Meta-analysis evaluating the effects of transdiagnostic psychological treatments for emotional disorders in individuals with comorbid somatic conditions and on overall somatic symptom burden: Does the blues (and anxiety) run the game?

Depression, anxiety disorders, and persistent physical symptoms are major public health concerns that often occur together. Transdiagnostic psychological interventions for emotional disorders have been found to reduce depressive symptoms and anxiety, with moderate between-group effects versus mostly rudimentary controls. Little is known, however, about typical effects in populations with comorbid somatic conditions, and the extent to which these interventions affect somatic symptom burden. This comment addresses these questions by expanding on a recently published systematic review by Jiménez-Orenga et al. with further random-effects meta-analyses. Twenty-nine of 94 randomized controlled trials (31%) recruited samples with somatic comorbidities. Somatic conditions that were the focus of more than one trial were: cancer (various forms, including survivors; k = 6), cardiovascular disease (various forms; k = 5), chronic obstructive pulmonary disease (k = 4), pregnancy (k = 4), patients on dialysis (k = 2), and Parkinson’s disease (k = 2). The pooled effect on depressive symptoms and anxiety versus mostly rudimentary controls was not significantly lower in the somatic-comorbidity samples (g = 0.45, 95% CI: 0.27-0.63) than in the non-somatic samples (g = 0.61, 95% CI: 0.49-0.73). Sensitivity analyses accounting for the control condition, and based on a more restrictive definition of somatic comorbidity, corroborated this finding. Somatic symptom burden was reported as an outcome in primary publications for 6 trials. Based on these trials, the pooled effect on somatic symptom burden was moderate versus rudimentary treatment-as-usual and waitlist controls (g = 0.66, 95% CI: 0.44-0.89). In summary, transdiagnostic psychological interventions for emotional disorders appear to typically work also when the patient is suffering from a comorbid somatic condition, and effects are seen also on somatic symptom burden. This aligns with the broader literature indicating that somatic complaints are an integral part of internalizing psychopathology.