Mental health specialist video consultations for patients with somatic symptom disorder in primary care: protocol for a.., 2022, Haun et al

Full title: Mental health specialist video consultations for patients with somatic symptom disorder in primary care: protocol for a randomised feasibility trial (the VISION trial)

Abstract

Introduction
General practitioners (GP) report increasing difficulties in referring patients with somatic symptom disorder (SSD) in specialised psychosocial care. Barriers are structural conditions of the respective healthcare system and patients’ reservations against receiving specialised psychosocial care. As patients with SSD often predominantly assume somatic influencing factors for the development and maintenance of their somatic complaints, close collaboration between the GP and mental health specialist (MHS) seems particularly important. Integrating internet-based video consultations by remotely located MHS and primary care can improve effective treatment of patients with SSD by overcoming structural barriers and provide low-threshold and timely care. The aim of this randomised controlled feasibility trial is to investigate the feasibility of implementing MHS video consultations in primary care practices.

Methods and analysis
Fifty primary care patients with SSD will be individually randomised in two groups receiving either enhanced treatment as usual as provided by their GP (control group) or two versus five video consultations conducted by an MHS additionally to enhanced treatment as usual. The video consultations focus on (a) diagnostic clarification, (b) the development of a biopsychosocial disorder model, and (c) development of a treatment plan against the background of a stepped-care algorithm based on clinical outcomes. We will investigate the following outcomes: effectiveness of the recruitment strategies, patient acceptance of randomisation, practicability of the technical and logistical processes related to implementing video consultations in the practices’ workflows, feasibility of the data collection and clinical parameters.

Ethics and dissemination
This trial has undergone ethical scrutiny and has been approved by the Medical Faculty of the University of Heidelberg Ethics Committee (S-620/2021). The findings will be disseminated to the research community through presentations at conferences and publications in scientific journals. This feasibility trial will prepare the ground for a large-scale, fully powered randomised controlled trial.

Open access, https://bmjopen.bmj.com/content/12/4/e058150

 

I think this is interesting in that it gives the lie to the claim that it is only a small vocal minority of patients who are dissatisfied with the BPS approach.

So many patients object to this approach that the treatment programme has to be redesigned.

I am also interested in the candid explanation in this protocol. Do the patients get to see this explanation of the trial when they sign a consent form. If so it may be quite interesting to see what happens. Rather than selling the videos as amazing new treatment they are selling them as something they have to do to get around the fact that the patients don't want the treatment.

 

There probably exist patients who like being told that there is nothing wrong and that their illness is a figment of their imagination and that they need psychotherapy to stop believing they're ill and/or feel better.

But I suspect they like it only because of a combination of specific factors at that time: they have a lot of trust, can't tell they're being conned, their illness is mild and therefore more ambiguous with respect to its causes, they genuinely think it's a method for getting better. Who wouldn't want to get better?

 

Are you saying physical symptoms with psychological causes can't be severe? Simon disapproves.

 

Let's be honest, the fact that most patients object to this ideology has been discussed in the literature for many decades, over a century in fact. It was never a credible lie, it's basically an obsession and makes up two of the most common recipes in the genre: why don't patients accept our psychological mumbo jumbo and how can we manipulate them to agree with us? There are hundreds, at this point probably thousands of papers on this.

It's even discussed casually whenever physicians dismiss the very concept, rolling their eyes about how so many just refuse to accept the mumbo jumbo. It's so well-known that many euphemisms and concepts have been invented to address it without naming it, usually labeled "therapeutic alliance" or framed as building trust with the patient, explicitly to better lie to us.

The only reason this big lie stands is because we can't defend ourselves visibly. We are an actual silent majority, which usually doesn't even exist when people use it to justify their ideologies. If we could stand up for ourselves, we would, and this trope would have died a long time ago. It's truly only because ignoring us is 100% effective at keeping us silent. Here is an example where might made right, bullying works when the victims are defenseless, even better when the bullies are the same people tasked with defending us, statutory bullying.

Basically a small minority are active, but it's an open secret that we represent what the majority think and say. As Big Lies go, this one is an especially disgusting one, but it was never credible. It's in the exact same category as any other form of bigotry: a convenient but blatant lie.

 

Perhaps I've just led a sheltered life but I have never met a single person who has eased any chronic symptoms by going through CBT.

 

I heard about a CBT therapist once who ruined her marriage with compulsive shopping behaviour that she couldn't stop. Isn't that the kind of problem CBT is meant to fix?

 

In a con, the sale is the product. This is their product.

 

It should, according to the wild promises. If CBT worked, it would be massively useful to quit smoking and other habits like adhering to diets. It could also be very useful at disciplined behavior, for things like athletes and highly skilled professions. No one uses it for any of the intended uses because it's all a con.

CBT "works" at changing answers on questionnaires. Any other attempt to measure anything else "working" has failed.

 

Haven't read the comments above but I'm wondering how they will evaluate the "intervention"; I'm pretty confident that there will not be objective outcome criteria, like ability to return to normal life --- Why mess up the case for a treatment by testing if it has any real world benefits i.e. beyond providing a living for the "therapist"!

 

I have a friend who quickly abandoned the psychology degree they started out on --- he said that most of the class were obviously there to try to figure out what was wrong with them ----
If you were normal then would you spend your time trying to figure others out?