ÖAW-DOC Stipendium für Klara Hagspiel zum Thema: "Improving the diagnosis and treatment of people with persistent somatic symptoms", 36 Monate

Theoretical Framework Approximately 50% of symptoms presented in primary care cannot be attributed to a somatic cause. These non-organic symptoms, along with symptoms that are disproportionate to the underlying disease, are often classified as medically unexplained symptoms (MUS). About 20% of MUS in primary care develop into chronic conditions. Experiencing chronic MUS is highly distressing to the individual and unfortunately heavily impacts their daily functioning. Moreover, chronic MUS impose a substantial financial burden on healthcare systems and labour markets worldwide. Diagnosis: Correctly diagnosing chronic MUS is currently very challenging. In the medical field, patients may be diagnosed with specific functional somatic syndromes such as fibromyalgia or chronic fatigue syndrome. In psychiatry, they might receive a diagnosis of somatic symptom disorder or bodily distress disorder. Years of research have shown shared aetiological mechanisms, significant symptom overlap, and comorbidity among these disorders. Consequently, a new overarching diagnosis called Functional Somatic Disorders (FSD) has been introduced, encompassing all persistent and distressing somatic symptoms not attributable to other diagnoses. This new diagnosis already found support from researchers across the world. However, what is currently unknow is whether psychological factors are relevant for people with FSDs and if they are, which one of them are most common. Looking into psychological factors in FSDs will shed light into important aetiological and maintaining mechanisms, while also investigating very promising treatment features. Treatment: In addition to the limited understanding of psychological factors in FSDs, numerous studies highlight the need to enhance treatment approaches for individuals with these conditions. Currently, both pharmacological and non-pharmacological treatments for FSDs yield only small to moderate effect sizes. Many experts advocate for a highly interconnected, diverse, and collaborative care network as a potential solution to the current treatment inefficacy. However, the actual effectiveness of such interventions remains unclear and their accessibility to the general population is questionable. On top, they do not address the significant issue that patients with FSDs experience an average duration of untreated illness of 25.2 years. Innovative approaches, such as ecological momentary interventions (EMIs), present a promising alternative. EMIs have proven effective for other mental health conditions and can be adapted for a wide range of individuals, even while they are still in the process of ruling out other disorders. Objectives My two proposed research projects aim to address two crucial research gaps in the care for people with FSDs: diagnosis uncertainty and non-effective treatment. Building on previous research and findings from our lab, I hypothesize for my first study that the majority (approximately 70%-80%) of individuals with FSDs will exhibit a relationship between psychological factors and somatic symptoms. Specifically, I predict that health anxiety, rumination, catastrophizing, negative self-concept, body checking, avoidance, and negative 2 affectivity will be closely linked to the intensity and impairment caused by somatic symptoms. This relationship is expected to occur concurrently and time lagged. For my second study, I will develop a new EMI with feedback from patients with FSDs. I hypothesize that this EMI will significantly reduce patients' levels of negative psychological factors and somatic symptoms. Additionally, I predict that this 3-week EMI program will lead to substantial improvements in participants' psychological well-being, health anxiety and overall quality of life. Methods To test these hypotheses, my first study will involve recruiting approximately 60 individuals diagnosed with FSDs. Over a two-week period, participants will use an app to record data on seven psychological factors as well as the intensity of and impairment by their somatic symptoms. Assessments will be taken four times a day with three assessments point being randomly triggered and the fourth assessment being self-initiated in the evening. The second study, focusing on the treatment of FSDs, will consist of two phases. The first phase is the prototype development phase. During this phase, five individuals with FSDs will use the newly developed EMI over a three-day test trial. Following the test run, participants will participate in interviews and fill out questionnaires to provide feedback and suggest improvements to the intervention. After incorporating this feedback, the actual efficacy of the EMI will be assessed in the second phase through a 30-day intervention trial. In this trial, approximately 98 individuals with FSDs will be randomly assigned to either the control or intervention group. Both groups will complete pre- and post-assessments, with the intervention group having an additional assessment one month after the intervention. The intervention group will receive the EMI immediately after the pre-assessments, while the control group will be waitlisted and receive the intervention at a later timepoint. Level of innovation Both studies are notable for their unique focus on an FSD sample, which is especially essential for the ongoing debate on whether the diverse disorders in this area should be classified as a single entity. Furthermore, study 1 is one of the few studies to assess multiple psychological factors. Additionally, it is the first to analyze within this sample both somatic and psychological symptoms in daily life. Study 2, on the other hand, develops and evaluates a groundbreaking treatment approach for FSD patients. Hereby, it is the first to address significant limitations in current care through enabling a reduction of waiting time, availability during acute somatic episodes, and broad applicability.