The somatic symptom and related disorders in primary care: the impact of behavior on symptom burden and a randomized controlled trial of exposure-based therapy versus standardized education

The annual societal cost of medically unexplained symptoms in Sweden is approximately 40 billion SEK, i.e., similar to the cost of cancer.

Common chronic diseases like asthma and diabetes also commonly involve physical symptoms that cause distress and behavioral changes that lead to disability and increased healthcare consumption.

Exposure-based treatment has shown promise in reducing the somatic symptom load and increasing quality of life in several populations that report distress related to somatic symptoms.

In primary care, however, access is limited as there exists no flexible exposure protocol that can be easily tailored to suit a wide spectrum of patients who report substantial distress related to somatic symptoms.

In a recent feasibility trial (N=33), we found that a flexible exposure-based treatment can be delivered online with high patient satisfaction, large and lasting improvement, and no serious adverse events.

We now wish to complete a randomized controlled trial (N=160) in primary care to (a) test if flexible exposure-based treatment is more efficacious than standardized education for adults with distress related to somatic symptoms, (b) study the determinants of subjective symptom burden, and (c) finalize a new self-report measure of symptom preoccupation.

We expect this project to be of clinical importance by improving our understanding of subjective symptom burden and improving access to psychological treamtent for this large patient group in primary care.