PSYCHOTHERAPY TREATMENT OF PSYCHOSOMATIC DISEASES
by Oana Maria Popescu
UPLOADED 28/3/2006

In the 19 th century somatic manifestations in hysteria, like blindness and fainting, resembling severe organic pathology, were treated by clinicians without having any medical explanation. Hysteria as a disease inspired the theoreticians of the period to elaborate models in which the mental and somatic factors were intimately correlated or viewed as different aspects of the same unit.

With the term of “psychosomatic” the body-mind integration began. By psychosomatic disease we understand a psychological problem generating somatic symptoms, psychosomatic diseases being psychological or psychogenic in nature, without any organic foundation. Initially, psychosomatic concepts were derived from the psychoanalytic theory, but in the ‘50s stress became the focus in psychosomatics, the main promoter of the idea being Hans Selye. Later on, the environment and social models were combined with the one of major life changes and social stress, and within this context Sidney Cobb and Robert M. Rose studied high blood pressure, duodenal ulcer and diabetes mellitus, while David Jenkins promoted his ideas on the type A behavior as a risk factor in the coronary disease. In the same time, the Gestalt theory sustained that in psychosomatic diseases there is a multiple determinism, at the Umwelt level both psychological and somatic factors being manifested. The psychoanalysts sustain that psychosomatic illnesses are produced by repressed anger and/or guilt. Our body releases various chemical substances and when emotions are suppressed and there is no external release, sadness and guilt lead to an impressive number of diseases due to their suppression. It is a well known fact that psychological and social factors exert an influence over bowel and gastric dysfunctions, mainly esophageal reflux, peptic ulcer and the irritable bowel syndrome, the biopsychosocial model being a huge step forward toward the understanding of these diseases.

Nowadays somatic dissociation and psychosomatic diseases are clearly differentiated. Somatic dissociation refers to modified perceptions regarding some body parts or regions, while psychosomatic symptoms are physical symptoms generated by psychological factors. On the other hand, each organic disease is accompanied by psychological symptoms. For instance diabetes mellitus patients are generally sad, have frequent mood changes, feelings of anger and low self esteem. Psychological and social factors act indirectly upon the glycemia level by the degree of treatment compliance, and directly, through neuroendocrine effects. In its turn glycemia levels may influence the emotional state, in this instance most useful being cognitive- behavioral therapy, which improves the coping capacity, the treatment compliance and the glycemia control. Another significant example along these lines is that of duodenal ulcer, having multifactor etiology. Neither the psychiatric concept according to which peptic ulcer is a psychosomatic disease, nor the medical theory saying that this disease is due to Helicobacter pylorii infection, are entirely true. Helicobacter infection is now fashionable, but it cannot be viewed as a sufficient cause, especially because up to the age of 70 50% of the population become infected with Helicobacter and not all peptic ulcer patients are infected with H. pylorii.

The patients with physical symptoms and psychological disturbances due to psychosomatic diseases often have special therapeutic needs (Frederick, Phillips, 1992). At a conscious level they have pessimistic views related to future, including the spectrum of imminent death. In hypnosis age progression may increase positive survival expectancies on behalf of the patient, ego strengthening and integration proving their utility in this respect. Sachse (1990) was saying that therapists exert strong influences over the client's explanatory processes, the type of references the therapist makes strongly influencing the effect of interventions in psychosomatic clients. An aspect not to be neglected refers to suicidal tendencies which might appear in the course of therapy for psychosomatic patients (Balon, 2006).

Presently psychosomatic treatment uses psycho-education, relaxation techniques, stress management and supportive therapy, mainly cognitive- behavioral and psychodynamic therapies. Psychotherapy seems to be efficient in the treatment of bronchial asthma, duodenal ulcer and migraine, and less efficient in the treatment of high blood pressure and ulcerative colitis, the results being variable depending on the type of therapy involved.

Herbert Benson is the promoter of relaxation techniques as strategic and preventive therapy approaches in psychosomatics, later on the relaxation techniques being combined with biofeedback, in which different biological variables as blood pressure or muscular tension are registered, displayed and shown to the patient as a method of controlling arterial hypertension and other diseases.

Relaxation was first described as transcendental Buddhist mediation. In 1929 Edmund Jacobson introduced progressive muscle relaxation as therapy for anxiety, and in 1975 Herbert Benson was describing the detailed mechanisms through which the body eliminates the fight or flight response and leads to a decrease of blood pressure, muscular relaxation and the control of cardiac rhythm.

Relaxation is of several types: release, profound and controlled relaxation. Therapy begins with the Jacobson deep muscle relaxation, a technique which can be recorded and given to the patient to listen to at home, with the recommendation to practice the exercise daily. Release relaxation, like deep relaxation, has the purpose of reducing muscular tension, without reference to both muscular relaxation and contraction like in the Jacobson relaxation technique. Release relaxation is recommended as a next step, after the patient becomes familiar with the deep muscle relaxation. Controlled relaxation combines relaxation and deep breathing exercises, using a word or image to trigger the immediate feeling of muscle relaxation. Relaxation may be counter- indicated for some patients, for instance those with organic cerebral diseases or head injuries and cognitive impairment, depending on their functioning level

Deep breathing exercises improve the respiratory function and eliminate stress and tension.

Guided imagery is another useful technique. It is a two component process: the first component implies deep relaxation by using relaxation techniques and breathing training. In the relaxation stage the patient closes his/ her eyes and concentrates upon breathing or muscle tension, often on a background of serene music or natural sounds, as for instance the sound of waves or birds singing, which induce relaxation. Once the patient is relaxed the imagery exercise begins, with restful images for the mind and body. The patient can use the memory of this image, of a situation or a scene to diminish anxiety, as in labor, surgical procedures or anxiety causing events. The patient can imagine himself/ herself as taking each step toward anxiety and overcoming the feeling.

In hypnotic trance the imagery of the favorite place, the techniques for enhancing self esteem, the anxiometer technique and guided imagery in a trance state with somatic oriented metaphors have proven useful. There are distinct therapeutic protocols for many of the psychosomatic diseases, together with imagery techniques destined for pain control.

Ericksonian therapy offers an integrative perspective related to the client's personal development, facilitating unconscious mechanisms that work permanently for maintaining the balance.

In the past few years many useful therapeutic techniques applied in psychosomatics were developed, cognitive - behavioral therapy gaining terrain. Derived form cognitive- behavioral therapy is the biofeedback technique, combining relaxation, visualization and cognitive methods. Although by using biofeedback we may give the client a chance to see the results of his/ her efforts, biofeedback may be harmful for people with pace - makers.

Sound therapy, including music therapy, incantations and natural sounds, is also useful in the treatment of psychosomatic diseases. Different sounds lead to different emotions and reactions. It is sustained that sound therapy is beneficial in the treatment of stress, anxiety, high blood pressure, depression and autism. In the therapy of Alzheimer disease incantations are being used, because it is thought they may help for the better functioning of memory. Tomatis therapy is promoted for patients with motor and coordination problems.

Other therapeutic methods in psychosomatics are directive counseling, based on the explanations given by the patient, psychodynamic therapy and client centered therapy.

Although a varied range of therapeutic methods destined for the psychosomatic therapy exist nowadays, in Western cultures there is still a problem in the relationship between psychology and physical health, probably due to the persistence of the influence yielded by Rene Descartes ( 1637) whose philosophy refers to dualism, a separation between mind and body.