H0**$*D60*_!/>_!p$990%_!8>_!K)#<67#<20D0%_!=>_!G!a)<![+,-P^>!LB*7($)*2! N">#+@B&"!&'(A?-)@,#A&@+*&0%>#"(?)%+?%O&ke [-^_!.dEg. >!! W(*&,!>-001(3! Working group PISO In 2006 a group of researchers with a psychodynamic background (“PISO working group”) started after thorough preparation a large multicenter randomized clinical trial. The study was supported by the German Research Foundation DFG. W1/RY($-#'! Patients with distressing bodily symptoms – in particular when these cannot be sufficiently explained by organic causes – are common in the healthcare system. Although many of these patients are not satisfied with the delivered medical treatment they remain to be heavy users of healthcare, thus incurring large costs to health services and society. Although there is some evidence that psychotherapy is a promising option for this disorder, trials studying cognitive–behavioural therapy (CBT) and short-term psychodynamic therapies have been of less than adequate size or did not address the full diagnostic range of these disorders. =&.4$'2! We conducted our study at six university departments of psychosomatic medicine, were we recruited 211 patients from the out-patient departments of neurology and internal medicine, from pain treatment centres and an orthopaedics private practice. The included patients required to have a minimum of three current somatoform symptoms (pain, dizziness, bowel dysfunction, fatigue, etc.) that are functionally disabling and that an organic disease or another mental disorder cannot sufficiently explain plus a history of somatoform symptoms on at least half of the days over at least 2 years, resulting in healthcare use. These were established by the somatoform disorders and hypochondria sections of the Structured Clinical Interview for DSM-IV (SCID). The data storage and monitoring as well as the statistical analysis of the primary outcome was executed by an independent clinical study coordination centre, following high methodological standards. The dimensions assessed in our study covered self-report data on physical and mental quality of life, psychopathology (depression, somatization, (health-) anxiety), illness perception, health care use, attachment styles, alexithymia and an evaluation of the therapeutic process. The assessments were made before and after treatment, plus a follow up, which was carried out 9 months after end of therapy. Additionally heart rate variability was measured as an indicator for organismic adaptability.

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