Psychotherapy in Peptic Ulcer Disease

Psychotherapy in Peptic Ulcer Disease. A controlled outcome study. By Ingemar Sjödin, Department o f Psychiatry, Sahlgren's Hospital, Göteborg, Sweden. Thesis defended 20th May 1983. Problem. Although the peptic ulcer disease (PUD) has long had the post on of a psychosomatic disorder, the approach to treatment has been principally somatic. Many PUD‐patients are not helped sufficiently by medical treatment alone. The purpose was to study the significance of a psychosomatic mode of treatment in respect of effect, mechanisms of therapeutic action and prognostic variables. Methods. Short‐term psychotherapy administrated in one‐hour weekly sessions with a limit of ten added to medical treatment was compared to medical treatment only by randomizing PUD‐outpatients into two treatment groups consisting of 50 and 53 patients respectively. Assessments were made by independent raters and self‐ratings before intake, after the three months treatment course and at follow up after 15 months. Changes in the severity of symptoms, social dysfunction and the mode of handling of problems focused in the therapy were the main criteria of outcome. Results. There were only two droup‐outs. The patients in both groups improved somatically and mentally during treatment to a similar extent, except for pain, dyspepsia and self‐rated social maladjustment where the psychotherapy group was superior. At follow up there was a significant difference in favour of the psychotherapy group in most symptoms, coping ability, self‐confidence and belief in own capacity to resolve the problems. Globally rated, 42 per cent had improved in the psychotherapy group vs 28 per cent in the control group. The ability to cope with problems was improved in 58 per cent vs 28 per cent. Confounding factors such as use of drugs, smoking and drinking habits, treatment outside the programme and exposure to life events could not account for the different outcome. Due to alexithymic personality traits, in more than half of the patients the psychotherapy had to develop through phases of symptom‐orientation and support before conflicts could be focused, but in about one third the psychotherapy could be conflict‐oriented from the start. Conclusions. The findings are in agreement with a psychosomatic approach according to which treatment is more effective if it covers both somatic and psychological aspects of a disorder. Psychsomatic treatment of PUD, of the type described in this study, may be given in primary care and be supervised by psychiatrists.