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Randomized Controlled Trial
. 2023 Sep 20;13(1):15615.
doi: 10.1038/s41598-023-42186-y.

Treatment-associated network dynamics in patients with globus sensations: a proof-of-concept study

Marina N Imperiale  1 , Roselind Lieb  1 , Gunther Meinlschmidt  2   3   4
Affiliations
Randomized Controlled Trial

Treatment-associated network dynamics in patients with globus sensations: a proof-of-concept study

Marina N Imperiale et al. Sci Rep. .

Abstract

In this proof-of-concept study, we used a systems perspective to conceptualize and investigate treatment-related dynamics (temporal and cross-sectional associations) of symptoms and elements related to the manifestation of a common functional somatic syndrome (FSS), Globus Sensations (GS). We analyzed data from 100 patients (M = 47.1 years, SD = 14.4 years; 64% female) with GS who received eight sessions of group psychotherapy in the context of a randomized controlled trial (RCT). Symptoms and elements were assessed after each treatment session. We applied a multilevel graphical vector-autoregression (ml GVAR) model approach resulting in three separate, complementary networks (temporal, contemporaneous, and between-subject) for an affective, cognitive, and behavioral dimension, respectively. GS were not temporally associated with any affective, cognitive, and behavioral elements. Temporally, catastrophizing cognitions predicted bodily weakness (r = 0.14, p < 0.01, 95% confidence interval (CI) [0.04-0.23]) and GS predicted somatic distress (r = 0.18, p < 0.05, 95% CI [0.04-0.33]). Potential causal pathways between catastrophizing cognitions and bodily weakness as well as GS and somatic distress may reflect treatment-related temporal change processes in patients with GS. Our study illustrates how dynamic NA can be used in the context of outcome research.

Trial registration: ClinicalTrials.gov NCT01590992.

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Conflict of interest statement

GM received funding from the Stanley Thomas Johnson Stiftung & Gottfried und Julia Bangerter-Rhyner-Stifung under projects no. PC 28/17 and PC 05/18, from Gesundheitsförderung Schweiz under project no. 18.191/K50001, from the Swiss Heart Foundation under projects no. FF21101, from the Research Foundation of the International Psychoanalytic University (IPU) Berlin under projects no. 5087 and 5217, from the German Federal Ministry of Education and Research under budget item 68606, from the Hasler Foundation under project no. 23004, in the context of a Horizon Europe project from the Swiss State Secretariat for Education, Research and Innovation (SERI) under contract number 22.00094, and from Wings Health in the context of proof-of-concept study. GM is a co-founder, member of the board, and shareholder of Therayou AG, active in digital and blended mental healthcare. GM receives royalties from publishing companies as author, including a book published by Springer, and an honorarium from Lundbeck for speaking at a symposium. Furthermore, GM is compensated for providing psychotherapy to patients, acting as a supervisor, serving as a self-experience facilitator (‘Selbsterfahrungsleiter’), and for postgraduate training of psychotherapists and supervisors.

Figures

Figure 1
Figure 1
Flow Chart. Note. This figure depicts the flow chart of the study procedure. CBT Cognitive Behavioural Therapy. GS Globus Sensations. ITT Intention-to-treat. PMR Progressive Muscle Relaxation.
Figure 2
Figure 2
Associations Between Affective Elements and GS. Note. Temporal, contemporaneous and between-subject network model of affective elements and GS. Edges represent autocorrelations (temporal network) and partial correlations. 95% CIs are provided in brackets [] next to the partial correlation for each edge. Positive associations are depicted in blue, negative associations are dashed and in red. Maximum edge strength is set to the strongest edge identified across all three networks so that edges are visually comparable. CI Confidence interval. GS Globus Sensations. * indicates stable edges, i.e., edges that were included in at least 50% of the bootstrapped samples.
Figure 3
Figure 3
Associations Between Cognitive Elements and GS. Note. Temporal, contemporaneous and between-subject network model of cognitive elements and GS. Edges represent autocorrelations (temporal network) and partial correlations. 95% CIs are provided in brackets [] next to the partial correlation for each edge. Positive associations are depicted in blue, negative associations are dashed and in red. Maximum edge strength is set to the strongest edge identified across all three networks so that edges are visually comparable. CI Confidence interval. GS Globus Sensations. * indicates stable edges, i.e., edges that were included in at least 50% of the bootstrapped samples.
Figure 4
Figure 4
Associations Between Behavioral Elements and GS. Note. Temporal, contemporaneous and between-subject network model of behavioral elements and GS. Edges represent autocorrelations (temporal network) and partial correlations. 95% CIs are provided in brackets [] next to the partial correlation for each edge. Positive associations are depicted in blue, negative associations are dashed and in red. Maximum edge strength is set to the strongest edge identified across all three networks so that edges are visually comparable. CI Confidence interval. GS Globus Sensations. * indicates stable edges, i.e., edges that were included in at least 50% of the bootstrapped samples.
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