Master Your symptoms: personalized online Self-help for somatic symptom disorder (MYSelf)

Symptom Symptom Disorder (SSD) is characterized by persistent somatic symptoms that are associated with maladaptive thoughts, feelings and behaviors. The estimated prevalence of SSD is 3-8%, making it more common than diabetes, coronary artery disease or depression. SSD occurs more often in females, at middle-age, and with low socio-economic status. Psychotherapy is an evidence-based treatment for SSD, and current guidelines recommend it as the first choice treatment. Psychotherapy reduces symptoms and improves quality of life, but is only indicated for severe cases and not well accepted by patients. In addition, it does not work for all patients who are willing to follow psychotherapy. A likely explanation for this is the large heterogeneity within the SSD group, which stresses the need for personalized psychotherapy. Guidelines suggest that the GP should treat mild to moderate SSD, using explanation and self-help advice. However, research indicates that they experience considerable difficulties with this patient group, especially in the provision of self-help advice. We developed the online intervention Master Your Symptoms self-help (MYSelf) to improve early intervention for mild to moderate SSD in primary care. In the MYSelf intervention, patients fill out a set of online questionnaires exploring unhelpful cognitions, emotions, behaviors, and social factors associated with the symptoms. With the responses on these questionnaires, a personal problem profile is generated, identifying perpetuating factors that are relevant to the individual. Patients will then receive personalized, concrete self-help exercises that are tailored to their problem profile. These will be offered online, and guided by the General Practice Mental Health Worker (GP-MHW). The intervention will ultimately result in a personalized self-help guide. This book is composed of texts that are extracted from the exercises patients completed during the interventions, and their reflections on what they learned with regard to self-help strategies that were or were not useful for their own personal situation. All patients end the intervention with an exercise in which they write a foreword for their own personal self-help guide. The effectiveness of this eHealth intervention will be compared to care as usual (CAU) in a pragmatic randomized controlled trial (RCT) in primary care. Practices will be randomized to MYSelf or CAU. Randomization at the level of GP prevents risk of contamination and increases contrast between CAU and intervention group. Patients are eligible if they are adults presenting with SSD and a main symptom of pain, gastro-intestinal complaints or fatigue, who are capable of understanding questionnaires and in possession of an email account and internet access. Exclusion criteria are current treatment in mental health care, recent change in dosage of psychotropic medication, presence of severe anxiety, depression, substance abuse or SSD, pregnancy, and a current legal procedure concerning disability-related financial benefits. These criteria will be evaluated by an online tool. In practices randomized to use the MYSelf intervention, patients will complete online questionnaires. Based on their results, the system will recommend a set of personalized self-help exercises. Patients will perform these exercises sequentially, supported by the GP-MHW. The exercises come from various backgrounds, and include education, cognitive interventions and relaxation. On a weekly basis, patients are asked to score the intensity of their symptoms and their functional limitations. The GP-MHW will invite the participants for face-to-face contact at the start and after every four weeks, to show empathy and to motivate patients. In the care as usual group, patients are supposed to receive care according to the Dutch guidelines. The main question of this RCT is whether MYSelf is superior to care as usual in improving physical health-related quality of life. As secondary outcomes, we will study acceptability of MYSelf by patients and primary care professionals. We also aim to study which characteristics of patients and primary care professionals modify effectiveness of MYSelf, and test self-efficacy as the main mechanism mediating the effects of MYSelf on primary outcome. Finally, we will also study costs and benefits associated with MYSelf. To our knowledge, this is the first study to combine the concepts of eHealth, self-help, and personalized medicine to SSD. Unique characteristics are that patients do not have to be referred to mental health care. The patient-tailoring is based on formal algorithms, and although each patient gets his or her own unique treatment, its efficacy can be studied in a scientifically sound way. MYSelf has the potential to improve early intervention for mild to moderate SSD in primary care.