Mindfulness-Based Stress Reduction, Somatic Symptoms & Related Disorders

The DSM-5 defines somatic symptom disorders as a group of disorders that share one common feature: "the prominence of somatic [that is, physical] symptoms associated with significant distress and impairment." The Merck Manual notes that this distinquishes these disorders from most other mental health disorders, which are "characterized by mental symptoms," such as "unusual or disturbing thoughts, moods, and/or behaviors" (Dimsdale, n.d.).

The Merck Manual further explains these disorders as follows: "Everyone reacts on an emotional level when they have physical symptoms. However, people with a somatic symptom disorder have exceptionally intense thoughts, feelings, and behaviors in response to their symptoms" (Dimsdale, n.d.). The DSM-5 notes that some, but not all, individuals with these disorders have "medically unexplained symptoms." 

The DSM-5 lists the following criteria for somatic symptom disorder: A) At least one somatic symptom that is distressing or causes "significant disruption of daily life." B) "Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns." C) The "state of being symptomatic is persistent (typically more than 6 months)." Dimsdale, J.E. (n.d.). 

Overview of somatic symptom and related disorders. Merck Manual, Consumer Version. Retrieved from http://www.merckmanuals.com/home/mental-health-disorders/somatic-symptom-and-related-disorders/overview-of-somatic-symptom-and-related-disorders

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American Jon Kabat-Zinn developed Mindfulness-Based Stress Reduction (MBSR) in 1979 for patients with chronic pain and illness who were not responding to traditional treatments.

He believed that teaching patients to practice Buddhist mindfulness meditation would reduce their suffering. Kabat-Zinn (2003) defined mindfulness as "the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment.”

MBSR is an effective treatment for somatic symptoms disorders. For example:

* MBSR has been found to reduce stress and anxiety in chronically ill patients (Praissman, 2008).

* MBSR has been found to reduce depression and anxiety in physically ill patients (Fjorback, Arendt, Ørnbøl, Fink, & Walach, 2011).

MBSR also improves the self-reported physical health of patients with chronic, distressing pain. Fjorback et al. (2013) found that a combination of MBSR and CBT improved patient perceptions of their health. Those patients who received enhanced treatment as usual (including an individualized two-hour consultation with a psychiatrist) reported similar health improvements, but the MBSR-CBT participants reported improvements more than one year earlier.

A 2013 review found that MBSR helped individuals with somatic symptom disorder (classified at the time as somatization disorder) (Lakhan and Schofield). Individuals who received MBSR, compared to individuals who received no treatment, experienced "small to moderate" reductions in "pain, symptom severity, depression, and anxiety" and equally small to moderate improvements in quality of life. MBSR has no known adverse side effects (Praissman, 2008).

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Fjorback, L. O., Arendt, M., Ørnbøl, E., Fink, P., & Walach, H. (2011). Mindfulness‐based stress reduction and mindfulness‐based cognitive therapy: A systematic review of randomized controlled trials. Acta Psychiatrica Scandinavica, 124(2), 102-119. doi:10.1111/j.1600-0447.2011.01704.x

• This article reviews 21 MBSR studies and concludes that MBSR effectively improves mental health and reduces the symptoms of stress, anxiety, and depression. This article also concludes that most MBSR studies lack long-term follow-up and active control groups.

Fjorback, L. O., Arendt, M., Ørnbøl, E., Walach, H., Rehfeld, E., Schröder, A., & Fink, P. (2013). Mindfulness therapy for somatization disorder and functional somatic syndromes—Randomized trial with one-year follow-up. Journal of Psychosomatic Research, 74(1), 31-40.

• This study assigned individuals with somatic symptom disorder to one of two groups, one that received MBSR-CBT, the other that received an individualized two-hour meeting with a psychiatrist. At 15-month follow-up, both groups reported improved health conditions, but only the MBSR-CBT group reported health improvements immediately after completing therapy.

Kabat‐Zinn, J. (2003). Mindfulness‐based interventions in context: past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144-156.

• This is a history of MBSR and other mindfulness therapies by MBSR’s founder. It is a great resource for better understanding the practice and its Buddhist foundations in more depth. 

Lakhan, S. E., & Schofield, K. L. (2013). Mindfulness-based therapies in the treatment of somatization disorders: a systematic review and meta-analysis. PloS One, 8(8), e71834.

• This is a comprehensive review of MBSR’s effectiveness at treating somatic symptom disorder. The review shows that, compared to individuals who receive no treatment, individuals who receive MBSR tend to experience small to moderate reductions in "pain, symptom severity, depression, and anxiety" and equally small to moderate improvement in quality of life .

Praissman, S. (2008). Mindfulness-based stress reduction: A literature review and clinician's guide. Journal of the American Academy of Nurse Practitioners, 20(4), 212. doi:10.1111/j.1745-7599.2008.00306.x

• This study reviews MBSR as a general stress-reduction technique for people with chronic pain and somatic symptoms as well as generalized stress. It discusses the history of the modality, structure, and differences between it and CBT. 

Substance Abuse and Mental Health Services Administration. (2012). Mindfulness-Based Stress Reduction (MBSR). Retrieved from http://legacy.nreppadmin.net/ViewIntervention.aspx?id=238