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Short-term Psychodynamic Psychotherapy for Functional Somatic Disorders:
针对功能性躯体障碍的短期心理动力学心理疗法：

A Meta-analysis of Randomized Controlled Trials
随机对照试验的元分析

Running Head: STPP for Functional Somatic Disorders
标题： STPP 治疗功能性躯体障碍

Allan Abbass, MD 1 1 ^(1){ }^{1}
艾伦-阿巴斯，医学博士 1 1 ^(1){ }^{1} Joel Town, DClinPsy 1 1 ^(1){ }^{1}
乔尔-汤，心理医生 1 1 ^(1){ }^{1} Hannah Holmes, Ph.D. 2 2 ^(2){ }^{2}
汉娜-霍姆斯，博士 2 2 ^(2){ }^{2} Patrick Luyten, Ph.D. 3 , 4 3 , 4 ^(3,4){ }^{3,4}
Patrick Luyten 博士 3 , 4 3 , 4 ^(3,4){ }^{3,4} Angela Cooper, DClinPsy 1 1 ^(1){ }^{1}
安吉拉-库珀，心理学博士 1 1 ^(1){ }^{1} Leo Russell, DClinPsy 5 5 ^(5){ }^{5}
利奥-罗素，心理学博士 5 5 ^(5){ }^{5} Mark A. Lumley, Ph.D 2 2 ^(2){ }^{2}
马克-A-卢姆雷，博士 2 2 ^(2){ }^{2} Howard Schubiner MD 6 6 ^(6){ }^{6}
霍华德-舒比纳医学博士 6 6 ^(6){ }^{6} Jenny Allinson, MBBS MRCGP PGCE 7 7 ^(7){ }^{7}
珍妮-艾林森， MBBS MRCGP PGCE 7 7 ^(7){ }^{7} Denise Bernier, Ph.D. 1 1 ^(1){ }^{1}
Denise Bernier 博士 1 1 ^(1){ }^{1} Celine De Meulemeester, MSc 3 3 ^(3){ }^{3}
Celine De Meulemeester，理学硕士 3 3 ^(3){ }^{3} Kurt Kroenke, MD 8 8 ^(8){ }^{8}
库尔特-克伦克，医学博士 8 8 ^(8){ }^{8} Steve Kisely MD, Ph.D., DMedRes 1 , 9 1 , 9 ^(1,9){ }^{1,9}1 Centre for Emotions and Health, Dalhousie University, Halifax, Canada
1 加拿大哈利法克斯达尔豪西大学情绪与健康中心2 Department of Psychology, Wayne State University, Detroit, USA
2 美国底特律韦恩州立大学心理学系3 University of Leuven, Belgium
3 比利时鲁汶大学4 University College London, UK
4 英国伦敦大学学院5 Devon Partnership NHS Trust, UK
5 英国德文郡合作国民医疗服务信托基金6 Ascension Providence Hospital and Michigan State University College of Human Medicine,
6 Ascension Providence 医院和密歇根州立大学人类医学院、Southfield, MI, USA  美国密歇根州南菲尔德7 Babylon Health, UK  7 英国巴比伦健康8 Indiana University and Regenstrief Institute, USA
8 美国印第安纳大学和Regenstrief研究所9 University of Queensland, Australia
9 澳大利亚昆士兰大学Contact: Allan Abbass  联系人： Allan Abbass阿兰-阿巴斯Rm 7508, 5909 Veteran's Memorial Lane, Halifax, NS, Canada, B3H 2E2,
Rm 7508, 5909 Veteran's Memorial Lane, Halifax, NS, Canada, B3H 2E2、Fax 1-902-473-7122 email allan.abbass@dal.ca
传真：1-902-473-7122 电子邮件：allan.abbass@dal.ca

Word Count: 3549  字数3549
Key words: short-term psychodynamic psychotherapy, somatoform disorders, somatization, somatic symptom disorders, medically unexplained symptoms, functional somatic disorders, emotion, alexithymia
关键词：短期心理动力学心理治疗、躯体形式障碍、躯体化、躯体症状障碍、医学上无法解释的症状、功能性躯体障碍、情绪、亚历山大症
Acknowledgements: This research was supported by the Dalhousie University Department of Psychiatry and the Nova Scotia Department of Health and Wellness.
致谢：本研究得到了达尔豪斯大学精神病学系和新斯科舍省卫生与健康部的支持。
Conflicts of Interest: Some of the authors (AA, JT, AC, ML, HS) provide training in short-term psychodynamic therapy methods
利益冲突：部分作者（AA、JT、AC、ML、HS）提供短期心理动力学治疗方法培训

Abstract  摘要

Introduction: Functional somatic disorders (FSD) are common and costly, thereby driving the need for the development of effective brief treatment options. Short-term Psychodynamic Psychotherapy (STPP) is one candidate treatment method. Objective: To review and metaanalyse, where possible, randomized controlled trials (RCTs) of STPP for FSD. Methods: Following a systematic search of the literature, we performed a meta-analysis of available groups of RCTs of the effects of STPP on a range of outcomes at post-treatment, medium- and longterm follow-up. Results: In meta-analyses of 17 RCTs, STPP significantly outperformed minimal treatment, treatment-as-usual or waitlist controls on somatic symptom measures at all time frames, with small to large magnitude effect sizes. Descriptive reviews of five RCTs suggest that STPP performed at least as well as other bona fide psychological therapies. Limitations of this meta-analysis include small samples of studies and possible publication bias. Conclusions: STPP is a valid treatment option for diverse FSD conditions resulting in somatic symptom reductions that persist over time. STPP should be included in FSD treatment guidelines.
简介：功能性躯体失调症（FSD）是一种常见疾病，治疗费用高昂，因此需要开发有效的简短治疗方案。短期心理动力学心理疗法（STPP）是一种可供选择的治疗方法。研究目的在可能的情况下，对 STPP 治疗 FSD 的随机对照试验 (RCT) 进行回顾和元分析。方法：在对文献进行系统检索后，我们对现有的随机对照试验组进行了荟萃分析，分析了 STPP 在治疗后、中期和长期随访中对一系列结果的影响。分析结果在对 17 项研究性临床试验进行的荟萃分析中，STPP 在所有时间范围内的躯体症状测量结果均明显优于最小治疗、常规治疗或候补对照组，效应大小从大到小不等。对五项 RCT 的描述性回顾表明，STPP 的疗效至少与其他真正的心理疗法相当。这项荟萃分析的局限性包括研究样本较少以及可能存在出版偏差。结论：STPP 是一种有效的治疗方法，可用于治疗各种 FSD 病症，从而减轻躯体症状，并可长期持续。STPP 应被纳入 FSD 治疗指南。

Short-term Psychodynamic Psychotherapy for Functional Somatic Disorders: A Meta-analysis of Randomized Controlled Trials
针对功能性躯体障碍的短期心理动力学心理疗法：随机对照试验的元分析

Introduction  导言

Functional somatic disorders (FSD) are a collection of conditions with distressing symptoms related to functional impairments in neurobiological systems implicated in pain and emotion regulation. FSD is an umbrella term that includes somatoform disorders, psychophysiological disorders, so-called medically unexplained symptoms, and most conditions under the rubric of DSM-5 somatic symptom and related disorders [1]. These conditions account for up to one-half of primary care visits and medical consultations as well as an excess of hospital days, medications, investigations, and disability costs [2-4]. Given the major health system and patient burden of these disorders coupled with access limitations to public mental health services, the establishment of efficacious short-term therapies is of prime importance [5].
功能性躯体障碍（Functional somatic disorders，FSD）是指与疼痛和情绪调节相关的神经生物系统功能障碍有关的一系列令人痛苦的症状。功能性躯体障碍是一个总括术语，包括躯体形式障碍、心理生理学障碍、所谓的医学上无法解释的症状，以及 DSM-5 中躯体症状及相关障碍的大多数病症[1]。这些病症占到初级保健就诊和医疗咨询的二分之一，并造成住院天数、药物、检查和残疾费用的增加[2-4]。鉴于这些疾病给卫生系统和患者带来的沉重负担，以及公共精神卫生服务的使用限制，建立有效的短期疗法至关重要[5]。
Short-term psychodynamic psychotherapies (STPP) are treatments of 40 or fewer sessions that emphasize psychodynamic concepts and techniques. These interventions share a focus on emotional and relational processes that are linked to developmental deficits, unresolved conflicts, and past adverse experiences. These methods commonly use the triangle of conflict linking feelings, anxiety and defenses, and the triangle of person linking past, current and therapeutic relationship experiences [6]. The methods also emphasize unconscious content in terms of thoughts, fantasies and feelings tied to adverse life events. The range of techniques used in STPP include supportive techniques, interpretation, challenge to defenses, efforts to develop insight, and efforts to experience and express unprocessed feelings related to adverse events and psychological conflicts (See Figure 1). These treatment elements are distinguishable from cognitive behavioral therapy techniques [7]. For these reasons, STPP is considered a type of therapy that is distinct and can be studied as a collection even while technical treatment details vary among STPP subtypes [8]. Some forms of STPP, such as Intensive Short-term Dynamic Psychotherapy (ISTDP) [9, 10] and Emotional Awareness and Expression Therapy (EAET) [11] emphasize helping the patient to somatically experience and process unconscious feelings to correct emotion dysregulation underlying somatic symptoms in FSD [12] while other methods such as Time Limited Dynamic Psychotherapy [13], Luborsky’s Supportive Expressive Therapy
短期心理动力学心理疗法（STPP）是一种强调心理动力学概念和技术的治疗方法，疗程不超过 40 次。这些干预措施共同关注与发展缺陷、未解决的冲突和过去的不良经历有关的情感和关系过程。这些方法通常使用将情感、焦虑和防御联系起来的三角冲突，以及将过去、现在和治疗关系经历联系起来的三角人际关系[6]。这些方法还强调与不良生活事件相关的思想、幻想和情感等无意识内容。STPP 中使用的一系列技术包括支持性技术、解释、挑战防御、努力发展洞察力，以及努力体验和表达与不良事件和心理冲突有关的未处理感受（见图 1）。这些治疗要素有别于认知行为疗法技术[7]。由于这些原因，STPP 被认为是一种独特的治疗类型，即使 STPP 亚型之间的技术治疗细节各不相同，也可以作为一个集合进行研究[8]。一些 STPP 形式，如强化短期动态心理疗法（ISTDP）[9, 10]和情感意识与表达疗法（EAET）[11]，强调帮助患者躯体体验和处理无意识的情感，以纠正 FSD 躯体症状背后的情感失调[12]。
[14] and Malan’s Short-term Dynamic Psychotherapy [6] emphasize building insight into unconscious processes more so than emotional experiencing.
[14]和马兰的短期动态心理疗法[6]更强调建立对无意识过程的洞察力，而不是情绪体验。
STPP methods have been studied in over 250 randomized controlled trials for a wide range of conditions [15]. STPP has been found efficacious for depression [16], anxiety [17], personality disorders [18] and common mental disorders in general [8]. In 2009, we reported on 23 trials of STPP for mixed somatic conditions and found it to be effective and superior to controls, with moderate to large treatment effects that tended to be sustained or increase at follow-up [19]. That meta-analysis, however, included only 7 RCTs of FSD, whereas the others were uncontrolled or non-randomized studies, and some examined clear somatic diseases such as Crohn’s disease [20] and rheumatoid arthritis [21] rather than FSD.
STPP 方法已在 250 多项随机对照试验中得到研究，适用于多种疾病[15]。STPP 对抑郁症 [16]、焦虑症 [17]、人格障碍 [18] 和一般常见精神障碍 [8] 均有疗效。2009 年，我们报告了 23 项 STPP 治疗混合性躯体疾病的试验，发现 STPP 疗效显著，优于对照组，治疗效果中等至较大，且在随访中趋于持续或增强[19]。不过，该荟萃分析只包括 7 项针对 FSD 的 RCT，而其他研究均为无对照或非随机研究，其中一些研究针对的是克罗恩病[20] 和类风湿性关节炎[21] 等明确的躯体疾病，而非 FSD。
Alongside RCTs, meta-analyses are currently placed at a high level of evidence and are commonly used to inform treatment guidelines, despite the fact that meta-analysis is controversial because of limitations in this research method [22]. Where possible, clinical expertise integrated with a review of the literature may be more clinically useful. Along this line, Henningsen and colleagues recently reviewed the literature on FSD and concluded that emotional factors including adverse childhood experiences, attachment disorders, personality disorders and problems identifying emotions are risk factors for FSD [23]. They also concluded that treatments such as STPP, which focus on the emotional impacts of childhood adversity and personality dysfunction, may be clinically useful [23]. Given these recommendations and the need for a current estimate of the impact of STPP on FSD, here we provide an updated review and meta-analysis.
尽管荟萃分析因其研究方法的局限性而备受争议，但目前荟萃分析与随机对照研究一样，都被列为高水平的证据，并常用于为治疗指南提供信息[22]。在可能的情况下，将临床专业知识与文献综述相结合可能对临床更有用。沿着这一思路，Henningsen 及其同事最近回顾了有关 FSD 的文献，得出结论认为，包括童年不良经历、依恋障碍、人格障碍和情绪识别问题在内的情绪因素是 FSD 的风险因素[23]。他们还得出结论，STPP 等治疗方法关注童年逆境和人格功能障碍对情绪的影响，可能对临床有用[23]。鉴于这些建议以及目前对 STPP 对 FSD 影响的估计需求，我们在此提供了最新的综述和荟萃分析。
In this review, we included only RCTs and excluded studies of somatic conditions or diseases with known structural pathology. We meta-analyzed RCTs that compared STPP to treatment-as-usual/waiting list/minimal treatment and targeted somatic symptoms as the primary outcome at three separate follow-up time-points used in previous STPP meta-analyses [8]: shortterm ( < 3 < 3 < 3<3 months), medium-term (3-9 months) and long-term ( > 9 > 9 > 9>9 months). We also conducted meta-analyses of subgroups of RCTs based on certain methodological features, treatment characteristics, or disorder types to determine the effects of STPP in more homogeneous samples. Finally, we provide a brief descriptive review of RCTs that compared STPP to bona fide comparator psychological interventions.
在本综述中，我们只纳入了研究性临床试验，排除了对已知结构性病理的躯体状况或疾病的研究。我们对将 STPP 与常规治疗/等待名单/最低限度治疗进行了比较，并将躯体症状作为主要结果的 RCT 进行了荟萃分析，这些 RCT 在之前的 STPP 荟萃分析[8]中使用了三个不同的随访时间点：短期（ < 3 < 3 < 3<3 个月）、中期（3-9 个月）和长期（ > 9 > 9 > 9>9 个月）。我们还根据某些方法特征、治疗特点或疾病类型对研究性治疗方案的亚组进行了荟萃分析，以确定 STPP 在更同质样本中的效果。最后，我们对将 STPP 与真正的参照心理干预进行比较的 RCT 进行了简要的描述性回顾。

Methods  方法

Study registration  学习注册

We registered our research plan with PROSPERO, a prospective registry of systematic review protocols, prior to commencing this study (PROSPERO 2017 CRD42017083235). We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations for the background, search strategy, methods, results, discussion and conclusions [24].
在本研究开始之前，我们在系统综述方案前瞻性注册机构 PROSPERO 注册了我们的研究计划（PROSPERO 2017 CRD42017083235）。我们在背景、检索策略、方法、结果、讨论和结论方面遵循了系统综述和元分析首选报告项目（Preferred Reporting Items for Systematic Reviews and Meta-Analyses，PRISMA）的建议[24]。

Selection Criteria  遴选标准

We included all RCTs of adult patient populations treated with STPP. The following criteria were used: verbal face-to-face treatments informed by known STPP theorists; treatments that were 40 or fewer standard-length sessions; provided in either group or individual formats; and provided in any clinical setting. Studies had to provide outcome data. We included studies of STPP for any FSD and excluded studies of somatic conditions with known structural pathology or disease.
我们纳入了所有采用 STPP 治疗成年患者的 RCT。采用的标准如下：由已知的 STPP 理论家提供的面对面口头治疗；40 次或更少的标准疗程；以小组或个人形式提供；在任何临床环境中提供。研究必须提供结果数据。我们纳入了针对任何 FSD 的 STPP 研究，但排除了针对已知结构性病理或疾病的躯体状况的研究。

Search Strategy  搜索策略

Our prior meta-analysis covered studies published prior to 2008; for this updated review, we searched for all studies published from January 2006 through November 2019 and combined these with the search results from the 2009 meta-analysis. Such an interval allowed detection of studies published from 2006-2008 that might have been missed in the prior search window and went up to current time. All studies included in the previous review were evaluated for inclusion in this review. A broad search was conducted, and this is described in the PROSPERO registration (See Online Supplement).
我们之前的荟萃分析涵盖了 2008 年之前发表的研究；在本次更新的综述中，我们搜索了 2006 年 1 月至 2019 年 11 月期间发表的所有研究，并将这些研究与 2009 年荟萃分析的搜索结果进行了合并。这样的时间间隔可以发现在之前的搜索窗口中可能遗漏的 2006-2008 年间发表的研究，并一直延续到当前时间。上一次综述中包含的所有研究都经过了评估，以纳入本次综述。我们进行了广泛的检索，PROSPERO 注册中对此进行了说明（参见在线补充）。

Selection process  遴选过程

Two reviewers (PL, CD) screened titles and abstracts to confirm eligibility. Full-text versions of studies were then examined for inclusion/exclusion by pairs of reviewers (PL, AA and JT, LR). Disagreement between authors over inclusion or exclusion was discussed toward reaching consensus and when consensus could not be reached, a third author (SK) was consulted.
两名审稿人（PL、CD）对标题和摘要进行筛选，以确认是否符合条件。然后由两位审稿人（PL、AA 和 JT、LR）对研究报告的全文进行审查，以确定是否纳入/排除。作者之间对纳入或排除的意见不一致时，会进行讨论以达成共识；无法达成共识时，会咨询第三位作者（SK）。

Data extraction  数据提取

Descriptive data were extracted and tabulated by pairs of reviewers (AC, HS, ML, HH, JA, AA). The features extracted included the number and gender of patients, type of STPP, treatment duration, and follow-up intervals. Reviewers also recorded, where possible, whether or not outcome ratings were blinded, therapy was manualized, adherence ratings were performed, and the treatment placed a primary emphasis on emotion experiencing (versus the development of insight).
描述性数据由一对审稿人（AC、HS、ML、HH、JA、AA）提取并制表。提取的特征包括患者人数和性别、STPP 类型、治疗持续时间和随访间隔。在可能的情况下，评审员还记录了结果评级是否盲法、治疗是否手册化、治疗依从性评级以及治疗是否主要强调情绪体验（相对于洞察力的发展）。
Raw data for effect sizes for the various outcome measures were extracted separately by a reviewer (HH) who has no affiliation with STPP. Data entry was spot checked by 2 others (AA, SK).
各种结果测量的效应大小的原始数据由一名与 STPP 无关的审查员（HH）单独提取。数据录入由另外两人（AA、SK）抽查。

Outcomes  成果

The primary outcome category was somatic symptoms. Secondary outcomes included anxiety, depression, general symptoms, interpersonal problems, physical function, quality of life and health care use and cost. Study designs were classified into the following two categories based on the control or comparison conditions used: a) treatment-as-usual/minimal treatment/wait-list, or b) bona fide active comparison psychological treatments.
主要结果类别是躯体症状。次要结果包括焦虑、抑郁、一般症状、人际交往问题、身体功能、生活质量以及医疗服务的使用和成本。研究设计根据所使用的对照或比较条件分为以下两类：a) 照常治疗/最低限度治疗/等待名单，或 b) 真正的积极比较心理治疗。

Quality ratings  质量评级

The quality of the included RCTs was assessed independently by 2 reviewers (AA, DB) using the Cochrane Collaboration’s Assessment of Bias tool in terms of allocation concealment, blinding and the handling of withdrawals and drop outs [25]. Differences in findings were discussed to reach consensus. Further, qualitative features of RCTs were evaluated by blinded, pairs of reviewers (AA, DB, KK) based on parameters described previously in this journal [26].
两名审稿人（AA 和 DB）使用 Cochrane 协作的 "偏倚评估 "工具对纳入的 RCT 在分配隐藏、盲法以及退出和退出的处理等方面的质量进行了独立评估[25]。对研究结果的差异进行讨论，以达成共识。此外，RCT 的定性特征由一对双盲审稿人（AA、DB、KK）根据本期刊之前描述的参数进行评估[26]。

Data analysis  数据分析

Where data were available for 3 or more RCT studies, they were combined in a metaanalysis comparing STPP to controls/comparisons using the software program RevMan. Where STPP was compared with two different control/comparison conditions and both controls were included in an overall meta-analysis, the number of patients in the STPP condition was halved to avoid inflating numbers by double-counting patients. We classified outcomes into short-term (up
如果有 3 项或更多 RCT 研究的数据，则使用软件程序 RevMan 将这些数据合并在一项荟萃分析中，对 STPP 与对照组/比较组进行比较。如果 STPP 与两种不同的对照/比较条件进行了比较，且两种对照都被纳入整体荟萃分析，则 STPP 条件下的患者人数减半，以避免重复计算患者而夸大数字。我们将结果分为短期（至
to 3 months), medium term (3-9 months) and long-term (over 9 months) [8], and measured effect size (ES) using standardized mean differences. The random effects model was used for all the analyses because we could not definitively exclude between-study variation even in the absence of statistical heterogeneity. Consistent with convention, we defined effect sizes as small (ES or d d dd of 0.20-0.49), medium (ES or d d dd of 0.5 − 0.79 0.5 − 0.79 0.5-0.790.5-0.79 ) and large (ES or d d dd of ≥ 0.8 ≥ 0.8 >= 0.8\geq 0.8 ) [27]. Significance was assessed using 95% confidence intervals, and heterogeneity by using I 2 I 2 I^(2)I^{2} statistic. A value of 50 70 % 70 % 70%70 \% for the I 2 I 2 I^(2)\mathrm{I}^{2} statistic indicates moderate heterogeneity. We explored any heterogeneity further through sensitivity analyses of the effect of omitting each study in turn. When multiple measures were used for the same outcome, we also undertook sensitivity analyses of the effect of substituting one for the other. We tested for publication bias for our primary outcome using funnel plot asymmetry, where low p p pp values suggest publication bias.
8]，并使用标准化平均差来衡量效应大小（ES）。所有分析均采用随机效应模型，因为即使没有统计异质性，我们也无法明确排除研究间的差异。按照惯例，我们将效应大小定义为小（ES 或 d d dd 为 0.20-0.49）、中（ES 或 d d dd 为 0.5 − 0.79 0.5 − 0.79 0.5-0.790.5-0.79 ）和大（ES 或 d d dd 为 ≥ 0.8 ≥ 0.8 >= 0.8\geq 0.8 ）[27]。显著性采用 95% 置信区间评估，异质性采用 I 2 I 2 I^(2)I^{2} 统计量评估。如果 I 2 I 2 I^(2)\mathrm{I}^{2} 统计量的值为50 70 % 70 % 70%70 \% ，则表示存在中等程度的异质性。我们通过依次忽略每项研究的影响的敏感性分析，进一步探讨了任何异质性。当对同一结果采用多种测量方法时，我们还对用一种方法替代另一种方法的效果进行了敏感性分析。我们使用漏斗图不对称检验了主要结果的发表偏倚，低 p p pp 值表明存在发表偏倚。
To examine more homogeneous samples, when there was a sufficient number of studies, we undertook subgroup analyses of those studies that had adherence ratings, had video or audio review, had fewer than 12 sessions, were of higher quality, used STPP that was primarily focused on emotion experiencing, or were conducted on a sample with chronic pain. These analyses were done only on the primary outcome of somatic symptoms.
为了考察更多的同质样本，当研究数量足够多时，我们对以下研究进行了分组分析：有依从性评分、有视频或音频回顾、疗程少于 12 次、质量较高、使用的 STPP 主要侧重于情绪体验，或对慢性疼痛样本进行了研究。这些分析仅针对躯体症状这一主要结果。
Where there were not sufficient studies to combine in a meta-analysis for our primary outcome, results were summarized in a descriptive form.
如果没有足够的研究来对我们的主要结果进行荟萃分析，则以描述性的形式对结果进行总结。

Results  成果

Characteristics of Included Studies
纳入研究的特点

Our search identified 491 titles through bibliographic databases and 253 studies through other sources such as the ISRCTN trial registry (Online Supplement Figure 1). After removing duplicates, 438 records were screened, and 45 full texts were read for eligibility. Following exclusions, 17 RCTs were included for meta-analysis. These 17 studies included 2004 patients with a mean age of 42.9 years (SD 10.9), 67.5 % 67.5 % 67.5%67.5 \% of whom were female. These studies were generally of chronic somatic conditions present for many months to years. Six studies were of functional gastrointestinal disorders, 5 were of mixed chronic pain conditions, 2 were of fibromyalgia, 2 were of mixed somatic symptom conditions, 1 was of bruxism and 1 was of urethral syndrome with pelvic pain. Eleven RCTs had treatment-as-usual or minimal treatment conditions, and 2 had wait-list controls. Six had bona fide comparison psychological treatments:
我们通过书目数据库检索到 491 篇标题，通过 ISRCTN 试验登记等其他来源检索到 253 项研究（在线附图 1）。去除重复内容后，筛选出 438 条记录，并阅读了 45 篇全文以确定是否符合条件。经排除后，纳入了 17 项 RCT 进行荟萃分析。这 17 项研究共纳入 2004 名患者，平均年龄为 42.9 岁（SD 10.9），其中 67.5 % 67.5 % 67.5%67.5 \% 为女性。这些研究一般都是针对病程长达数月至数年的慢性躯体疾病。6项研究涉及功能性胃肠道疾病，5项研究涉及混合性慢性疼痛，2项研究涉及纤维肌痛，2项研究涉及混合性躯体症状，1项研究涉及磨牙症，1项研究涉及伴有骨盆疼痛的尿道综合征。有 11 项研究采用了 "照常治疗 "或 "最低限度治疗 "的条件，2 项采用了 "等待名单对照 "的条件。有 6 项研究采用了真正的心理治疗对比方法：
2 compared STPP with group cognitive behavioral therapy (CBT) and one compared it to individual CBT all for chronic pain; 1 compared it to Structured Relaxation Training for IBS, 1 to Mindfulness-based Stress Reduction (MBSR) for chronic pain and one to paroxetine for irritable bowel syndrome. Treatments averaged 13.5 (SD 7.6, range 3-33) sessions. All studies had follow-up evaluations beyond post treatment; the longest follow-up assessments averaged 10.4 (SD 10.5, range 2.5-48) months (Online Supplement Table 1).
2 项研究将 STPP 与治疗慢性疼痛的团体认知行为疗法 (CBT) 进行了比较，1 项研究将 STPP 与治疗慢性疼痛的个体 CBT 进行了比较；1 项研究将 STPP 与治疗肠易激综合征的结构化放松训练进行了比较，1 项研究将 STPP 与治疗慢性疼痛的正念减压疗法 (MBSR) 进行了比较，1 项研究将 STPP 与治疗肠易激综合征的帕罗西汀进行了比较。治疗的平均疗程为 13.5 次（标准差为 7.6 次，范围为 3-33 次）。所有研究都在治疗后进行了随访评估；最长的随访评估平均为 10.4 个月（标准差 10.5，范围 2.5-48）（在线补充表 1）。
All but 2 of the RCTs delivered treatment following a specific STPP model, and all but one had a manual or guide for treatment delivery. Four RCTs (23.5%) used PsychodynamicInterpersonal Therapy (PIT) [28], 3 (17.6%) used Intensive Short-term Dynamic Psychotherapy (ISTDP)[9, 29] , 2 used Emotional Awareness and Expression Therapy (EAET), [11], and 1 each used Short-Term Dynamic Psychotherapy (STDP) [6], Supportive Expressive Therapy [14], Time-limited Dynamic Psychotherapy [13], the Affect Consciousness Model [30], a combination of Malan’s STDP plus ISTDP, and a combination of EAET plus ISTDP. Two studies had general short-term psychodynamic approaches without a specific, cited model (Online Supplement Table 1).
除 2 项研究外，其他所有研究都按照特定的 STPP 模式进行治疗，除 1 项研究外，其他所有研究都有治疗手册或指南。6%）使用了强化短期动力心理疗法（ISTDP）[9, 29]，2 项使用了情感认知与表达疗法（EAET）[11]，另有 1 项使用了短期动力心理疗法（STDP）[6]、支持性表达疗法[14]、限时动力心理疗法[13]、情感意识模型[30]、马兰的 STDP 与 ISTDP 的组合以及 EAET 与 ISTDP 的组合。有两项研究采用了一般的短期心理动力学方法，但没有引用具体的模式（在线补充表 1）。

Study Quality  研究质量

The overall quality of the RCT studies was moderate using the Cochrane Risk of Bias Tool [25]. Ten of the 17 (58.8%) studies had blinded measurement of some outcomes (6 did not, 1 unclear), 9 (52.9%) had adequate allocation concealment (7 unclear, 1 did not), 11 (64.7%) had random sequence generation such as by a computer program (3 were unclear, 3 did not), and 13 (76.4%) had complete outcome data or adjustments to correct for missing data such as intention to treat methods (3 did not, 1 unclear). It was not possible to determine if outcome reporting was complete due to lack of published protocols, except for 3 studies that did appear complete. Blinding of either therapists or patients is not possible in psychotherapy research so this was rated as absent in each case (Online Supplement Table 2).
根据科克伦偏倚风险工具[25]，RCT 研究的总体质量为中等。17项研究中有10项（58.8%）对某些结果进行了盲法测量（6项未进行盲法测量，1项不清楚），9项（52.9%）进行了充分的分配隐藏（7项不清楚，1项未进行分配隐藏），11项（64.7%）进行了随机序列生成，如通过计算机程序（3项不清楚，3项未进行随机序列生成），13项（76.4%）有完整的结果数据或对缺失数据进行了校正调整，如意向治疗法（3项未进行意向治疗，1项不清楚）。由于缺乏公开发表的方案，除了 3 项研究的结果报告看起来完整外，其他研究的结果报告都无法确定是否完整。在心理治疗研究中不可能对治疗师或患者进行盲法，因此每项研究都被评为不存在盲法（在线补充表 2）。
Other measures revealed variability of study rigour. All but 1 study (94.1%) used treatment manuals or manual-like guides, 9 studies (52.9%) had adherence ratings and 9 studies (52.9%) used video or audio recording for case review and/or supervision. Sixteen of the studies (94.1%) described the longitudinal development of the somatic condition, 13 (76,4%) described past/current medication use, 11 (64.7%) described weakness of controls (4 were not applicable, 2
其他衡量标准显示研究的严谨性存在差异。除 1 项研究（94.1%）外，其他所有研究都使用了治疗手册或类似手册的指南，9 项研究（52.9%）进行了依从性评级，9 项研究（52.9%）使用了视频或音频记录进行病例审查和/或监督。其中 16 项研究（94.1%）描述了躯体状况的纵向发展，13 项研究（76.4%）描述了过去/当前的药物使用情况，11 项研究（64.7%）描述了对照组的弱点（4 项不适用，2 项适用）。
did not), 7 (41.1%) had objective measures, only 3 (17.6%) described adverse effects beyond drop-out rates, and only 4 (23.5%) reported rates of deterioration after treatment beyond drop-out rates. All of the studies (100%) described treatment components (Online Supplement Table 3).
只有 3 项研究（17.6%）描述了除辍学率以外的不良反应，只有 4 项研究（23.5%）报告了除辍学率以外的治疗后恶化率。所有研究（100%）都描述了治疗内容（在线补充表 3）。

Outcomes  成果

Primary outcome: Somatic Symptoms
主要结果：躯体症状

It was only possible to undertake meta-analyses of studies comparing STPP to minimal treatment, treatment as usual or wait-list controls. STPP outperformed minimal treatment/TAU/waitlist controls on somatic symptoms, with significant effects at all three time points. There were large effects at short-term and long-term, but small effects in the mediumterm, based on a smaller sample of 4 studies. (Table 1, Online Supplement Figure 2).
目前只能对 STPP 与最低限度治疗、常规治疗或等待名单对照进行比较的研究进行荟萃分析。在躯体症状方面，STPP 的疗效优于最低限度治疗/TAU/等待名单对照组，在所有三个时间点均有显著效果。基于 4 项研究的较小样本，短期和长期疗效显著，但中期疗效较小。(表 1，在线附图 2）。
RCTs of STPP versus bona fide psychological treatments were too varied to metaanalyze so we describe them herein. One well-powered RCT in fibromyalgia found that group EAET was equivalent to group CBT on the primary measure (pain severity) but had greater effects than CBT on a specific measure of fibromyalgia in follow-up [31]. In an RCT for older veterans with chronic pain, group EAET combined with ISTDP led to greater pain reduction than group CBT in short and medium-term follow-ups [32]. A well-powered study of ISTDP found it to be equivalent to individual CBT in reduction of chronic pain [33], and another, found ISTDP was superior to MBSR in reducing chronic pain in both short-term and medium-term follow-ups [34]. Finally, a study of IBS found that EAET was equal to structured relaxation training in reducing IBS symptoms [35].
STPP 与真正的心理治疗的 RCT 差异太大，无法进行元分析，因此我们在此加以说明。一项针对纤维肌痛的研究发现，在主要测量指标（疼痛严重程度）上，EAET组与CBT组相当，但在纤维肌痛的特定测量指标上，EAET组的随访效果要优于CBT组[31]。在一项针对患有慢性疼痛的老年退伍军人的 RCT 研究中，在短期和中期随访中，EAET 小组与 ISTDP 相结合比 CBT 小组能更有效地减轻疼痛[32]。一项关于 ISTDP 的强效研究发现，在减少慢性疼痛方面，ISTDP 与个别 CBT 相等[33]；另一项研究发现，在短期和中期随访中，ISTDP 在减少慢性疼痛方面优于 MBSR [34]。最后，一项针对肠易激综合征的研究发现，在减轻肠易激综合征症状方面，EAET 与结构化放松训练效果相当[35]。

Secondary Outcomes  次要结果

Meta-analysis showed that on measures of anxiety and depression, STPP led to greater effects than minimal treatment/TAU/ wait list controls with significant medium to large effects at short-and long-term follow-up; effect were modest and not significant at medium term followup. The effects on general symptoms were large but non-significant in the short-term but large and significant in long-term follow-up. STPP also outperformed controls on measures of physical function at short-term follow-up, although this large effect was non-significant and STPP had a small, non-significant effect on physical function at long-term follow-up. As with
Meta 分析表明，在焦虑和抑郁的测量方面，STPP 比最小治疗/TAU/等待名单对照组有更大的效果，在短期和长期随访中具有显著的中度到高度效果；在中期随访中效果一般且不显著。对一般症状的短期疗效大但不显著，但在长期随访中疗效大且显著。在短期随访中，STPP 在身体功能方面的表现也优于对照组，尽管这种巨大的影响并不显著，而且在长期随访中，STPP 对身体功能的影响很小，也不显著。与
somatic symptoms, heterogeneity was high for the majority of these analyses. (Table 1, Online Supplement Figure 2).
在这些分析中，大多数分析的异质性都很高。(表 1，在线附图 2）。

Subgroup and sensitivity analyses
分组和敏感性分析

Subgroup analyses showed STPP was significantly superior to minimal treatment/TAU/wait list controls in studies that had adherence ratings, video or audio review, were shorter (</= 12 sessions), of higher quality, focused primarily on emotion experiencing, and conducted on pain populations. Heterogeneity was lower in these subgroup analyses, likely reflecting more uniformity of the clinical samples (Table 2).
亚组分析表明，在具有依从性评分、视频或音频回顾、疗程较短（<= 12 次）、质量较高、主要关注情绪体验以及针对疼痛人群进行的研究中，STPP 明显优于最小治疗/TAU/候补对照。在这些亚组分析中，异质性较低，这可能反映了临床样本的一致性更高（表 2）。
Sensitivity analyses of somatic outcome measures examined the effect of substituting one measure for another when multiple instruments were used for the same outcome. These analyses made little difference to the findings. Similarly, our overall and subgroup results were largely unaltered on sensitivity analyses of the effect of omitting each study in turn, including the one outlier study [44]. However, heterogeneity was greatly reduced when this single outlier study was excluded. For instance, the result for overall somatic symptoms in the short term was -0.47 [ − 0.70 , − 0.23 ] , p < 0.0001 , I 2 = 55 % [ − 0.70 , − 0.23 ] , p < 0.0001 , I 2 = 55 % [-0.70,-0.23],p < 0.0001,I^(2)=55%[-0.70,-0.23], p<0.0001, \mathrm{I}^{2}=55 \% and that for the long-term was − 0.17 [ − 0.32 , − 0.02 ] , p < 0.03 , I 2 − 0.17 [ − 0.32 , − 0.02 ] , p < 0.03 , I 2 -0.17[-0.32,-0.02],p < 0.03,I^(2)-0.17[-0.32,-0.02], p<0.03, \mathrm{I}^{2} = 9%
躯体结果测量的敏感性分析研究了在对同一结果使用多种测量工具时，用一种测量工具替代另一种测量工具的效果。这些分析对结果影响不大。同样，在依次忽略每项研究（包括一项离群研究）的影响的敏感性分析中，我们的总体和亚组结果基本没有变化[44]。然而，排除了这一项离群研究后，异质性大大降低。例如，短期总体躯体症状的研究结果为-0.47 [ − 0.70 , − 0.23 ] , p < 0.0001 , I 2 = 55 % [ − 0.70 , − 0.23 ] , p < 0.0001 , I 2 = 55 % [-0.70,-0.23],p < 0.0001,I^(2)=55%[-0.70,-0.23], p<0.0001, \mathrm{I}^{2}=55 \% ，长期总体躯体症状的研究结果为 − 0.17 [ − 0.32 , − 0.02 ] , p < 0.03 , I 2 − 0.17 [ − 0.32 , − 0.02 ] , p < 0.03 , I 2 -0.17[-0.32,-0.02],p < 0.03,I^(2)-0.17[-0.32,-0.02], p<0.03, \mathrm{I}^{2} =9%。

Publication Bias  出版偏差

We used funnel plots to assess possible effects of publication bias on our primary outcome. Egger’s regression asymmetry test on somatic symptom measures was positive (-3.49 ( 90 % 90 % 90%90 \% C.I., -5.65 to − 1.33 , p = 0.047 − 1.33 , p = 0.047 -1.33,p=0.047-1.33, p=0.047 ) indicating possible publication bias. We did not use trim and fill given this method performs poorly in the setting of heterogeneity [24]. We found similar results for Egger’s regression asymmetry test in the case of depression (-4.04 (90% C.I., -6.39 to − 1.69 , p = 0.038 − 1.69 , p = 0.038 -1.69,p=0.038-1.69, p=0.038 ) and anxiety ( − 4.87 , 90 % − 4.87 , 90 % -4.87,90%-4.87,90 \% C.I., -7.53 to 2.2 , p = 0.029 2.2 , p = 0.029 2.2,p=0.0292.2, p=0.029 ). There was inadequate data to evaluate the case of general symptoms.
我们使用漏斗图来评估发表偏倚对主要结果可能产生的影响。关于躯体症状测量的 Egger 回归不对称检验呈阳性（-3.49（ 90 % 90 % 90%90 \% C.I.，-5.65 至 − 1.33 , p = 0.047 − 1.33 , p = 0.047 -1.33,p=0.047-1.33, p=0.047 ），表明可能存在发表偏倚。鉴于修剪和填充法在异质性情况下表现不佳，我们没有使用这种方法[24]。我们在抑郁症（-4.04（90% C.I.，-6.39 至 − 1.69 , p = 0.038 − 1.69 , p = 0.038 -1.69,p=0.038-1.69, p=0.038 ）和焦虑症（ − 4.87 , 90 % − 4.87 , 90 % -4.87,90%-4.87,90 \% C.I.，-7.53 至 2.2 , p = 0.029 2.2 , p = 0.029 2.2,p=0.0292.2, p=0.029 ）的 Egger 回归不对称检验中发现了类似的结果。没有足够的数据对一般症状进行评估。

Discussion  讨论

Since the last review and meta-analysis over a decade ago [19], many new RCTs of STPP for people with FSDs have been published, reflecting increased interest in both this treatment and clinical population. We updated the original meta-analysis by adding 10 new RCTs and by
自十多年前的上一次综述和荟萃分析[19]以来，又发表了许多关于 STPP 治疗 FSD 患者的新 RCT，反映出人们对这种治疗方法和临床人群的兴趣日益浓厚。我们更新了最初的荟萃分析，增加了 10 项新的 RCT，并且
focusing only on functional somatic disorders, excluding somatic conditions with clear disease or tissue pathology. Our meta-analyses suggest that the use of STPP facilitates sustained benefits for patients with a spectrum of functional somatic disorders.
我们的荟萃分析只关注功能性躯体疾病，不包括有明确疾病或组织病理的躯体疾病。我们的荟萃分析表明，使用 STPP 可使各种功能性躯体疾病患者持续获益。
In the current meta-analyses, STPP outperformed minimal treatment/TAU/waitlist controls on reducing somatic symptoms at all follow-up time frames, including long-term follow-up (> 9 months). The positive effects of STPP were large in magnitude at both short- and long-term follow-ups, although small at medium-term. Benefits of STPP on secondary measures of anxiety, depression, general symptoms, and physical function were more variable, but often large in magnitude, and all favoured STPP. Statistically significant benefits of STPP were observed when meta-analyses examined subgroups of studies that were much more homogeneous, including studies that were of higher quality, used audio or video review, rated adherence, and had STPP that was of shorter duration or focused on emotion experiencing. In 5 head-to-head RCTs, STPP appeared to be at least as effective as bona fide psychological treatments in reducing somatic symptoms such as pain. Overall, the current analyses make a good case that the use of STPP has a substantial treatment effect for FSDs.
在目前的荟萃分析中，STPP 在减少躯体症状方面的效果在所有随访时间框架内（包括长期随访（> 9 个月））都优于最小治疗/TAU/候补名单对照组。在短期和长期随访中，STPP 的积极效果都很大，但在中期随访中效果较小。STPP 对焦虑、抑郁、一般症状和身体功能等次要指标的益处变化较大，但幅度往往很大，而且都有利于 STPP。在对同质性更高的研究分组进行荟萃分析（包括质量更高、使用音频或视频回顾、对依从性进行评分、STPP 持续时间更短或侧重于情绪体验的研究）时，STPP 的益处在统计学上具有重大意义。在 5 项头对头研究中，STPP 在减轻疼痛等躯体症状方面似乎至少与真正的心理治疗一样有效。总之，目前的分析充分说明，使用 STPP 对 FSD 具有显著的治疗效果。
It is difficult to compare the findings of the current meta-analysis to those of the previous one [19]. That earlier meta-analysis included numerous non-randomized and uncontrolled trials as well as several studies of somatic conditions with disease or structural pathology. The current analyses included only RCTs-17 in total—and limited inclusion to studies of patients with FSD. Given the larger sample size, inclusion of only RCTs, and more homogeneous patient samples, we believe that the current meta-analyses provide more reliable indices of the effectiveness of STPP for FSD.
很难将目前的荟萃分析结果与之前的荟萃分析结果进行比较[19]。之前的荟萃分析包括大量非随机和非对照试验，以及几项关于躯体疾病或结构性病理的研究。本次分析仅纳入了 RCTs，共计 17 项，并且仅限于纳入 FSD 患者的研究。鉴于样本量更大，仅纳入了 RCT，且患者样本更均匀，我们认为目前的荟萃分析为 STPP 治疗 FSD 的有效性提供了更可靠的指标。
These analyses indicate that improvements in somatic symptoms were maintained over time. This finding of sustained or increasing gains over follow-up has been noted in metaanalyses of STPP for mixed psychiatric disorders [36-38] and depression [16]. It has been postulated that psychodynamic therapies may create adaptive changes in relational and personality functioning that enable growth to continue after treatment [39], although there is evidence that this observation may not be unique to psychodynamic therapies [40, 41].
这些分析表明，躯体症状的改善随着时间的推移得以保持。在对 STPP 治疗混合型精神障碍[36-38]和抑郁症[16]的荟萃分析中，也发现了这种随访期间持续改善或改善程度增加的情况。有学者推测，心理动力学疗法可能会在人际关系和人格功能方面产生适应性变化，从而使患者在治疗后继续成长[39]，尽管有证据表明这种观察结果可能并非心理动力学疗法所独有[40, 41]。
STPP models focus on the awareness and processing of unconscious, emotion-laden material often related to childhood adversity and later trauma. Such difficulty accessing such emotions is common in FSD patients [12, 23]. Beyond emotion activation and processing, STPP
STPP 模型侧重于意识和处理往往与童年逆境和日后创伤有关的无意识的、充满情感的材料。在 FSD 患者中，这种难以获得的情绪很常见 [12，23]。除了情绪激活和处理，STPP
also assists patients to regulate anxiety and thereby settle the autonomic nervous system (ANS) much as some CBT methods do. Thus, it is logical that STPP should be beneficial in patients with functional somatic disorders who have such histories and unprocessed emotions and conflict leading to a dysregulated ANS. There is some evidence from related research that emotional processing predicts treatment outcomes in psychotherapy overall [42] and STPP in specific [4345]. Patients with FSD, in particular, report that emotion processing in STPP is very important [46].
与某些 CBT 方法一样，STPP 也能帮助患者调节焦虑，从而稳定自律神经系统（ANS）。因此，STPP 对功能性躯体障碍患者有好处是合乎逻辑的，因为这些患者有这样的历史、未处理的情绪和冲突，导致自律神经系统（ANS）失调。相关研究有证据表明，情绪处理可预测心理治疗的整体治疗效果[42]，特别是 STPP [4345]。尤其是 FSD 患者，他们表示 STPP 中的情绪处理非常重要 [46]。
Nonetheless, we cannot draw a conclusion that STPP’s specific treatment ingredients are responsible for the observed benefits in these studies. To answer such a research question requires different methods [22] including dismantling procedures or detailed study of case series such as those that informed the development of many STPP models [6, 47]. This is but one limit of the value of traditional meta-analyses pointing to the need for consideration of diverse research inputs to inform treatment guidelines [22].
尽管如此，我们还不能得出结论说 STPP 的特定治疗成分是这些研究中观察到的益处的原因。要回答这样的研究问题，需要采用不同的方法[22]，包括拆解程序或详细的病例系列研究，例如为 STPP 模型的开发提供信息的研究[6, 47]。这只是传统荟萃分析价值的一个局限，说明需要考虑不同的研究投入，为治疗指南提供信息[22]。
Beyond this factor, this study has other limitations. First, the quality of studies was variable and moderate overall. Second, despite the finding of large benefits with STPP on the primary outcome of somatic symptoms in short and long-term, treatment effects on some of the secondary outcomes were not always statistically significant, raising questions about how generalized the benefits of STPP are. Finally, there were relatively few studies in some of the analyses, especially at medium-term ( 3 to 9 months post-treatment) suggesting the need for additional research. Although STPP appeared to perform at least as well as bona fide controls, there were inadequate numbers of similar comparators to meta-analyze, leaving in question how STPP compares to treatments such as CBT.
除这一因素外，本研究还有其他局限性。首先，研究的质量参差不齐，总体上处于中等水平。其次，尽管研究发现 STPP 对躯体症状这一主要结果的短期和长期疗效显著，但对一些次要结果的治疗效果并不总是具有显著的统计学意义，这就令人怀疑 STPP 的疗效是否具有普遍性。最后，一些分析中的研究相对较少，尤其是中期研究（治疗后 3 至 9 个月），这表明需要进行更多的研究。虽然 STPP 的效果似乎至少与真正的对照组一样好，但类似的对照组数量不足，无法进行元分析，因此 STPP 与 CBT 等治疗方法的比较尚存疑问。

Conclusions  结论

This review and meta-analysis provide evidence that the use of STPP leads to treatment benefits for those with diverse somatic symptom conditions, yielding sizeable and sustained benefits relative to treatment-as-usual/waitlist/minimal treatment controls. Five further individual studies suggest STPP effects are at least comparable to a range of other bona fide psychotherapies. Hence, STPP should be included in treatment guidelines for these common clinical presentations.
这篇综述和荟萃分析提供的证据表明，使用 STPP 可为各种躯体症状患者带来治疗益处，相对于 "常规治疗"/"等待治疗"/"最低限度治疗 "对照组，STPP 可产生可观且持续的益处。另有五项单独研究表明，STPP 的效果至少可与一系列其他真正的心理疗法相媲美。因此，STPP应被纳入这些常见临床表现的治疗指南中。
Future research into possible therapeutic mechanisms when treating somatic symptom disorders should emphasize both between- and within-model key therapeutic processes, such as emotion processing; such studies may then be meta-analyzable to make more specific recommendations about effective processes [48]. Future studies should also consider current study quality recommendations [26] and should include the broader range of outcomes that are targeted specifically by psychodynamic therapy, such as improved relationship function, as well as determine potential healthcare cost savings of these often high-service-using clinical populations [49]. Finally, more studies are needed that compare STPP against other manualised psychotherapies such as CBT.
在治疗躯体症状障碍时，对可能的治疗机制的未来研究应强调模式间和模式内的关键治疗过程，如情绪处理；这样的研究可以进行元分析，从而对有效的治疗过程提出更具体的建议[48]。未来的研究还应考虑当前的研究质量建议[26]，并应包括心理动力学疗法所特别针对的更广泛的结果，如改善人际关系功能，以及确定这些通常使用大量服务的临床人群可能节省的医疗成本[49]。最后，还需要进行更多的研究，将 STPP 与其他手册化的心理疗法（如 CBT）进行比较。

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Figure 1: Common Factors of Short-term Psychodynamic Psychotherapy
图 1：短期心理动力学心理治疗的共同因素

Focus on affect and expression of emotion
关注情感和情感表达
Exploration of attempts to avoid distressing thoughts and feelings
探索避免痛苦想法和感受的尝试
Identification of recurring emotional and relational themes and patterns
识别反复出现的情感和关系主题与模式
Exploration of past experiences and conflicts and how they relate to present experiences
探索过去的经历和冲突，以及它们与当前经历的关系
Focus on past and current interpersonal relationships
关注过去和现在的人际关系
Focus on the therapeutic relationship
注重治疗关系
Exploration of unconscious wishes and fantasies
探索无意识的愿望和幻想
Time limitation or time restriction using 40 or fewer sessions
时间限制或使用 40 次或 40 次以下的时间限制
Table 1: Meta-analyses of RCT studies of STPP for Somatic Symptom
表 1：对 STPP 治疗躯体症状的 RCT 研究进行的 Meta 分析
Comparison  比较 Studies  研究 n n nn

效果估计值 [95% CI]
Effect Estimate [95%
CI]
Effect Estimate [95% CI]| Effect Estimate [95% | | :---: | | CI] |
 Significance  重要意义

STPP 与最小治疗/TAU/等待治疗前至治疗后 < 3 个月的对比
STPP vs Minimal Treatment/TAU/ Waitl
Pre to < 3 months Post
STPP vs Minimal Treatment/TAU/ Waitl Pre to < 3 months Post| STPP vs Minimal Treatment/TAU/ Waitl | | :--- | | Pre to < 3 months Post |
 11 895 − 0.84 [ − 1.35 , − 0.33 ] − 0.84 [ − 1.35 , − 0.33 ] -0.84[-1.35,-0.33]-0.84[-1.35,-0.33] 0.001
Somatic Symptoms  躯体症状 5 407 − 1.02 [ − 2.22 , 0.17 ] − 1.02 [ − 2.22 , 0.17 ] -1.02[-2.22,0.17]-1.02[-2.22,0.17] 0.09
General Symptoms  一般症状 9 773 − 0.74 [ − 1.27 , − 0.21 ] − 0.74 [ − 1.27 , − 0.21 ] -0.74[-1.27,-0.21]-0.74[-1.27,-0.21] 0.006
Depression  抑郁症 9 684 − 0.79 [ − 1.50 , − 0.08 ] − 0.79 [ − 1.50 , − 0.08 ] -0.79[-1.50,-0.08]-0.79[-1.50,-0.08] 0.03
Anxiety  焦虑 5 515 − 1.93 [ − 3.97 , 0.11 ] − 1.93 [ − 3.97 , 0.11 ] -1.93[-3.97,0.11]-1.93[-3.97,0.11] 0.06
Physical Function  身体机能
4 479 − 0.45 [ − 0.69 , − 0.20 ] ∗ − 0.45 [ − 0.69 , − 0.20 ] ∗ -0.45[-0.69,-0.20]^(**)-0.45[-0.69,-0.20]^{*} 0.0003
Pre to 3-6 months Post
前至 3-6 个月后		 4 478 − 0.41 [ − 0.84 , 0.02 ] ∗ − 0.41 [ − 0.84 , 0.02 ] ∗ -0.41[-0.84,0.02]^(**)-0.41[-0.84,0.02]^{*} 0.07
Somatic Symptoms  躯体症状 3 446 − 0.19 [ − 0.50 , 0.11 ] ∗ − 0.19 [ − 0.50 , 0.11 ] ∗ -0.19[-0.50,0.11]^(**)-0.19[-0.50,0.11]^{*} 0.21
Depression  抑郁症
Anxiety  焦虑
Comparison Studies n "Effect Estimate [95% CI]" Significance "STPP vs Minimal Treatment/TAU/ Waitl Pre to < 3 months Post" 11 895 -0.84[-1.35,-0.33] 0.001 Somatic Symptoms 5 407 -1.02[-2.22,0.17] 0.09 General Symptoms 9 773 -0.74[-1.27,-0.21] 0.006 Depression 9 684 -0.79[-1.50,-0.08] 0.03 Anxiety 5 515 -1.93[-3.97,0.11] 0.06 Physical Function 4 479 -0.45[-0.69,-0.20]^(**) 0.0003 Pre to 3-6 months Post 4 478 -0.41[-0.84,0.02]^(**) 0.07 Somatic Symptoms 3 446 -0.19[-0.50,0.11]^(**) 0.21 Depression Anxiety | Comparison | Studies | $n$ | Effect Estimate [95% <br> CI] | Significance | | :--- | :--- | :--- | :--- | :--- | | STPP vs Minimal Treatment/TAU/ Waitl <br> Pre to < 3 months Post | 11 | 895 | $-0.84[-1.35,-0.33]$ | 0.001 | | Somatic Symptoms | 5 | 407 | $-1.02[-2.22,0.17]$ | 0.09 | | General Symptoms | 9 | 773 | $-0.74[-1.27,-0.21]$ | 0.006 | | Depression | 9 | 684 | $-0.79[-1.50,-0.08]$ | 0.03 | | Anxiety | 5 | 515 | $-1.93[-3.97,0.11]$ | 0.06 | | Physical Function | | | | | | | 4 | 479 | $-0.45[-0.69,-0.20]^{*}$ | 0.0003 | | Pre to 3-6 months Post | 4 | 478 | $-0.41[-0.84,0.02]^{*}$ | 0.07 | | Somatic Symptoms | 3 | 446 | $-0.19[-0.50,0.11]^{*}$ | 0.21 | | Depression | | | | | | Anxiety | | | | |
Pre to > > >> 6 months Post
前至 > > >> 6 个月后
Somatic Symptoms  躯体症状 7 859 − 1.00 [ − 1.78 , − 0.22 ] − 1.00 [ − 1.78 , − 0.22 ] -1.00[-1.78,-0.22]-1.00[-1.78,-0.22] 0.01
General Symptoms  一般症状 5 778 − 0.93 [ − 1.75 , − 0.10 ] − 0.93 [ − 1.75 , − 0.10 ] -0.93[-1.75,-0.10]-0.93[-1.75,-0.10] 0.03
Depression  抑郁症 5 649 − 1.02 [ − 1.94 , − 0.10 ] − 1.02 [ − 1.94 , − 0.10 ] -1.02[-1.94,-0.10]-1.02[-1.94,-0.10] 0.03
Anxiety  焦虑 3 650 − 0.96 [ − 1.86 , − 0.06 ] − 0.96 [ − 1.86 , − 0.06 ] -0.96[-1.86,-0.06]-0.96[-1.86,-0.06] 0.04
Physical Function  身体机能 377 − 0.42 [ − 4.16 , 3.32 ] − 0.42 [ − 4.16 , 3.32 ] -0.42[-4.16,3.32]-0.42[-4.16,3.32] 0.82
Pre to > 6 months Post Somatic Symptoms 7 859 -1.00[-1.78,-0.22] 0.01 General Symptoms 5 778 -0.93[-1.75,-0.10] 0.03 Depression 5 649 -1.02[-1.94,-0.10] 0.03 Anxiety 3 650 -0.96[-1.86,-0.06] 0.04 Physical Function 377 -0.42[-4.16,3.32] 0.82 | Pre to $>$ 6 months Post | | | | | | :--- | :--- | :--- | :--- | :--- | | Somatic Symptoms | 7 | 859 | $-1.00[-1.78,-0.22]$ | 0.01 | | General Symptoms | 5 | 778 | $-0.93[-1.75,-0.10]$ | 0.03 | | Depression | 5 | 649 | $-1.02[-1.94,-0.10]$ | 0.03 | | Anxiety | 3 | 650 | $-0.96[-1.86,-0.06]$ | 0.04 | | Physical Function | 377 | $-0.42[-4.16,3.32]$ | 0.82 | |
∗ = I 2 ≤ 50 % ∗ = I 2 ≤ 50 % **=I^(2) <= 50%*=\mathrm{I}^{2} \leq 50 \% suggesting lower level of heterogeneity
∗ = I 2 ≤ 50 % ∗ = I 2 ≤ 50 % **=I^(2) <= 50%*=\mathrm{I}^{2} \leq 50 \% 表明异质性水平较低
Table 2: Subgroup Analyses of RCTs of STPP versus Minimal Treatment, TAU or Waitlist Controls
表 2：STPP 与最小治疗、TAU 或候补对照的 RCT 分组分析
Subgroup  分组 Studies  研究 n n nn I 2 I 2 I^(2)\mathbf{I}^{2}

效果估计值 [95% CI]
Effect Estimate [95%
CI]
Effect Estimate [95% CI]| Effect Estimate [95% | | :---: | | CI] |
 Significance  重要意义
Pre to < 3 months
3 个月前至 < 3 个月
Adherence Rated  坚持率评级 6 675 74 % 74 % 74%74 \% − 0.44 [ − 0.48 , − 0.16 ] − 0.44 [ − 0.48 , − 0.16 ] -0.44[-0.48,-0.16]-0.44[-0.48,-0.16] 0.004
Pain Studies  疼痛研究 4 452 81 % 81 % 81%81 \% − 0.54 [ − 1.02 , − 0.06 ] − 0.54 [ − 1.02 , − 0.06 ] -0.54[-1.02,-0.06]-0.54[-1.02,-0.06] 0.02
Audio/Video Review  音频/视频评论 6 495 46 % 46 % 46%46 \% − 0.38 [ − 0.67 , − 0.09 ] − 0.38 [ − 0.67 , − 0.09 ] -0.38[-0.67,-0.09]-0.38[-0.67,-0.09] 0.01
Emotion Experiencing  情感体验 4 258 0 % 0 % 0%0 \% − 0.48 [ − 0.73 , − 0.23 ] − 0.48 [ − 0.73 , − 0.23 ] -0.48[-0.73,-0.23]-0.48[-0.73,-0.23] 0.0002
< / = 12 < / = 12 < //=12</=12 sessions   < / = 12 < / = 12 < //=12</=12 会议 7 572 94 % 94 % 94%94 \% − 1.01 [ − 1.81 , − 0.22 ] − 1.01 [ − 1.81 , − 0.22 ] -1.01[-1.81,-0.22]-1.01[-1.81,-0.22] 0.01
Higher Quality (a)  更高质量 (a) 6 672 46 % 46 % 46%46 \% − 0.35 [ − 0.57 , − 0.12 ] − 0.35 [ − 0.57 , − 0.12 ] -0.35[-0.57,-0.12]-0.35[-0.57,-0.12] 0.004
Subgroup Studies n I^(2) "Effect Estimate [95% CI]" Significance Pre to < 3 months Adherence Rated 6 675 74% -0.44[-0.48,-0.16] 0.004 Pain Studies 4 452 81% -0.54[-1.02,-0.06] 0.02 Audio/Video Review 6 495 46% -0.38[-0.67,-0.09] 0.01 Emotion Experiencing 4 258 0% -0.48[-0.73,-0.23] 0.0002 < //=12 sessions 7 572 94% -1.01[-1.81,-0.22] 0.01 Higher Quality (a) 6 672 46% -0.35[-0.57,-0.12] 0.004| Subgroup | Studies | $n$ | $\mathbf{I}^{2}$ | Effect Estimate [95% <br> CI] | Significance | | :---: | :---: | :---: | :---: | :---: | :--- | | Pre to < 3 months | | | | | | | Adherence Rated | 6 | 675 | $74 \%$ | $-0.44[-0.48,-0.16]$ | 0.004 | | Pain Studies | 4 | 452 | $81 \%$ | $-0.54[-1.02,-0.06]$ | 0.02 | | Audio/Video Review | 6 | 495 | $46 \%$ | $-0.38[-0.67,-0.09]$ | 0.01 | | Emotion Experiencing | 4 | 258 | $0 \%$ | $-0.48[-0.73,-0.23]$ | 0.0002 | | $</=12$ sessions | 7 | 572 | $94 \%$ | $-1.01[-1.81,-0.22]$ | 0.01 | | Higher Quality (a) | 6 | 672 | $46 \%$ | $-0.35[-0.57,-0.12]$ | 0.004 |
Pre to 3-6 months Post
前至 3-6 个月后
Pain Studies  疼痛研究 3 117 49 % 49 % 49%49 \% − 0.56 [ − 1.01 , − 0.11 ] − 0.56 [ − 1.01 , − 0.11 ] -0.56[-1.01,-0.11]-0.56[-1.01,-0.11] 0.01
Emotion Experiencing  情感体验 3 117 49 % 49 % 49%49 \% − 0.56 [ − 1.01 , − 0.11 ] − 0.56 [ − 1.01 , − 0.11 ] -0.56[-1.01,-0.11]-0.56[-1.01,-0.11] 0.01
Pre to 3-6 months Post Pain Studies 3 117 49% -0.56[-1.01,-0.11] 0.01 Emotion Experiencing 3 117 49% -0.56[-1.01,-0.11] 0.01| Pre to 3-6 months Post | | | | | | | :---: | :---: | :---: | :---: | :---: | :---: | | Pain Studies | 3 | 117 | $49 \%$ | $-0.56[-1.01,-0.11]$ | 0.01 | | Emotion Experiencing | 3 | 117 | $49 \%$ | $-0.56[-1.01,-0.11]$ | 0.01 |
Pre to > 6 > 6 > 6>\mathbf{6} months Post
前至 > 6 > 6 > 6>\mathbf{6} 月 后
Emotion Experiencing  情感体验 3 132 0 % 0 % 0%0 \% − 0.38 [ − 0.62 , − 0.14 ] − 0.38 [ − 0.62 , − 0.14 ] -0.38[-0.62,-0.14]-0.38[-0.62,-0.14] 0.002
Pre to > 6 months Post Emotion Experiencing 3 132 0% -0.38[-0.62,-0.14] 0.002| Pre to $>\mathbf{6}$ months Post | | | | | | | :---: | :---: | :---: | :---: | :---: | :---: | | Emotion Experiencing | 3 | 132 | $0 \%$ | $-0.38[-0.62,-0.14]$ | 0.002 |
(a) On a threshold of 3 on the Risk of Bias Tool
(a) 在 "偏差风险工具 "上的临界值为 3 时

Online Supplement  在线增刊

Search Strategy  搜索策略

Our prior meta-analysis covered studies published prior to 2008; thus, for this updated review, we searched for all studies published from January 2006 through July 2018. Such an interval allowed detection of studies published from 2006-2008 that may have been missed in the prior search window. All studies included in the previous review were evaluated for inclusion in this review. We used combinations of the following terms: psychotherapy or psychoanalytic or psychodynamic or dynamic or short-term therapy, 2) clinical trial or randomized controlled trial and 3) search terms for various conditions including Chest Pain, Pain, Somatoform Disorder, Medically Unexplained Symptoms, Psychogenic Pain, Conversion Disorder, Somatosensory Disorder, Urethral Syndrome, Fibromyalgia, Functional Neurological Disorder, Functional Movement Disorder, Psychogenic Non-Epileptic Seizures, Non Epileptic Attack Disorder, Headache, Migraine, Irritable Bowel, Dyspepsia, Dermatitis, Inflammatory Dermatosis, Laryngospasm, Pharyngospasm, Hysteria, Hypochondriasis, Tics, Tourette’s, Tinnitus, Temporomandibular syndrome, Bruxism, Abdominal Pain, Leg Pain, Foot Pain, Back Pain, Muscle Tension, Muscular Disorder, Muscle Strain, Arm Pain, Hand Pain, Chronic Fatigue Syndrome, Fatigue, Alexithymia, Somatic Symptom Disorder, Somatization Disorder, Medically Unexplained Symptoms, Functional Somatic Symptom, Functional Somatic Syndrome, Functional Somatic Disorder. These three sets of search terms were combined as follows: #1 AND #2 AND #3. There was no restriction on language. In addition, prospective trial registers were searched for unpublished ongoing research (e.g. http://www.controlled-trials.com, https://clinicaltrials.gov/). An internet database of controlled and comparative outcome studies on psychological treatments of somatic symptom disorders was searched (http://www.psychotherapyrcts.org). An email group of several hundred psychodynamic researchers was contacted for any in process or upcoming studies.
我们之前的荟萃分析涵盖了 2008 年之前发表的研究；因此，在本次更新的综述中，我们搜索了 2006 年 1 月至 2018 年 7 月期间发表的所有研究。这样的间隔可以发现之前的搜索窗口可能遗漏的 2006-2008 年间发表的研究。上一篇综述中纳入的所有研究都经过了评估，以纳入本综述。我们使用了以下术语的组合：心理治疗或精神分析或心理动力学或动态或短期治疗；2）临床试验或随机对照试验；3）各种病症的检索词，包括胸痛、疼痛、躯体形式障碍、医学上无法解释的症状、精神性疼痛、转换障碍、躯体感觉障碍、尿道综合征、纤维肌痛、功能性神经障碍、功能性运动障碍、精神性非癫痫性发作、非癫痫性发作障碍、头痛、偏头痛、肠易激综合征、消化不良、腹泻、腹痛、腹胀、腹泻消化不良、皮炎、炎症性皮肤病、喉痉挛、咽痉挛、癔病、疑病症、抽搐症、抽动症、耳鸣、颞下颌综合征、磨牙症、腹痛、腿痛、足痛、背痛、肌肉紧张、肌肉失调、肌肉劳损、臂痛、手痛、慢性疲劳综合征、疲劳、亚历山大症、躯体症状障碍、躯体化障碍、医学上无法解释的症状、功能性躯体症状、功能性躯体综合征、功能性躯体障碍。这三组检索词组合如下：#1、#2 和 #3。语言不限。 此外，还搜索了前瞻性试验登记册中未发表的正在进行的研究（如 http://www.controlled-trials.com、https://clinicaltrials.gov/）。我们还搜索了一个互联网数据库（http://www.psychotherapyrcts.org），该数据库收录了有关躯体症状障碍心理治疗的对照和比较结果研究。我们还联系了一个由数百名心理动力学研究人员组成的电子邮件群组，以了解任何正在进行或即将进行的研究。

Online Supplement Figure 1: PRISMA Diagram
在线补充图 1：PRISMA 图表

Online Supplement Figure 2: Meta-analyses of STPP versus Controls and Comparison Conditions
在线附图 2：STPP 与对照组和比较条件的 Meta 分析

Online Supplement Table 1: Studies included in Meta-analysis of Randomized Controlled Trials of Short-term Psychodynamic Therapies
在线补充表 1：短期心理动力学疗法随机对照试验元分析所包含的研究
Lead Author year  主要作者年份 Patient Group  患者小组 % Female %  Female  {:[%],[" Female "]:}\begin{gathered} \% \\ \text { Female } \end{gathered} Mean Age  平均年龄 n
  STPP 模式
STPP
Model
STPP Model| STPP | | :--- | | Model |
 Sessions  会议 Longest followup (Months)
最长随访时间（月）		 Control  控制
Baldoni 1995  巴尔多尼 1995 Urethral Syndrome/ pelvic pain
尿道综合征/骨盆疼痛		 100 40 36 ISTDP + Malan  ISTDP +   Malan  [" ISTDP + "],[" Malan "]\begin{gathered} \text { ISTDP + } \\ \text { Malan } \\ \hline \end{gathered} 14 48 TAU
Bassett 1985  巴塞特 1985 Chronic Pain  慢性疼痛 17 40.8 22 Unclear  不清楚 12 12 MT
Chavooshi 2016  查沃希 2016 Medically unexplained pain
医学上无法解释的疼痛		 70 32.7 63 ISTDP 20 3 MBSR, TAU
Chavooshi 2017 Medically unexplained pain
医学上无法解释的疼痛		 70.1 36.2 341 ISTDP 16 3 CBT
Chirco 2015  奇尔科 2015 Bruxism  磨牙 59.6 43 41 ISTDP 20 12 WL
Creed 2003  信条 2003 Severe IBS  严重肠易激综合征 79.8 39 257 PIT 8 12 MED TAU  MED   TAU  [" MED "],[" TAU "]\begin{aligned} & \hline \text { MED } \\ & \text { TAU } \end{aligned}
Faramarzi 2015  法拉马尔齐 2015 Functional Dyspepsia  功能性消化不良 69 32.8 49 SET 16 12 TAU
Guthrie 1993  格思里 1993 Refractory IBS  难治性肠易激综合征 86 47 102 PIT 7 3 MT
Hamilton 2000  汉密尔顿 2000 Chronic Dyspepsia  慢性消化不良 59.5 - 77 PIT 8 12 MT
Jazi, 2019 Chronic Pain  慢性疼痛 17 73.9 64 EAET + ISTDP 8 3 CBT
Lumley 2017 Fibromyalgia  纤维肌痛 93.9 49.13 230 EAET 8 6 CBT, MT
Monsen 2000  蒙森 2000 Chronic Pain  慢性疼痛 35 45.5 40 ACTM 33 12 TAU
Sattel 2012 Multisomatoform Disorder
多音节失调症		 65.9 47.9 106 PIT 12 9 TAU
Schaefert 2013 MUS 75 49.1 304 PIT 12 9 TAU
Scheidt 2013 Fibromyalgia with depression
纤维肌痛伴有抑郁		 100 48.8 47 Unclear  不清楚 25 12 TAU
Svedlund 1983  斯韦德伦德 1983 IBS 70 24 119 Malan  马兰 8 6 TAU
Thakur 2017  塔库尔 2017 IBS 80 36.1 106 EAET 3 2.5 WL, SR
Lead Author year Patient Group "% Female " Mean Age n "STPP Model" Sessions Longest followup (Months) Control Baldoni 1995 Urethral Syndrome/ pelvic pain 100 40 36 " ISTDP + Malan " 14 48 TAU Bassett 1985 Chronic Pain 17 40.8 22 Unclear 12 12 MT Chavooshi 2016 Medically unexplained pain 70 32.7 63 ISTDP 20 3 MBSR, TAU Chavooshi 2017 Medically unexplained pain 70.1 36.2 341 ISTDP 16 3 CBT Chirco 2015 Bruxism 59.6 43 41 ISTDP 20 12 WL Creed 2003 Severe IBS 79.8 39 257 PIT 8 12 " MED TAU " Faramarzi 2015 Functional Dyspepsia 69 32.8 49 SET 16 12 TAU Guthrie 1993 Refractory IBS 86 47 102 PIT 7 3 MT Hamilton 2000 Chronic Dyspepsia 59.5 - 77 PIT 8 12 MT Jazi, 2019 Chronic Pain 17 73.9 64 EAET + ISTDP 8 3 CBT Lumley 2017 Fibromyalgia 93.9 49.13 230 EAET 8 6 CBT, MT Monsen 2000 Chronic Pain 35 45.5 40 ACTM 33 12 TAU Sattel 2012 Multisomatoform Disorder 65.9 47.9 106 PIT 12 9 TAU Schaefert 2013 MUS 75 49.1 304 PIT 12 9 TAU Scheidt 2013 Fibromyalgia with depression 100 48.8 47 Unclear 25 12 TAU Svedlund 1983 IBS 70 24 119 Malan 8 6 TAU Thakur 2017 IBS 80 36.1 106 EAET 3 2.5 WL, SR| Lead Author year | Patient Group | $\begin{gathered} \% \\ \text { Female } \end{gathered}$ | Mean Age | n | STPP <br> Model | Sessions | Longest followup (Months) | Control | | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | | Baldoni 1995 | Urethral Syndrome/ pelvic pain | 100 | 40 | 36 | $\begin{gathered} \text { ISTDP + } \\ \text { Malan } \\ \hline \end{gathered}$ | 14 | 48 | TAU | | Bassett 1985 | Chronic Pain | 17 | 40.8 | 22 | Unclear | 12 | 12 | MT | | Chavooshi 2016 | Medically unexplained pain | 70 | 32.7 | 63 | ISTDP | 20 | 3 | MBSR, TAU | | Chavooshi 2017 | Medically unexplained pain | 70.1 | 36.2 | 341 | ISTDP | 16 | 3 | CBT | | Chirco 2015 | Bruxism | 59.6 | 43 | 41 | ISTDP | 20 | 12 | WL | | Creed 2003 | Severe IBS | 79.8 | 39 | 257 | PIT | 8 | 12 | $\begin{aligned} & \hline \text { MED } \\ & \text { TAU } \end{aligned}$ | | Faramarzi 2015 | Functional Dyspepsia | 69 | 32.8 | 49 | SET | 16 | 12 | TAU | | Guthrie 1993 | Refractory IBS | 86 | 47 | 102 | PIT | 7 | 3 | MT | | Hamilton 2000 | Chronic Dyspepsia | 59.5 | - | 77 | PIT | 8 | 12 | MT | | Jazi, 2019 | Chronic Pain | 17 | 73.9 | 64 | EAET + ISTDP | 8 | 3 | CBT | | Lumley 2017 | Fibromyalgia | 93.9 | 49.13 | 230 | EAET | 8 | 6 | CBT, MT | | Monsen 2000 | Chronic Pain | 35 | 45.5 | 40 | ACTM | 33 | 12 | TAU | | Sattel 2012 | Multisomatoform Disorder | 65.9 | 47.9 | 106 | PIT | 12 | 9 | TAU | | Schaefert 2013 | MUS | 75 | 49.1 | 304 | PIT | 12 | 9 | TAU | | Scheidt 2013 | Fibromyalgia with depression | 100 | 48.8 | 47 | Unclear | 25 | 12 | TAU | | Svedlund 1983 | IBS | 70 | 24 | 119 | Malan | 8 | 6 | TAU | | Thakur 2017 | IBS | 80 | 36.1 | 106 | EAET | 3 | 2.5 | WL, SR |
IBS: Irritable Bowel Syndrome, MUS: Medically Unexplained Symptoms, ISTDP: Intensive Short-term Dynamic Psychotherapy, PIT: Psychodynamic Interpersonal Therapy, SET: Supportive Expressive Therapy, EAET: Emotional Awareness and Expression Therapy. WL: wait list, MT: minimal treatment, CBT: Cognitive Behavioral Therapy, TAU: treatment as usual, MBSR: mindfulness-based stress reduction, MED: medication, SR: structured relaxation, ACTM: Affect Consciousness Treatment Model.
IBS：肠易激综合征肠易激综合征，MUS：医学上无法解释的症状，ISTDP：强化短期动态心理疗法，PIT：心理动力学人际关系疗法，SET：医学上无法解释的症状：强化短期动态心理疗法、PIT：心理动力学人际关系疗法、SET：支持性表达疗法、EAET：心理动力学人际关系疗法：支持性表达疗法，EAET：EAET：情感认知与表达疗法。WL：候补名单；MT：最小治疗；CBT：认知行为疗法；TAU：照常治疗；MBSR：正念减压；MED：药物治疗；SR：结构化放松；ACTM：情感意识治疗模式。
Online Supplement Table 2: Study Characteristics and Risk of Bias Ratings
在线补充表 2：研究特征和偏倚风险评级
First Author and Year
第一作者和年份		 Adherence Rated  坚持率评级
  音频/视频评论
Audio/
Video
Review
Audio/ Video Review| Audio/ | | :--- | | Video | | Review |
 Manual or Guide  手册或指南 Emotion Focused  注重情感 < / = 12 sessions < / = 12  sessions  [ < //=12],[" sessions "]\begin{aligned} & \hline</=12 \\ & \text { sessions } \end{aligned} Blinded subjects/ therapists
盲人受试者/治疗师		 Blinded Ratings  失明评级 Allocation Concealment  分配隐藏 Random Sequence Generation
随机序列生成
  完整的成果数据
Complete
Outcome
Data
Complete Outcome Data| Complete | | :--- | | Outcome | | Data |

完整的成果报告
Complete
Outcome
Reporting
Complete Outcome Reporting| Complete | | :--- | | Outcome | | Reporting |
Baldoni 1995  Baldoni  1995 [" Baldoni "],[1995],[]\begin{aligned} & \hline \text { Baldoni } \\ & 1995 \\ & \hline \end{aligned} No  没有 No  没有 Yes  是 Yes  是 No  没有 No  没有 No  没有 Unclear  不清楚 No  没有 Yes  是 Unclear  不清楚
Bassett 1995  Bassett  1995 [" Bassett "],[1995]\begin{aligned} & \hline \text { Bassett } \\ & 1995 \end{aligned} No  没有 Yes  是 No  没有 No  没有 Yes  是 No  没有 Yes  是 Unclear  不清楚 No  没有 No  没有 Unclear  不清楚
Chavooshi 2016  Chavooshi  2016 [" Chavooshi "],[2016]\begin{aligned} & \hline \text { Chavooshi } \\ & 2016 \end{aligned} Yes  是 Yes  是 Yes  是 Yes  是 No  没有 No  没有 Yes  是 Unclear  不清楚 Unclear  不清楚 Unclear  不清楚 Unclear  不清楚
Chavooshi 2017  Chavooshi  2017 [" Chavooshi "],[2017],[]\begin{aligned} & \hline \text { Chavooshi } \\ & 2017 \\ & \hline \end{aligned} Yes  是 Yes  是 Yes  是 Yes  是 No  没有 No  没有 No  没有 Yes  是 Yes  是 Yes  是 Unclear  不清楚
Chirco 2015  Chirco  2015 [" Chirco "],[2015]\begin{aligned} & \hline \text { Chirco } \\ & 2015 \end{aligned} No  没有 Yes  是 Yes  是 Yes  是 No  没有 No  没有 Unclea   叔叔a r r r\mathrm{r} Unclear  不清楚 No  没有 No  没有 Unclear  不清楚
Creed 2003  信条 2003 Yes  是 No  没有 Yes  是 No  没有 Yes  是 No  没有 Yes  是 Yes  是 Yes  是 Yes  是 Unclear  不清楚
Faramarzi 2015  Faramarzi  2015 [" Faramarzi "],[2015]\begin{aligned} & \hline \text { Faramarzi } \\ & 2015 \end{aligned} No  没有 No  没有 Yes  是 No  没有 No  没有 No  没有 Yes  是 Yes  是 Yes  是 Yes  是 Yes  是
Guthrie   格思里 1993 1993 19931993 No  没有 No  没有 Yes  是 No  没有 Yes  是 No  没有 Yes  是 Unclear  不清楚 Unclear  不清楚 Yes  是 Unclear  不清楚
Hamilton 2000  Hamilton  2000 [" Hamilton "],[2000],[]\begin{aligned} & \hline \text { Hamilton } \\ & 2000 \\ & \hline \end{aligned} Yes  是 Yes  是 Yes  是 No  没有 Yes  是 No  没有 Yes  是 Yes  是 Yes  是 Yes  是 Unclear  不清楚
Jazi, 2019 Yes  是 Yes  是 Yes  是 Yes  是 Yes  是 No  没有 No  没有 Yes  是 Yes  是 No  没有 Yes  是
Lumley   拉姆利 2017 2017 20172017 Yes  是 Yes  是 Yes  是 Yes  是 Yes  是 No  没有 Yes  是 Yes  是 Yes  是 Yes  是 Yes  是
Monsen 2000  Monsen  2000 {:[" Monsen "],[2000]:}\begin{aligned} & \text { Monsen } \\ & 2000 \end{aligned} No  没有 No  没有 Yes  是 Yes  是 No  没有 No  没有 Yes  是 Unclear  不清楚 Unclear  不清楚 Yes  是 Unclear  不清楚
Sattel 2012 Yes  是 Yes  是 Yes  是 No  没有 No  没有 No  没有 Yes  是 Yes  是 Yes  是 Yes  是 Unclear  不清楚
Schaefert 2013  Schaefert  2013 {:[" Schaefert "],[2013]:}\begin{aligned} & \text { Schaefert } \\ & 2013 \end{aligned} No  没有 No  没有 Yes  是 No  没有 Yes  是 No  没有 No  没有 No  没有 Yes  是 Yes  是 Unclear  不清楚
Scheidt 2013  Scheidt  2013 [" Scheidt "],[2013]\begin{aligned} & \hline \text { Scheidt } \\ & 2013 \end{aligned} Yes  是 No  没有 Yes  是 No  没有 No  没有 No  没有 No  没有 Yes  是 Yes  是 Yes  是 Unclear  不清楚
Svedlund 1983  Svedlund  1983 [" Svedlund "],[1983],[]\begin{aligned} & \hline \text { Svedlund } \\ & 1983 \\ & \hline \end{aligned} No  没有 No  没有 Yes  是 No  没有 Yes  是 No  没有 Yes  是 Unclear  不清楚 Unclear  不清楚 Yes  是 Unclear  不清楚
Thakur 2017  Thakur  2017 [" Thakur "],[2017],[]\begin{aligned} & \hline \text { Thakur } \\ & 2017 \\ & \hline \end{aligned} Yes  是 Yes  是 Yes  是 Yes  是 Yes  是 No  没有 No  没有 Yes  是 Yes  是 Yes  是 Unclear  不清楚
First Author and Year Adherence Rated "Audio/ Video Review" Manual or Guide Emotion Focused " < //=12 sessions " Blinded subjects/ therapists Blinded Ratings Allocation Concealment Random Sequence Generation "Complete Outcome Data" "Complete Outcome Reporting" " Baldoni 1995 " No No Yes Yes No No No Unclear No Yes Unclear " Bassett 1995" No Yes No No Yes No Yes Unclear No No Unclear " Chavooshi 2016" Yes Yes Yes Yes No No Yes Unclear Unclear Unclear Unclear " Chavooshi 2017 " Yes Yes Yes Yes No No No Yes Yes Yes Unclear " Chirco 2015" No Yes Yes Yes No No Unclea r Unclear No No Unclear Creed 2003 Yes No Yes No Yes No Yes Yes Yes Yes Unclear " Faramarzi 2015" No No Yes No No No Yes Yes Yes Yes Yes Guthrie 1993 No No Yes No Yes No Yes Unclear Unclear Yes Unclear " Hamilton 2000 " Yes Yes Yes No Yes No Yes Yes Yes Yes Unclear Jazi, 2019 Yes Yes Yes Yes Yes No No Yes Yes No Yes Lumley 2017 Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes " Monsen 2000" No No Yes Yes No No Yes Unclear Unclear Yes Unclear Sattel 2012 Yes Yes Yes No No No Yes Yes Yes Yes Unclear " Schaefert 2013" No No Yes No Yes No No No Yes Yes Unclear " Scheidt 2013" Yes No Yes No No No No Yes Yes Yes Unclear " Svedlund 1983 " No No Yes No Yes No Yes Unclear Unclear Yes Unclear " Thakur 2017 " Yes Yes Yes Yes Yes No No Yes Yes Yes Unclear| First Author and Year | Adherence Rated | Audio/ <br> Video <br> Review | Manual or Guide | Emotion Focused | $\begin{aligned} & \hline</=12 \\ & \text { sessions } \end{aligned}$ | Blinded subjects/ therapists | Blinded Ratings | Allocation Concealment | Random Sequence Generation | Complete <br> Outcome <br> Data | Complete <br> Outcome <br> Reporting | | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | | $\begin{aligned} & \hline \text { Baldoni } \\ & 1995 \\ & \hline \end{aligned}$ | No | No | Yes | Yes | No | No | No | Unclear | No | Yes | Unclear | | $\begin{aligned} & \hline \text { Bassett } \\ & 1995 \end{aligned}$ | No | Yes | No | No | Yes | No | Yes | Unclear | No | No | Unclear | | $\begin{aligned} & \hline \text { Chavooshi } \\ & 2016 \end{aligned}$ | Yes | Yes | Yes | Yes | No | No | Yes | Unclear | Unclear | Unclear | Unclear | | $\begin{aligned} & \hline \text { Chavooshi } \\ & 2017 \\ & \hline \end{aligned}$ | Yes | Yes | Yes | Yes | No | No | No | Yes | Yes | Yes | Unclear | | $\begin{aligned} & \hline \text { Chirco } \\ & 2015 \end{aligned}$ | No | Yes | Yes | Yes | No | No | Unclea $\mathrm{r}$ | Unclear | No | No | Unclear | | Creed 2003 | Yes | No | Yes | No | Yes | No | Yes | Yes | Yes | Yes | Unclear | | $\begin{aligned} & \hline \text { Faramarzi } \\ & 2015 \end{aligned}$ | No | No | Yes | No | No | No | Yes | Yes | Yes | Yes | Yes | | Guthrie $1993$ | No | No | Yes | No | Yes | No | Yes | Unclear | Unclear | Yes | Unclear | | $\begin{aligned} & \hline \text { Hamilton } \\ & 2000 \\ & \hline \end{aligned}$ | Yes | Yes | Yes | No | Yes | No | Yes | Yes | Yes | Yes | Unclear | | Jazi, 2019 | Yes | Yes | Yes | Yes | Yes | No | No | Yes | Yes | No | Yes | | Lumley $2017$ | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | | $\begin{aligned} & \text { Monsen } \\ & 2000 \end{aligned}$ | No | No | Yes | Yes | No | No | Yes | Unclear | Unclear | Yes | Unclear | | Sattel 2012 | Yes | Yes | Yes | No | No | No | Yes | Yes | Yes | Yes | Unclear | | $\begin{aligned} & \text { Schaefert } \\ & 2013 \end{aligned}$ | No | No | Yes | No | Yes | No | No | No | Yes | Yes | Unclear | | $\begin{aligned} & \hline \text { Scheidt } \\ & 2013 \end{aligned}$ | Yes | No | Yes | No | No | No | No | Yes | Yes | Yes | Unclear | | $\begin{aligned} & \hline \text { Svedlund } \\ & 1983 \\ & \hline \end{aligned}$ | No | No | Yes | No | Yes | No | Yes | Unclear | Unclear | Yes | Unclear | | $\begin{aligned} & \hline \text { Thakur } \\ & 2017 \\ & \hline \end{aligned}$ | Yes | Yes | Yes | Yes | Yes | No | No | Yes | Yes | Yes | Unclear |
Online Supplement Table 3: Description of Study Qualities per Guidi et al, 2018
在线补充表 3：Guidi 等人 2018 年的研究质量描述

第一作者和年份
First
author
and year
First author and year| First | | :---: | | author | | and year |

疾病纵向发展描述
Description
of
longitudinal
development
of the
disorder
Description of longitudinal development of the disorder| Description | | :---: | | of | | longitudinal | | development | | of the | | disorder |

描述当前或过去的用药情况
Description
of
current or
past
medication
Description of current or past medication| Description | | :---: | | of | | current or | | past | | medication |

讨论候补名单或技术援助股的弱点
Discussion
of
weaknesses
of
waiting list
or TAU
Discussion of weaknesses of waiting list or TAU| Discussion | | :---: | | of | | weaknesses | | of | | waiting list | | or TAU |

处理组件说明
Description
of freatment
components
Description of freatment components| Description | | :---: | | of freatment | | components |

观察者和自我评级工具
Both
observer-
and self-
rated tools
Both observer- and self- rated tools| Both | | :---: | | observer- | | and self- | | rated tools |

评估副作用或不良反应
Assessment
of side effects
or adverse
effects
Assessment of side effects or adverse effects| Assessment | | :---: | | of side effects | | or adverse | | effects |

说明有多少参与者
Description
of number
of
participants
who
Description of number of participants who| Description | | :---: | | of number | | of | | participants | | who |
  巴尔多尼 1995
Baldoni
1995
Baldoni 1995| Baldoni | | :--- | | 1995 |
 Yes  是 Yes  是 Yes  是 Yes  是 No  没有 No  没有

治疗后病情恶化
deteriorated
after
treatment
deteriorated after treatment| deteriorated | | :---: | | after | | treatment |
Bassett 1995  巴塞特 1995
Bassett 1995| Bassett 1995 | | :--- |
 Yes  是 No  没有 Yes  是 Yes  是 No  没有 No  没有 Yes  是
  查沃希 2016
Chavooshi
2016
Chavooshi 2016| Chavooshi | | :--- | | 2016 |
 Yes  是 No  没有 No  没有 Yes  是 No  没有 No  没有 No  没有
Chavooshi
2017
Chavooshi 2017| Chavooshi | | :--- | | 2017 |
 Yes  是 Yes  是 N/A  不适用 Yes  是 No  没有 Yes  是 No  没有
Chirco 2015  奇尔科 2015 No  没有 No  没有 No  没有 Yes  是 Yes  是 No  没有 No  没有
Creed 2003  信条 2003 Yes  是 Yes  是 N/A  不适用 Yes  是 Yes  是 Yes  是 No  没有
  法拉马尔齐 2015
Faramarzi
2015
Faramarzi 2015| Faramarzi | | :--- | | 2015 |
 Yes  是 Yes  是 Yes  是 Yes  是 No  没有 No  没有 No  没有
  格思里 1993
Guthrie
1993
Guthrie 1993| Guthrie | | :--- | | 1993 |
 Yes  是 Yes  是 Yes  是 Yes  是 Yes  是 Yes  是 No  没有
  汉密尔顿 2000
Hamilton
2000
Hamilton 2000| Hamilton | | :--- | | 2000 |
 Yes  是 Yes  是 Yes  是 Yes  是 Yes  是 No  没有 No  没有
Jazi 2019  雅姿 2019
Jazi 2019| Jazi 2019 | | :--- |
 Yes  是 Yes  是 N/A  不适用 Yes  是 No  没有 No  没有 No  没有
Lumley
2017
Lumley 2017| Lumley | | :--- | | 2017 |
 Yes  是 Yes  是 N/A  不适用 Yes  是 Yes  是 Yes  是 Yes  是
  蒙森 2000
Monsen
2000
Monsen 2000| Monsen | | :--- | | 2000 |
 Yes  是 No  没有 Yes  是 Yes  是 No  没有 No  没有 No  没有
Sattel 2012 Yes  是 Yes  是 Yes  是 Yes  是 Yes  是 No  没有 No  没有
Schaefert
2013 2013 20132013 ~
Schaefert 2013| Schaefert | | :--- | | $2013 ~$ |
 Yes  是 Yes  是 Yes  是 Yes  是 Yes  是 No  没有 No  没有
Scheidt
2013
Scheidt 2013| Scheidt | | :--- | | 2013 |
 Yes  是 Yes  是 Yes  是 Yes  是 No  没有 No  没有 No  没有
  斯韦德伦 1983
Svedlund
1983
Svedlund 1983| Svedlund | | :--- | | 1983 |
 Yes  是 Yes  是 Yes  是 Yes  是 No  没有 No  没有 Yes  是
Thakur 2017  塔库尔 2017 Yes  是 Yes  是 Yes  是 Yes  是 No  没有 No  没有 No  没有
"First author and year" "Description of longitudinal development of the disorder" "Description of current or past medication" "Discussion of weaknesses of waiting list or TAU" "Description of freatment components" "Both observer- and self- rated tools" "Assessment of side effects or adverse effects" "Description of number of participants who" "Baldoni 1995" Yes Yes Yes Yes No No "deteriorated after treatment" "Bassett 1995" Yes No Yes Yes No No Yes "Chavooshi 2016" Yes No No Yes No No No "Chavooshi 2017" Yes Yes N/A Yes No Yes No Chirco 2015 No No No Yes Yes No No Creed 2003 Yes Yes N/A Yes Yes Yes No "Faramarzi 2015" Yes Yes Yes Yes No No No "Guthrie 1993" Yes Yes Yes Yes Yes Yes No "Hamilton 2000" Yes Yes Yes Yes Yes No No "Jazi 2019" Yes Yes N/A Yes No No No "Lumley 2017" Yes Yes N/A Yes Yes Yes Yes "Monsen 2000" Yes No Yes Yes No No No Sattel 2012 Yes Yes Yes Yes Yes No No "Schaefert 2013" Yes Yes Yes Yes Yes No No "Scheidt 2013" Yes Yes Yes Yes No No No "Svedlund 1983" Yes Yes Yes Yes No No Yes Thakur 2017 Yes Yes Yes Yes No No No| First <br> author <br> and year | Description <br> of <br> longitudinal <br> development <br> of the <br> disorder | Description <br> of <br> current or <br> past <br> medication | Discussion <br> of <br> weaknesses <br> of <br> waiting list <br> or TAU | Description <br> of freatment <br> components | Both <br> observer- <br> and self- <br> rated tools | Assessment <br> of side effects <br> or adverse <br> effects | Description <br> of number <br> of <br> participants <br> who | | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | | Baldoni <br> 1995 | Yes | Yes | Yes | Yes | No | No | deteriorated <br> after <br> treatment | | Bassett 1995 | Yes | No | Yes | Yes | No | No | Yes | | Chavooshi <br> 2016 | Yes | No | No | Yes | No | No | No | | Chavooshi <br> 2017 | Yes | Yes | N/A | Yes | No | Yes | No | | Chirco 2015 | No | No | No | Yes | Yes | No | No | | Creed 2003 | Yes | Yes | N/A | Yes | Yes | Yes | No | | Faramarzi <br> 2015 | Yes | Yes | Yes | Yes | No | No | No | | Guthrie <br> 1993 | Yes | Yes | Yes | Yes | Yes | Yes | No | | Hamilton <br> 2000 | Yes | Yes | Yes | Yes | Yes | No | No | | Jazi 2019 | Yes | Yes | N/A | Yes | No | No | No | | Lumley <br> 2017 | Yes | Yes | N/A | Yes | Yes | Yes | Yes | | Monsen <br> 2000 | Yes | No | Yes | Yes | No | No | No | | Sattel 2012 | Yes | Yes | Yes | Yes | Yes | No | No | | Schaefert <br> $2013 ~$ | Yes | Yes | Yes | Yes | Yes | No | No | | Scheidt <br> 2013 | Yes | Yes | Yes | Yes | No | No | No | | Svedlund <br> 1983 | Yes | Yes | Yes | Yes | No | No | Yes | | Thakur 2017 | Yes | Yes | Yes | Yes | No | No | No |