Intensive Short-Term Dynamic Psychotherapy Shows Promise in Reducing Somatization Patients’ Return Emergency Department Visits

By Michael Constantino and Jeffrey Magnavita.

Summary

Abbass et al. (2009) examined the preliminary efficacy of intensive short-term dynamic psychotherapy (ISTDP) in the treatment of patients with medically unexplained symptoms (i.e., somatization complaints) presenting to the emergency department (ED). ISTDP is a brief, although not time-restricted, approach that targets the unconscious emotional processes underlying patient’s manifest symptomatology (e.g., panic, back pain, headache). Using a pre-post intervention design, the researchers found that patients (n = 50) who received ISTDP following an ED visit evidenced a mean reduction of 3.2 (69%) ED visits in the following year compared to the year prior to the intervention. This reduction rate outperformed several benchmark comparison groups. Furthermore, patients evidenced significant favorable change in global symptom ratings following ISTDP. Although the study had limitations (e.g., lack of randomized control group), the findings provide preliminary evidence for the efficacy of a brief, dynamically oriented approach to somatization complaints.

Clinical Implications

The evidence, albeit preliminary, suggests that ED clinicians should consider helping patients to explore and to tolerate the emotional process connected to their manifest physical symptoms. Doing so might not only reduce ED subsequent visits, but also promote direct symptom reduction.

References

Abbass, A., Campbell, S., Magee, K., & Tarzwell, R. (2009). Intensive short-term dynamic psychotherapy to reduce rates of emergency department return visits for patients with medically unexplained symptoms: Preliminary evidence from a pre-post intervention study. CJEM, 11, 529-534.