Is Therapist Support Needed? Comparing Therapist- and Self-Guided Internet-Based CBT for Somatic Symptom Distress (iSOMA) in Emerging Adults

• Published in: Behavior therapy 2022-11, Vol.53 (6), p.1205-1218
• Main Authors: Hennemann, Severin, Böhme, Katja, Kleinstäuber, Maria, Ruckes, Christian, Baumeister, Harald, Daniel Ebert, David, Küchler, Ann-Marie, Witthöft, Michael
• Format: Article
• Language: English
• Subjects: cognitive behavioral therapy; emerging adults; internet intervention; persistent somatic symptoms; therapist guidance
• ISSN: 0005-7894; 1878-1888
• DOI: 10.1016/j.beth.2022.06.006

•Internet-delivered CBT (iSOMA) for emerging adults with somatic symptom distress.•Study investigated impact of regular vs. on-demand therapeutic guidance.•No difference between iSOMA with regular guidance compared to guidance-on-demand.•Findings offer possibilities for implementation into indicative prevention.•Further insights are needed to identify what type of guidance works for whom. Persistent somatic symptoms of varying etiology are very common in emerging adults and can lead to distress and impairment. Internet-delivered interventions could help to prevent the burden and chronicity of persistent somatic symptoms. This study investigated the impact of therapist guidance on the effectiveness of a cognitive-behavioral Internet intervention for somatic symptom distress (iSOMA) in emerging adults, as a secondary analysis of a two-armed randomized controlled trial. We included 149 university students (83.2% female, 24.60 yrs) with varying degrees of somatic symptom distress who were either allocated to the 8-week intervention with regular, written therapeutic guidance (iSOMA guided) or to the control group (waitlist), which was afterwards crossed over to receive iSOMA with guidance-on-demand (iSOMA-GoD). Primary outcomes were somatic symptom distress (assessed by the PHQ-15) and psychobehavioral symptoms of the somatic symptom disorder (assessed by the SSD-12) at pre- and post-treatment. Secondary outcomes included depression, anxiety, and disability. Both treatments showed statistically significant pre-post improvements in primary (iSOMA-guided: d = 0.86–0.92, iSOMA-GoD: d = 0.55–0.63) and secondary outcomes. However, intention-to-treat analysis revealed non-significant between-group effects for all outcomes (ps ≥ .335), after controlling for confounding variables, and effect sizes were marginal (d = −0.06 to 0.12). Overall, our findings indicate that Internet-delivered cognitive behavioral therapy with regular guidance is not unequivocally superior to guidance-on-demand in alleviating somatic symptom distress and associated psychopathology in emerging adults. As a next step, non-inferiority studies are needed to test the robustness of these findings and their impact on clinical populations.