It is unclear to what degree systematic exposure exercises contribute to the overall effects of exposure therapy (exposure and response prevention). This trial recruits individuals with high somatic symptom burden or reactivity to symptoms who, based on previous work, are likely to benefit specifically from exposure therapy. The aim of the study is to evaluate to what degree the effect of exposure therapy for this group is driven by the addition of structured exposure exercises to response prevention. This will be evaluated on the basis of a randomized controlled trial (N=360) where participants are enrolled either in response prevention (n=180), or exposure and response prevention (n=180). Primary outcome will be the between-group differences in the reduction in reactivity to symptoms, as measured week-by-week using the somatic symptom disorder B-criteria scale (SSD-12). Results from this project will be informative for exposure-based and various multicomponent behavioral treatments for individuals with persistent physical symptoms worldwide.
Bothered by at least one somatic symptom for at least 4 months.
High symptom burden, defined as a PHQ-15≥15 or SSD-12≥25.
Adult (≥18 years old).
Living in Stockholm County (catchment area of the clinic).
A maximum of half the sample (180 participants) will be included with health anxiety, i.e., a fear of or preoccupation with serious illness, as their principal clinical problem.
Clinical picture dominated by non-somatoform psychiatric disorder such as depression, panic disorder, or primary insomnia. Comorbidities are allowed.
Severe psychiatric condition (e.g., ongoing manic episode, psychotic disorder, severe depression) or markers for suicidality beyond sporadic ideation.
Clear medical risk in taking part in exposure-based treatment (e.g., pregnancy), or somatic condition, or treatment for somatic condition, makes treatment unfeasible.