Belemmerende factoren in de behandeling van patiënten met ernstige somatoforme stoornissen. Een kwalitatief-kwantitatief onderzoek vanuit het perspectief van de patiënt.

Abstract

Somatoform disorder is characterized by persistent physical complaints that cannot be fully explained by a medical or physical condition. Effect studies in severe somatoform disorder show low effect sizes in contrast to less severe cases or other psychological disorders. The aim of this study was to gain an insight into factors that hinder a positive therapy outcome and to determine which factors are considered most important from a patient perspective. It was expected that psychopathologic-, somatic-, psychological-, behavioral- and social factors would be identified as impeding. Social factors were expected to be considered the most important barrier. Interviews (n=12) and a card sorting task (n=10) among former patients of Altrecht Psychosomatiek Eikenboom (APS) were conducted. Hierarchical cluster analysis yielded 4 clusters: ‘attitude of therapists’, ‘organizational aspects’, ‘individual factors’ and ‘group factors’. The content of clusters could confirm the expectations that psychological factors like non acceptance, high expectations, absence of hope, catastrophizing and concern over symptoms, behavioral factors like passiveness and social factors like interpersonal problems and perception of low social support can impede a positive therapy outcome. In addition to these findings the attitude of therapists, organizational aspects in therapy, individual and group factors are also mentioned as impeding. Organizational aspects were considered the most important barrier. However, individual differences were large and suggest that barriers are far from the same for everyone. A personal inventory of hindering factors when starting therapy and during therapy could possibly enhance treatment efficacy.