IAHRW International Journal of Social Sciences © 2019 Indian Association of Health, Research and Welfare

Review, 2019, 7(2), 175-181 ISSN-2347-3797

UGC Journal No 41948 and NAAS Rating 2.72

Treating somatization: A multimodal approach

Ranjan Kumar Masroor Jahan Kangkan Pathak
Department of Psychology, RRS College Department of Clinical Psychology Department of Psychiatry
Patliputra University, Patna, Bihar RINPAS, Ranchi, Jharkhand LGBRIMH, Tezpur, Assam

Somatization disorder is a major public health issue for which effective treatment is rarely delivered. Several
models of psychotherapy are being practiced in treatment of somatization disorder. The study aimed to assess the
efficacy of multimodal psychotherapy package for management of somatization patients on different psychological
variables and to see the durability of the therapeutic gains. This study was a center based study using the pre - post
design with control group. 30 OPD patients with somatization disorder were selected by purposive sampling
technique and divided into two groups' i.e. intervention group and control group using simple random sampling
method. Intervention group was given twelve sessions of management package i.e. Symptoms monitoring form,
Scheduling of daily activity, Sleep hygiene, Diaphragmatic breathing, Psycho-social Intervention, Psychodynamic
individual psychotherapy, Cognitive restructuring (approximately 3 to 4 months). Efficacy and durability were
measured by The Bradford Somatic Inventory (BSI), General health Questionnaire-28 GHQ-28), Defense
Mechanism Inventory (DMI) and Sack's Sentence Completion Test (SSCT). For baseline analysis of the study
variables Mann Whitney U test and Chi square test were done. Wilcoxon Sign Rank test and Mann Whitney U test
were done to assess the changes at different time intervals. Results reveals that there is significant differences found
among intervention group in comparisons to control group in context of somatic complaints (Bradford Somatic
Inventory), quality of life (WHO-Quality of life scale), level of depression (Beck Depression Inventory), and in
level of anxiety (IPAT Anxiety Scale). Significant improvement also found between post intervention & follow-up
of the intervention group on different study variables. The present study findings established that multimodal
psychotherapy program is effective in the improvement of psychological functioning and improvement is also
sustained, maintained and improving till follow up sessions.

Keywords: somatisation, depression, anxiety, quality of life, multimodal approach

Somatization disorder, also termed Briquet's syndrome, is a distinct with costly, repetitive diagnostic procedures, and organ-oriented
clinical and epidemiological condition that lies in the borderland treatments with poor outcome (Bhugra et al., 1997; Ebigbo, 1982).
between clinical medicine and psychiatry (Escobar, Waitzkin, & Meta-analysis of the efficacy of multidisciplinary treatment
Silver, 1998). Somatization is the presentation of physical symptoms programs for somatoform patients has proven that this kind of
without an objective and identifiable cause, and the condition is treatment is superior to single discipline treatment, such as medical
among the most common and challenging problems in primary therapy or physical therapy. Moreover, the effects were seen to
medical care (Bakal, Steiert, Coll, & Schaefer, 2006). Somatic stabilize over time, and the beneficial effects were not limited to
complaints have wide cultural variation. Some complaints are improvements in pain, mood and interference, but also extended to
universal, described across cultures and countries. Prominent among behavioral variables, such as return to work or decreased use of the
those are fatigue and tiredness, aches and pains, notably headaches health care system (Parker, Gladstone, & Chee, 2001).
and generalized body pains and abdominal discomfort. Review studies suggest that there have been numerous of studies
Patients with somatization disorder have a persistent conviction of conducted in the field of somatization disorder, but very few
being ill, despite repeated negative results on laboratory tests, numbers of studies available were based on multimodal
diagnostic tests, consultations with specialists, and recurrent management approach. Most often such patients with somatization
hospitalizations (McCahill, 1995). Epidemiological research disorder show deficit in cognitive function as well as anxiety,
suggests that somatization disorder is relatively rare. The prevalence depression, health problem, poor quality of life, faulty use of defense
of somatization disorder in the general population has been estimated mechanism, etc. There are only limited studies on somatization
to be 0.1% to 0.7% (Faravelli et al., 1997; Weissman et al., 1978). disorder in Indian context and north east India particularly in Assam.
Somatization disorder is major public health issues for which The current study is being undertaken to explore whether
effective treatment is rarely delivered. These disorders are multimodal psychotherapy can be of clinical uses in reducing the
considered by many clinicians to be among the most frustrating above symptoms. The result and observations made from this study
disorders to manage, and levels of patient dissatisfaction are reported may be used to understand and plan a strategy to tackle somatization
to be high. The management of these disorders may be associated disorder. Keeping these points in view, the present study was done
with following aims:
Corresponding Author: AIM of the study
Ranjan Kumar The study aimed to assess the efficacy of multimodal psychotherapy
Assistant Professor, Department of Psychology program for management of somatization patients on different
RRS College, Patliputra University, Patna, Bihar psychological variables and to see the durability of the therapeutic gains.
E-mail: [email protected]
176 KUMAR ET AL./ TREATING SOMATIZATION: A MULTI MODAL APPROACH

Objective of the study Patients were motivated to identifying and the discussion of
psychosocial problem, identifying and the discussion of family
To find out the role of multimodal psychotherapy in reducing
perception and maladaptive responses.
symptoms of somatisation, in reducing level of depression, in
Psychodynamic individual psychotherapy: The aim of
reducing level of anxiety, and in improving quality of life of patients
psychodynamic individual psychotherapy was the verbalizations of
having somatization Disorder.
emotional and interpersonal problems in order to understand the
Method underlying intra-psychic and interpersonal conflicts and to enable
the patient to utilize a broader spectrum of coping strategies.
Participants Cognitive restructuring: Patient with somatization disorder tends to
30 OPD patients with somatization disorder from LGBRIMH, have dysfunctional belief about somatic sensations and often about
Tezpur were selected by purposive sampling technique and divided their ability to perform effectively. The cognitive-emotional
into two groups' i.e. intervention group and control group using elicitation/regulation module aimed to help patients differentiate
simple random sampling method. and understand their thoughts and feelings so that they can interact
more effectively with their environment. This was the treatment to
Research design help patients examine their cognitive tendencies and dysfunctional
This study was a center based study using the pre - post design with thinking pattern. Cognitive errors that we had observed included
control group. perfectionist thoughts, catastrophic thoughts (about physical
Inclusion criteria: Diagnosed as having from mild to moderate level symptoms as well as other life events), overestimation and
of somatization disorder according to the DCR of ICD 10 (WHO, dichotomous thinking. In cognitive restructuring techniques the
1993), Age range 20-40 years, At least educated up to middle class, therapist selected one of the patient's beliefs illustrating one of his
Patient who were cooperative, gave informed consent to participate cognitive tendencies. Next, the therapist and patients examine the
in the study and able to comprehend the instruction. thought from different prospective.
Exclusion criteria: With significant co-morbid psychiatric, physical Procedure
or neurological conditions, History of alcohol or any other substance
Outdoor patient diagnosed as having Somatization disorder
abuse, Psychopathology interfering in eliciting reliable information
according to the DCR of ICD 10 were called for interview. There
and implementing management plan, Family history of mental illness.
were 43 patients interviewed those who were found suitable
Instruments according to the inclusion and exclusion criteria. Total 30 patients
were selected those were ready to give consent to paticipate in the
Socio-demographic and Clinical Data Sheet: The Bradford Somatic
study. Patients were consequently selected for intervention group
Inventory, WHOQOL-BRIEF, Beck Depression Inventory, Hindi
(15) and control group (15) using purposive sampling. Information
Version of Cattell's Self Analysis Form or IPAT Anxiety Scale
about socio-demographic variables and clinical details were
Questionnaire (A.S.Q), and Multimodal psychotherapy package
collected and psychological variables were measured using selected
Description of Multimodal Psychotherapy is as follows: psychological tests from the drawn sample of 30 patients by trained
Psychotherapy sessions were conducted by trained RCI clinical psychologist.
(Rehabilitation Council of India, New Delhi) registered clinical
After that, first group, i.e., intervention group, underwent 12
psychologist at psychotherapy unit under premises of mental health
sessions of multimodal psychotherapy package and the second
institute. 60 to 90 minutes of individual sessions were followed after
group, i.e. control group, was under pharmacological treatment as
pharmacotherapy and other lab investigation. Sessions were focused
usual in psychiatric set-up. Intervention group was receiving the
on following major techniques of psychotherapy.
pharmacological intervention along with therapeutic package.
Symptoms monitoring form: Somatization patients were taught to
There were between 60 to 90 minutes of session provided twice in
monitor the thoughts and emotions that were associated with changes
a week but the time was varying depending on the severity of client's
in their physical symptoms. Symptom-monitoring forms were
problem. A total number of sessions were 12, and was completed
introduced to help patients focus their attention on thoughts and
within 3 to 4 months.
feelings between sessions. The monitoring form was used to detect
After a completion of 12 sessions of management package
patterns in symptoms and in the relationships among symptoms,
(approximately 3 to 4 months) both groups were reassessed using
thoughts, and emotions.
the same tools. Again after a follow-up period of next three months,
Scheduling of daily activity: Scheduling of daily activities was reassessment was done through same tools for intervention group.
introduced to promote daily physical, social, recreational, and
occupational activities, Scheduling pleasurable family activities, Statistical analysis
assigned need based behavioral assignment The statistical analysis was done with the help of Statistical Package
Sleep hygiene: Somatization patients report significant sleep for Social Sciences-16 (SPSS-16). For baseline analysis of the study
disturbance. Sleep hygiene was introduced to maintain sleep. variables Mann Whitney U test and Chi square test were done.
Diaphragmatic breathing: Diaphragmatic breathing was taught and Further analysis, Wilcoxon Sign Rank test and Mann Whitney U test
explained that the long-term goal for the patient to breathe were done to assess the changes at different time intervals within
abdominally as much as possible. The aim of breathing exercise was groups and between groups for all the study variables.
to acquire a relaxed abdominal breathing pattern.
Psycho-social intervention: Aims of Psycho social interventions Results and discussion
were the discussion of social issues concerning family, work, etc. Table-1 and 2 shows that there was no statistically significant
 IAHRW International Journal of Social Sciences Review, 2019, 7(2), 175-181 177

difference found in sex, education, marital status, domicile, religion, employment, type of family, age, onset age, and total duration of illness.

Table 1: Presents descriptive information about the socio-demographic characteristics of the entire
sample which is divided into two groups
Variables Intervention group Control group Chi square (df) p Value
Sex Male 8 9 0.13(1) .71
Female 7 6
Education 1-5 years 2 3 0.34(2) .84
6- 10 years 9 9
more than10 years 4 3
Marital status Married 11 9 2.2(2) .33
Unmarried 4 4
Divorced 0 2
Domicile Rural 8 9 0.17(2) .91
Urban 2 2
Semi urban 5 4
Religion Hindu 8 7 1.35(2) .50
Islam 6 8
Christian 1 0
Employment Employed 9 7 0.53(1) .46
Unemployed 6 8
Family Nuclear 7 9 0.53(1) .46
Joint 8 6

Table 2: Presents descriptive information about the socio-demographic characteristics (age,

onset and duration of illness) of the entire sample which is divided into two groups
Areas of Intervention group Control group df Mann Whitney U test
assessment (Mean ±SD) (Mean ±SD)
U value Z-score
Age 30.26 ± 7.34 31.13 ± 4.94 28 103.00 -.395
Onset 23.60 ± 3.96 24.00 ± 4.55 28 107.00 -.229
Duration 06.66 ± 4.16 07.00 ± 4.62 28 108.50 -.167

Comparison between intervention and control group on significant reduction in symptoms of somatization on Bradford
study variables at baseline Somatic Inventory (Z= -3.573, p< .001) among intervention group
in comparison to control group.
Mann Whitney U Test was conducted to evaluate the differences of Finding of the present study indicates that multimodal
findings of psychological variables between intervention and control management approach for the somatization disorder has been
group at baseline. Table 3 indicated that at baseline there were no found effective in reducing somatic complaint. The findings are
difference between intervention group and control group on level of similar to study conducted by Larisch et al. (2004). They
Bradford Somatic Inventory and on different domains of WHO- recruited 73 somatization patients in intervention group and 54
Quality, BDI and IPAT Anxiety Scale domains. somatization patients in control group through multilevel
Role of multimodal psychotherapy between intervention sampling technique. For psychosocial management they used
and control group different psychological intervention like role playing, psycho
education, relaxation, symptoms monitoring diary, worked on
To find out the role of multimodal psychotherapy, differences emotional distress and emotional regulation, explored
between the baseline and after intervention scores were calculated significant stressors in life and explained resolution of conflicts
for both the groups. These differences for the intervention and and they fixed systematic protocol for psychosocial
control group were calculated than compared using Mann Whitney U intervention. Measurements were done after intervention and
test was conducted to evaluate the efficacy of multimodal follow up session and found that patients of the intervention
psychotherapy package on psychological functioning. group showed significant improvement compared with patients
Table 4 reveals that after Multimodal Psychotherapy, there was of the control group on the reduction of physical symptoms,
178 KUMAR ET AL./ TREATING SOMATIZATION: A MULTI MODAL APPROACH

Table 3: Comparison of bradford somatic inventory, WHO-Quality of Life, BDI & IPAT Anxiety Scale between intervention
and control group at baseline
Areas of assessment Intervention group Control group df Mann Whitney U test
(Mean ±SD) (Mean ±SD)
U value Z-score
Bradford Somatic Inventory 48.20 ± 15.11 49.26 ± 10.40 28 107.50 -.208
WHO-QOL Physical 37.33 ± 09.87 33.06 ± 13.30 28 98.00 -.617
Psychological 38.53 ± 12.80 37.66 ± 10.80 28 111.00 -.064
Social relationship 46.33 ± 18.74 41.73 ± 15.82 28 96.00 -.694
Environmental 48.53 ± 17.22 44.26 ±14.94 28 97.50 -.627
BDI 24.53 ± 11.38 26.46 ± 09.56 28 98.00 -.614
IPAT Total 40.93 ± 13.12 39.40 ± 11.29 28 104.00 -.353
Overt 19.26 ± 07.06 18.93 ± 05.73 28 110.50 -.083
Covert 22.33 ± 07.01 20.93 ± 07.69 28 99.00 -.561
Ratio 00.89 ± 00.29 00.95 ± 00.26 28 87.000 -1.058
Apprehension 13.40 ± 05.44 12.06 ± 05.09 28 92.50 -.832
Tension 09.86 ± 05.81 10.26 ± 03.69 28 109.00 -.146
Low self control 08.00 ± 02.59 07.80 ± 04.24 28 107.50 -.208
Emotional stability 06.40 ± 02.19 05.20 ± 03.50 28 100.00 -.525
Suspicion 03.33 ± 02.28 02.13 ± 02.26 28 90.00 -.943

Table 4: Comparison of Bradford somatic inventory, WHO-Quality of life, BDI & IPAT Anxiety scores between intervention and control
group after multi modal psychotherapy
Area of Assessment Intervention group Mean ± SD Control Group Mean ± SD Mann Whitney U Test
Pre Post Difference Pre Post Difference U Value Z-score
(Pre-Post) (Pre-Post)
Bradford Somatic Inventory 48.20 ± 15.11 21.06 ± 07.50 -27.13 ± 09.25 49.26 ± 10.40 43.00 ± 11.16 -6.26 ± 13.07 26.50 -3.573***
WHO- Physical 37.33 ± 09.87 50.06 ± 09.17 -12.73 ± 10.08 33.06 ± 13.33 36.33 ± 11.15 -3.26 ± 09.39 57.50 -2.316*
Quality Psychological 38.53 ± 12.28 54.13 ± 14.29 -15.60 ± 01.14 37.66 ± 10.80 33.46 ± 08.83 -4.20 ± 12.50 26.00 -3.606***
of Life Social relationship 46.33 ± 18.74 55.60 ± 14.09 -09.26 ± 11.50 41.73 ± 15.82 48.06 ± 09.33 -6.33 ± 08.19 92.00 -0.859
Environmental 48.53 ± 17.22 54.20 ± 10.89 -05.66 ± 10.08 44.26 ± 14.94 49.66 ± 13.17 -5.40 ± 12.90 105.50 -0.293
BDI Row Score 24.53 ± 11.38 08.86 ± 40.17 -15.66 ± 10.39 26.46 ± 09.56 21.33 ± 08.10 -5.21 ± 02.86 40.50 -2.828**
IPAT Total Score 40.93 ± 13.12 30.80 ± 07.81 -10.13 ± 07.86 39.40 ± 11.29 35.73 ± 09.61 -3.66 ± 04.46 57.00 -2.309*
Overt 19.26 ± 07.06 16.46 ± 04.95 -02.80 ± 05.14 18.93 ± 05.73 15.13 ± 04.89 -3.80 ± 04.58 93.00 -0.813
Covert 22.33 ± 07.01 15.00 ± 03.68 -07.33 ± 06.60 20.93 ± 07.69 20.66 ± 06.68 -0.26 ± 06.82 49.50 -2.618**
Ratio 00.89 ± 00.29 01.13 ± 00.39 --0.24 ± 00.49 00.95 ± 00.26 00.77 ± 00.25 -0.17 ± 00.43 63.00 -2.053*
Apprehension 13.40 ± 05.44 09.73 ± 04.14 -03.66 ± 03.45 12.06 ± 05.09 11.46 ± 04.98 -0.60 ± 04.22 66.50 -1.918
Tension 09.86 ± 05.81 07.26 ± 04.72 -02.60 ± 03.04 10.26 ± 03.69 09.60 ± 03.77 -0.66 ± 02.84 77.50 -1.470
Low self control 08.00 ± 02.59 06.33 ± 01.95 -01.66 ± 02.46 07.80 ± 04.24 07.06 ± 02.73 -0.73 ± 02.68 85.50 -1.134
Emotional stability 06.40 ± 02.19 05.26 ± 02.08 -01.13 ± 01.64 06.66 ± 03.81 05.20 ± 03.50 -1.46 ± 03.48 105.00 -0.323
Suspicion 03.33 ± 02.28 02.20 ± 01.82 -01.13 ± 02.29 02.60 ± 02.19 02.13 ± 02.26 -0.46 ± 01.80 97.00 -0.658
(*Significant at 0.05 level, ** significant at 0.01 level, *** significant at 0.001 level)

reduction in depression score and reduction in anxiety score. with somatization disorder received 10 cognitive behavior therapy
Improvement is also maintained in follow up sessions. sessions or treatment as usual. Cognitive behavior therapy's goals
In another study Greck et al. (2013) reported that somatization were to reduce physiologic arousal though relaxation techniques,
patients showed a significant decrease in somatic complaints by enhance activity regulation through increasing exercise and
using multimodal psychodynamic psychotherapy and other meaningful pleasurable activities and pacing activities, increase
techniques such as medical therapy, music therapy, communicative awareness of emotions, modify dysfunctional beliefs, enhance
movement therapy, art therapy, social therapy, and various relaxation communication of thoughts and emotions, reduce spousal
methods. reinforcement of illness behavior.
Similar findings were reported by Allen et al. (2001) 84 patients Present study findings supported by study done by Speckens et al.
 IAHRW International Journal of Social Sciences Review, 2019, 7(2), 175-181 179

(1995) reported cognitive restructuring showed significantly greater psychodynamic individual therapy, psychodynamic group therapy,
improvement in their psychosomatic complaints. and medical therapy, music therapy, communicative movement
On WHO-Quality of life scale, there was significant improvement therapy, art therapy, social therapy, and various relaxation methods.
found among intervention group in Physical (Z= -2.396, p<.05), In another preliminary study on somatisation disorder done by
Psychological (Z=-3.606, p<.001), Social relationship (Z= -0.859, Allen (2006) reported that level of depression was significantly
p<.05) and environmental (Z= -0.293, p<.05) domains in reduced after intervention. In his study they recruited thirteen out
comparison to control group. patients with history of unexplained somatic symptoms, used
In the present study, findings indicate that multimodal structured interview and medical history review for inclusion in the
management approach is effective in improving overall quality of study. Ten weekly sessions of a manualized intervention expressly
life, physical quality of life and psychological quality of life of the designed for patients with somatization disorder includes training in
patients. Further result also indicate improvement pattern in social each of the following domains: relaxation, activity regulation,
relationship and environmental area of quality of life. cognitive restructuring, sleep hygiene, and communication. Beck
The findings of present study are consistent with the findings of Depression Inventory was used to see role of intervention and
Gili et al. (2014) They had implemented 10 ninety minutes weekly reported that depression scores were reduced over time with patients
session based on cognitive restructuring and behavioural coping reporting fewer symptoms of depression at post-treatment. Overall
strategies to improve health related quality of life in somatization findings are consistent with the findings of the present study.
patients. Reported that physical functioning, social functioning, Similarly Pieh et al. (2014) applied multimodal treatment
emotional problems and mental health significantly improved after program and reported that level of depression was significantly
intervention and also maintained in follow up session. reduced and correlated with improvement of pain perception in his
In a study of manualized mindfulness therapy Fjorback et al. study. The main modules of the multimodal treatment program were
(2013) used psycho-education, symptom registration, and a model acceptance, resource development, conflict management and
for graded exercise for management of somatization disorder and interpersonal skills training, implementation in daily life, and
found that outcome measures from baseline to 15-month follow-up. relapse prevention. The individual therapy focused on each patient's
Reported change in health related quality of life measures of the SF- specific impairment.
36 and symptoms such as illness worry, physical symptoms, and IPAT Anxiety Scale which assess overall level of anxiety and
severity of depression and anxiety. different domain of anxiety, results revel that in overall level of
In an open trial study done by Benítez et al. (2013) found anxiety (Z= -2.309, p<.05), on covert anxiety (Z= -2.618, p<.01) and
significant effects for functioning in the life household activities, and on ratio domains (Z= -2.053, p<.05) significant reduction were
in the life satisfaction subscales for somatization patients. Their found among intervention group in comparison to control group.
module comprised Cognitive Restructuring and its various Findings of the present study indicate overall levels of anxiety and
therapeutic strategies (e.g., thought records, downward arrow covert anxiety significantly reduce after intervention, also
technique, & behavioral experiments) which were used to address improvement maintained in follow-up session. Reduction pattern
dysfunctional beliefs associated with multiple unexplained physical also reported in overt level of anxiety, in apprehension, tension, in
symptoms. Other module included Relaxation Training low self control, in emotional stability and in suspicion components
(diaphragmatic breathing & autogenic relaxation), which was used of test.
to reduce physiological arousal and hypersensitivity to bodily Similar findings, Allen (2006) reported in his preliminary study
sensations that are common in patients with somatic complaints, on somatisation disorder that anxiety and level of depression was
Activity Regulation (i.e., activity scheduling & pacing), which significantly reduced after intervention.
mainly targeted management of physical symptoms. Findings of the present study are similar with some aspect of a
Similar findings reported by Egger et al. (2015) in their study, they study of manualized mindfulness therapy Fjorback et al. (2013)
used psycho-dynamic psychotherapy and cognitive behavior therapy reported that psycho-education, symptom registration, and a model
for the management of various anxiety related disorder and for graded exercise for management of somatization disorder is
somatization disorder and found that heath related quality of life effective in the reducing the level of anxiety of somatization patient.
improved significantly after implementation of psychological Findings of the present study were supported by Kleinstaeuber et
intervention. al. (2011) in his recently meta-analyzed 27 trials mainly applying
In a study of Brief psychodynamic interpersonal psychotherapy cognitive behavioural approaches, behavioural medical
for patients with multiple somatoform disorder Sattel et al. (2012) interventions or reattribution for multiple medically unexplained
reported that quality of life was significantly improved with elective symptoms. The effects of these studies also proved to be small to
approach of intervention. modest for the majority of approaches and observable primarily for
After Multimodal Psychotherapy, intervention group reported changes in physical symptoms and anxiety symptoms.
significant reduction in depressive symptoms in comparison to Another Meta analysis of psychodynamic psychotherapy for
control group (Z= -2.828, p<.01). Results of the present study somatic symptom disorders demonstrated medium to high short-
indicate that multimodal management program is effective in term and long term effects on depression, anxiety and somatic
reducing the level of depression in somatization patients. symptoms. Somatic symptom disorders refer to chronic pain (nearly
Similar findings reported by Greck et al. (2013) in his study half of the studies), irritable bowel syndrome and a number of
reported that post intervention somatoform disorder patient's level of organically explained diseases (Kroenke & Swindle, 2000).
depression on Beck Depression Inventory score had reduced Meta-analysis of the role of multidisciplinary treatment programs
significantly. For the therapeutic regime they included for somatoform patients has proven that this kind of treatment is
180 KUMAR ET AL./ TREATING SOMATIZATION: A MULTI MODAL APPROACH

superior to single discipline treatment, such as medical therapy or maintained on follow up. Table 20 shows comparison of BDI and
physical therapy. Moreover, the effects were seen to stabilize over IPAT Anxiety Scale scores between post intervention and follow-up
time, and the beneficial effects were not limited to improvements in scores of the intervention group. It shows that there was significant
pain, mood and interference, but also extended to behavioral difference on IPAT total score (Z = -2.163, p<.05), Overt score (Z= -
variables, such as return to work or decreased use of the health care .438, p<.05) and apprehension score (Z = --2.777, p<.01) between
system (Flor, 1992). post intervention and follow-up of the intervention group, which is
indicative of better improvement in intervention group. Other
Durability of multimodal psychotherapy domains were not found significantly different. It indicates
To find out durability of multimodal psychotherapy package, clinically therapeutic gain obtained after intervention and was
comparison between after intervention and on follow up scores for maintained on follow up.
the different domains of psychological testing for the intervention Findings of the present study indicate that the improvement of
group was performed using Wilcoxon Sign Rank Test. psychological functioning was sustained and improving till follow
Table 5 shows comparison of Bradford Somatic Inventory, WHO- up sessions in context of somatic complaints, general health, quality
Quality of Life findings between post intervention and follow-up of life, level of depression, level of anxiety, in context of defense
scores of the intervention group. It shows that there were significant mechanism, in area of significant life conflict, and cognitive
differences found on Bradford Somatic Inventory (Z= -2.846, problem which was measured by The Bradford Somatic Inventory,
p<.01), WHO-QOL Psychological domain score (Z= - 2.066, P< .05) WHOQOL, Beck Depression Inventory, Hindi Version of Cattell's
between post intervention and follow-up of the intervention group. It Self Analysis Form, after intervention and in follow up
indicates therapeutic gain obtained after intervention was assessment.

Table 5: Comparison of Bradford somatic inventory, WHO-Quality of Life, BDI & IPAT Anxiety between post
intervention and follow up scores of the intervention group
Areas of assessment Post Intervention group On Follow-up Wilcoxon Sign Rank Test
(Mean ±SD) (Mean ±SD)
Sign Mean Rank Z Score
Bradford Somatic Inventory 21.06 ± 07.50 17.86 ± 05.57 - 7.82 -2.846**
+ 2.50
+ 4.00
WHO-QOL Physical 50.06 ± 09.17 53.33 ± 05.72 - 7.17 -1.385
+ 6.28
Psychological 54.66 ± 14.93 58.80 ± 10.78 - 4.00 -2.066*
+ 5.88
Social relationship 55.60 ± 14.09 53.00 ± 10.60 - 8.38 -0.919
+ 6.33
Environmental 54.20 ± 10.89 56.26 ± 08.24 - 8.40 -0.673
+ 7.00
BDI Row Score 08.86 ± 04.17 08.46 ± 03.46 - 4.90 -0.923
+ 3.83
IPAT Total Score 30.80 ± 07.81 28.13 ± 05.81 - 7.39 -2.163*
+ 3.83
Overt 16.46 ± 04.95 13.86 ± 02.74 - 7.00 -2.438*
+ 4.00
Covert 15.00 ± 03.68 14.26 ± 03.26 - 5.50 -0.984
+ 7.33
Ratio 01.13 ± 0.39 00.98 ± 00.11 - 9.31 -1.381
+ 5.08
Apprehension 09.73 ± 04.14 08.06 ± 02.73 - 6.40 -2.777**
+ 2.00
Tension 07.26 ± 04.72 07.80 ± 03.16 - 8.40 -0.667
+ 7.00
Low self control 06.33 ± 01.95 05.53 ± 01.35 - 5.71 -2.111
+ 2.50
Emotional stability 05.26 ± 02.08 04.86 ± 01.68 - 6.20 -1.040
+ 3.50
Suspicion 02.20 ± 01.82 01.53 ± 01.24 - 5.20 -1.134
+ 3.33
(*Significant at 0.05 level, ** significant at 0.01 level, *** significant at 0.001 level)
 IAHRW International Journal of Social Sciences Review, 2019, 7(2), 175-181 181

The findings of the present study are consistent with study done by References
Larisch et al. (2004) in his study assessment was followed over 1 year
Allen, L.A., Woolfolk, R.L., Lehrer, P.M., Gara, M.A., & Escobar, J.I. (2001). Cognitive
at four assessment times: baseline and 3, 6, and 12 month follow-ups. behavior therapy for somatization disorder: A preliminary investigation. Journal of
They reported that reductions of somatic symptoms were maintained Behavior Therapy and Experimental Psychiatry, 32(2), 53-62.
in follow up sessions. Allen, L.A., Woolfolk, R.L., & Escobar, J.I. (2006). Cognitive-behavioral therapy for
somatization disorder: A randomized controlled trial. Archives of Internal Medicine,
Present findings suggest those qualities of life were maintained 166(14), 1512-1518.
and improving in follow up session. Similar findings were reported Bhugra, D., Baldwin, D., & Desai, M. (1997). Focus groups: Implications for primary
by Fjorback et al. (2013) and reported that therapy role was and cross cultural psychiatry. Primary Care Psychiatry, 3, 45-50.
maintained in follow up session. Bakal, D., Steiert, M., Coll, P., & Schaefer, J. (2006). An experiential mind-body
approach to the management of medically unexplained symptoms. Medical
The findings that psychological variables are improved in follow Hypotheses, 67(6), 1443-1447.
up session, were supported by several studies done for the management De Greck, M., Bölter, A.F., Lehmann, L., Ulrich, C., Stockum, E., Enzi, B., Hoffmann,
of somatization disorder. However assessment scales were different T., Tempelmann, C., Beutel, M., Frommer, J., & Northoff, G. (2013). Changes in
(Gili et al., 2014; Fjorback et al., 2013; Sattel et al., 2012). brain activity of somatoform disorder patients during emotional empathy after
multimodal psychodynamic psychotherapy. Frontiers in Human Neuroscience, 7,
Overall result tables indicative that most of the psychological 410.
measurement score were improved with therapeutic intervention. Escobar, J.I., Waitzkin, H., & Silver, R.C. (1998). Abridged somatization: A study in
Maintenance in improvement was observed in follow-up assessment. primary care. Psychosomatic Medicine, 60(4), 466-472.
Ebigbo, P.O. (1982). Development of a culture specific (Nigeria) screening scale of
Limitations of the study somatic complaints indicating psychiatric disturbance. Culture Medicine and
Psychiatry, 6(1), 29-43.
Since it is time bound study, sample size was small which limits the Egger, N., Konnopka, A., Beutel, M.E., Herpertz, S., Hiller, W., Hoyer, J., Salzer, S.,
Stangier, U., Strauss, B., Willutzki, U., Wiltink, J., Leichsenring, F., Leibing, E., &
generalizations of the findings. Due to small sample size, proper
König, H.H. (2015). Short-term cost-effectiveness of psychodynamic therapy and
stratification could not be done on the basis of socio-demographic cognitive-behavioral therapy in social anxiety disorder. Journal of Affective
variables such as age, sex, education, and socio-economic status; which Disorders, 180, 21-28.
also limits the understanding for impact of these variables on Fjorback, L.O., Arendt, M., Ornbol, E., Walach, H., Rehfeld, E., & Schroder, A. (2013).
Mindfulness therapy for somatization disorder and functional somatic syndromes
somatization patient's psychological variables and management related
randomized trial with one-year follow-up. Journal of Psychosomatic Research, 74,
measures. Since it is time bound study, longer duration of follow-up 31-40.
could not be taken which limits the broader understanding of impact Flor, H., Fydrich, T., & Turk, D.C. (1992). Efficacy of multi-disciplinary pain treatment
of multimodal management program over a longer period of time. centers: a meta-analytic review. Pain, 49, 221-230.
Faravelli, C., Salvatori, S., Galassi, F., Aiazzi, L., Drei, C., & Cabras, P. (1997).
Ethical considearation Epidemiology of somatoform disorders: A community survey in Florence. Social
Psychiatry and Psychiatric Epidemiology, 32(1), 24-29.
All standard ethical procedure were folowed during psychotherapy. Gili, M., Magallón, R., López-Navarro, E., Roca, M., Morenod, S., Bauzá, N., &
Proper ethihical clearance was taken from competent authority and García-Cammpayo, J. (2014). Health related quality of life changes in somatising
patients after individual versus group cognitive behavioural therapy. Journal of
research committe. Written informed consent was obtained from the Psychosomatic Research, 76, 89-93.
participants before inclusion. Kleinstaeuber, M., Witthoeft, M., & Hiller, W. (2011). Efficacy of short-term
psychotherapy for multiple medically unexplained physical symptoms: A meta-
Conclusion analysis. Clinical Psychology Review, 31, 146-160.
Kroenke, K., & Swindle, R. (2000). Cognitive behavioral therapy for somatization and
The present study concluded that multimodal psychotherapy symptom syndromes: A critical review of controlled clinical trials. Psychotherapy
program is effective in the improvement of psychological and Psychosomatics, 69, 205-215.
functioning and improvement is also persistent till follow up sessions Larisch, A., Schweickhardt, A., Wirsching, M., & Fritzsche, K. (2004). Psychosocial
interventions for somatizing patients by the general practitioner: A randomized
in context of somatic complaints, quality of life, level of depression, controlled trial. Journal of Psychosomatic Research, 57, 507-514.
level of anxiety. In term of general health significant improvement Mc Cahill, M.E. (1995). Focus on the somatoform disorders. Hospital Practice, 30(2),
was found in overall functioning and in follow up session significant 59, 62, 65-6.
improvement observed in overall score and psychological domain. Parker, G., Gladstone, G.L., & Chee, K.T. (2001). Depression in the planets largest
ethnic group: The Chinese. The American Journal of Psychiatry, 158, 857-864.
Improvement found in Physical, Psychological, Social and
Pérez-Benítez, C.I., Zlotnick, C., Gomez, J., Rendón, M.J., & Swanson, A. (2013).
Environmental domain of quality of life. On psychological domain Cognitive behavioral therapy for PTSD and somatization: An open trial. Behaviour
of quality of life was found significantly improved in follow up Research and Therapy, 51(6), 284-289.
session, suggesting that quality of life is improved and improvement Pieh, C., Neumeier, S., Loew, T., Altmeppen, J., Angerer, M., Busch, V., & Lahmann, C.
is also sustained in term of psychological functioning. Depressive (2014). Effectiveness of a multimodal treatment program for somatoform pain
disorder. Pain Practice, 14(3), E146-E151.
symptoms were reducing gradually after intervention and follow up Robins, L.N., & Reiger, D. (1991). Psychiatric disorders in America: The
session. Level of anxiety was reduced after intervention and in epidemiological catchment area study. New York: Free Press.
follow up session. Reduction pattern also reported in overt level of Speckens, A.E.M., Van Hemert, A.M., Bolk, J.H., Hawton, K.E., & Rooijmans, H.G.M.
anxiety, in apprehension, tension, in low self control, in emotional (1995). The acceptability of psychological treatment in patients with medically
unexplained physical symptoms. Journal of Psychosomatic Research, 39(7), 855-
stability and in suspicion components of test. 863.
Sattel, H., Lahmann, C., Gundel, H., Guthrie, E., Kruse, J., & Noll-Hussong, M. (2012).
Acknowledgments Brief psychodynamic interpersonal psychotherapy for patients with multi
somatoform disorder: Randomised controlled trial. The British Journal of
I am thankful to all the faculty member and officers of Department of Psychiatry, 200, 60-67.
Psychiatry, Psychiatric Social Work and Psychiatric Nursing, Weissman, M.M., Myers, J.K., & Harding, P.S. (1978). Psychiatric disorders in a U.S.
LGBRIMH, Tezpur for helping me during the process of data urban community: 1975-1976. The American Journal of Psychiatry, 135(4), 459-
collection and in scheduling therapeutic sessions. 462.