Stepped Care Approach for Medically Unexplained Physical Symptoms in Japan

2022 Fiscal Year Final Research Report

• Project/Area Number: 19K22738
• Research Category: Grant-in-Aid for Challenging Research (Exploratory)
• Allocation Type: Multi-year Fund
• Review Section: Medium-sized Section 58:Society medicine, nursing, and related fields
• Research Institution: Chiba University
• Principal Investigator: Shimizu Eiji 千葉大学, 大学院医学研究院, 教授 (00292699)
• Project Period (FY): 2019-06-28 – 2023-03-31
• Keywords: 身体症状症 / 認知行動療法 / 段階的ケア / オンライン

Outline of Final Research Achievements

In order to develop a stepped care approach for medically unexplained somatic symptoms (MUPS), somatic symptom disorder in Japan, we conducted a web survey for adults who gave us their informed consent after approval of the ethical review board, and found that people with somatic symptom disorder were more likely to have depression and anxiety symptoms and developmental characteristics of autism spectrum disorder and attention-deficit/hyperactivity disorder, and to receive long-term, frequent medical cares. As a web self-help intervention for mild cases, a randomized controlled trial was conducted for workers with chronic tension-type headache. Although there was no difference between groups, web based cognitive behavioral therapy or psychoeducation showed improvement after 6 weeks from baseline. We also explored the feasibility of clinical study design of online cognitive-behavioral therapy with a videoconferencing system to patients with severe somatic symptom disorder.

Free Research Field

行動科学

Academic Significance and Societal Importance of the Research Achievements

オランダのMUPS（身体症状症）のガイドラインでは、第一の低リスクの患者に再保証、第二のうつ病や不安症を合併する中等度リスクの患者に精神科連携下でのプライマリケア医の治療、第三の医師患者関係が安定しない高リスクの患者には精神科医から認知行動療法や薬物療法が提供される。日本でも、身体症状症の患者が診断されないまま、長期の頻回の医療を受けていることが明らかで、質問紙でのスクリーニングを行い、うつ、不安、発達特性の合併も検討し、低強度の介入で、WEB上での簡便なセルフヘルプの心理教育や認知行動療法を提供し、高強度の介入で、オンラインで認知行動療法を提供する段階的ケアの可能性が示されたことは意義深い。