title: Heart rate variability predicts therapy outcome in pain-predominant multisomatoform disorder.
abstract: BACKGROUND
  Autonomic imbalance establishes an important model to understand organically unexplained physical complaints. Our study aimed to investigate whether the functioning of the autonomous nervous system corresponds with somatoform symptoms and predicts the outcome of brief psychotherapy in these patients.
  
  
  METHODS
  As a part of multicenter study assessing effects of brief psychodynamic interpersonal therapy on multisomatoform disorder (PISO-study), 106 patients participated in a stress experiment investigating autonomic reactivity during application of the Stroop-test. Patients were randomized receiving either enhanced medical care (EMC, N=49) or psychotherapy (N=57). Autonomic baseline functioning as well as stress reactivity of heart rate (HR) and heart rate variability (HRV) were analyzed in their relation to symptom measures and as potential predictors of the primary outcome (Physical Component Score of the SF-36) during 9-month follow-up.
  
  
  RESULTS
  After therapy patients markedly and sustainably improved in physical quality of life, and this long-term improvement was predicted by baseline HR and HRV. HRV also predicted change in pain symptoms following psychotherapy. A responder analysis revealed a significant better treatment outcome in patients with high pre-treatment HRV (OR 3.4, CI: 1.2-9.9, p=.0035). No significant associations between HR or HRV and outcome measures were found in the EMC group.
  
  
  CONCLUSIONS
  In our study, the adaptability of the autonomous nervous system as indicated by low pretreatment HR and high HRV was associated with a more pronounced benefit from psychotherapy. This finding can be explained by a possible association between autonomic self-regulation and emotional learning capacities.
authors.affiliation: Parent/child unit for therapy and counseling, Hannover, Germany. Electronic address: a.angelovski@t-online.de.
authors.forename: Angela
authors.initials: A
authors.lastname: Angelovski
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universitaet Muenchen, Germany. Electronic address: h.sattel@tum.de.
authors.forename: Heribert
authors.initials: H
authors.lastname: Sattel
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universitaet Muenchen, Germany. Electronic address: p.henningsen@tum.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Henningsen
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universitaet Muenchen, Germany. Electronic address: m.sack@tum.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Sack
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology* / Q000523:psychology*; D059408:Pain Management / Q000379:methods* / Q000523:psychology; D011614:Psychotherapy, Brief; D011788:Quality of Life; D013001:Somatoform Disorders / Q000503:physiopathology* / Q000523:psychology*; D016896:Treatment Outcome