Most people now acknowledge that the mind and body are inextricably linked, and problems in one are often related to problems in the other. Yet some bodily complaints seem so physically based that it is hard to imagine that any kind of talk therapy could touch them. The six disorders below seem to be such cases—but every one of them can be treated with psychotherapy, according to recent studies. So consider all your options before reaching for a pill. —The Editors
HEADACHE When a headache hits, most of us reach for over-the-counter pain relievers, and in severe cases physicians might prescribe medication. Yet recent research suggests psychotherapy may prevent many headaches from materializing in the first place. Earlier studies demonstrated that mindfulness-based therapy could ease chronic pain, so researchers at the University of Canberra and elsewhere in Australia investigated whether a brief version of this approach would help people with chronic tension–type headaches (the most common kind). In a pilot study reported last year in Behavioural and Cognitive Psychotherapy, the researchers assigned participants to either a control group or to six sessions of mindfulness-based therapy over three weeks. The mindful participants had significantly fewer headaches but not the control group. Another recent study, reported in the Italian Journal of Pediatrics, found that a brief course of psychodynamic psychotherapy might be more effective than standard care in treating migraines and tension headaches in children. —Tori Rodriguez
INSOMNIA People who have trouble falling asleep or remaining asleep long enough to feel rested are typically treated with sedatives. Most popular are benzodiazepines, such as Valium and Xanax, or Z-drugs, such as Lunesta and Ambien. Evidence suggests that cognitive-behavior therapy (CBT) may work just as well, if not better, than these drugs at managing insomnia, especially in the long term. A 2005 randomized controlled trial found that insomniacs receiving CBT fell asleep faster and slept more soundly than those taking sedatives and that participants receiving both interventions did no better than those who underwent only therapy. In a 2012 review of five randomized controlled trials, researchers concluded that insomniacs who received CBT were more satisfied with their sleep and slept better than those who took sleep medications. —Victoria Stern
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FIBROMYALGIA Intense pain in joints and muscles, fatigue and depression characterize fibromyalgia, which is routinely treated with pain medications and antidepressants. Popular drugs Lyrica, Savella and Cymbalta are all approved to treat fibromyalgia pain and depression, but they vary in their success and can come with significant side effects. A growing body of research suggests that CBT can also help. A 2011 randomized controlled trial found that in patients with fibromyalgia, CBT reduced pain just as well as a standard drug regimen of Cymbalta or Lyrica, and it enhanced quality of life and perceptions of pain more dramatically. Other analyses concur, finding that psychological interventions, especially CBT, have a small but noticeable effect on reducing pain in patients with fibromyalgia, similar to that observed for drug therapy. —V.S.
IBS Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder that often includes symptoms of abdominal pain, bloating and diarrhea, and constipation. Medications for IBS can help people with constipation or diarrhea. Diet and lifestyle changes are an essential part of treatment, and many experts recognize the importance of addressing psychological symptoms because 50 to 90 percent of patients have co-occurring mental disorders such as anxiety, depression or social phobia. A new meta-analysis published online in December 2014 in the Journal of Psychosomatic Research examined data from 48 randomized controlled trials investigating psychological interventions for IBS. They found that symptoms improved when psychological distress diminished. The approaches that worked best were those that emphasized the link between symptoms and thoughts, incorporated self-monitoring and coping strategies, and provided feedback and general empathetic support. —T.R.
FSD Female sexual dysfunction (FSD) is a broad term that includes issues pertaining to sexual arousal or desire, orgasm or sex-related pain. Low de sire is the most common sexual complaint among women and can affect quality of life. Pharmaceutical companies continue to hunt for a “female Viagra” with little success, although some compounds are in the early stages of clinical trials now. Meanwhile researchers have found a promising psychological approach. In a study published last year in Behaviour Research and Therapy, 68 women attended four 90-minute sessions of mindfulness- based group therapy consisting of meditation, cognitive therapy and education, whereas 49 women were assigned to a delayed- treatment group. Results show that the mindful group had signicant improvements in sexual desire, arousal, lubrication and satisfaction, along with fewer symptoms of depression, which also predicted sexual improvements. —T.R.
INFERTILITY Fertility drugs, such as Clomid or Serophene, tend to be the first course of action to help women become pregnant. About half of women will get pregnant after taking these drugs, but for those who do not, doctors often recommend other medications—such as injectable hormones—or in vitro fertilization. Yet given the role stress can play in becoming pregnant, it makes sense that psychological treatments may also be an effective way to enhance fertility. A 2005 review found that 45 percent of participants who underwent psychotherapy became pregnant compared with only 14 percent of control subjects who received no intervention. The study also found that women who had psychotherapy alone versus psychotherapy paired with in vitro fertilization had identical pregnancy rates. A smattering of more recent studies have found similar results, but the idea of using psychotherapy for infertility remains on the fringe. —V.S.
