Objective
The aim was to explore how mindfulness group therapy for somatoform disorders influenced the patients' stress experiences, coping strategies and contextual psychosocial processes.
Methods
A longitudinal pre- and post-treatment design, using 22 semi-structured individual pre- and post-treatment interviews. Data-analysis was based on a thematic methodology.
Results
Pre-treatment patients were struggling in an existential crisis, feeling existentially insecure about their social identity, the causes, consequences and management of their illness; experiencing difficulties identifying and expressing stress-related cognitions, emotions and feelings, and low bodily and emotional self-contact; often leading to avoidant coping, making these individuals highly stress-vulnerable. Post-treatment, the overall change was conceptualized as increased existential security, defined by patients being more self-confident; more clarified with their social identity, the nature, management and future prospects of their illness; generally using more flexible coping strategies to reduce their daily stress experiences. Four related subthemes were identified contributing to increased existential security: 1) more secure illness perceptions — feeling existentially recognized as “really” ill, 2) enhanced relaxation ability — using mindfulness techniques, 3) increased awareness — connecting differently to mind and body 4) improved ability to identify and express needs and feelings of distress — more active communicating. Patients suggested that mindfulness therapy could be expanded with more time for group-discussions followed by additional individual therapy.
Conclusion
Generally, treatment positively influenced the patients' illness perceptions, stress-experiences, body- and self-awareness, coping strategies, self-image, social identity and social functioning. However, patients identified potentials for treatment improvements, and they needed further treatment to fully recover.
Physical complaints not attributable to conventionally defined diseases are prevalent in all medical settings [1], when the symptoms become chronic they could be diagnosed as somatoform disorders (SD). The interactions between stress, maladaptive coping patterns and bodily reactions involved in SD-pathology have been unclear [2], [3], [4], [5], [6], [7] and [8]. However, recent research shows that patients with SD are stress-vulnerable [9] having difficulties coping with psychosocial challenges and illness-related stress [10]. Exploring life-history patterns, SD-patients narrated how the communication of stressful circumstances with significant adults in their childhood was experienced as insufficient, conflicting or dismissive, generally involving avoidant coping strategies [9]. Patients adapted to this “emotional avoidance culture” by becoming emotionally avoidant themselves [2]. Findings also associates SD with alexithymia [11], [12], [13], [14] and [15], affect dysregulation [16], [17] and [18], insecure attachment [19], [20] and [21], poor expression abilities and avoidant coping [22]. In their adult lives, SD-patients feel a deep longing for existential recognition from others, while experiencing difficulties with self-recognition of concerns, needs, vulnerability and distress, which negatively frame their ability in expressing these essential aspects; as a consequence patients generally hide their concerns [10]. Hence, SD-patients do not achieve the stress-reducing effects normally gained when feelings are verbalized [16], [23], [24], [25] and [26]. Additionally, in keeping their concerns secret, they receive no social support, which makes people more resilient to chronic pain [27] and [28]. Suffering from a contested psychosomatic illness is found to be stressful, involving stigmatizing processes, diminished self-confidence and disrupted self-biography, leading to identity-crisis [10], [29], [30], [31] and [32] aggravated by insecure illness perceptions [30], [33] and [34] and insufficient treatment [2], [3], [4], [5], [6], [7] and [8]. Thus specialized treatments for these conditions are often lacking [35].
Treatments with mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) reduce SD-related symptoms of stress, anxiety, fatigue and depression [36], [37], [38], [39] and [40]. Mindfulness-based treatments for fibromyalgia have shown inconclusive results [41], [42], [43], [44] and [45]. A study of chronic pain-patients reported pain reduction as well as improved attention, sleep, mood and wellbeing [46]. Cognitive behavioral therapy (CBT) is shown to be the best established treatment for varying somatoform disorders [47] and [48]. Mindfulness therapy (MT) is a new manual-based group-treatment for people suffering from SD, combining MBSR-elements with CBT-elements [35] and [49]. Mindfulness is the awareness that emerges through nonjudgmentally paying attention to purpose and bodily sensations in the present moment [50], aiming for altering the stress-response from affective alarm – reacting automatically with fight-, flight- and freeze-reactions – to mindful pro-action by cognitive reappraisal and bodily contact [36]. The aim of this study is to gain new in-depth knowledge on how MT influenced the patients' stress experiences, coping strategies and the contextual psychosocial processes including their self-image and social identity.
