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“I Had to Force Myself to Learn How to Feel”: A Reflexive Thematic Analysis of Participants’ Experiences of Internet-delivered Emotional Awareness and Expression Therapy for Functional Somatic Disorders

Lindholm, Adrian LU and Wallseth, Lova LU (2025) PSPR14 20251
Department of Psychology
Abstract
Functional somatic disorders (FSD) are common, debilitating conditions that often leave patients caught between insufficient medical explanations and limited psychological treatment options. Internet-based emotional awareness and expression therapy (I-EAET) is a promising intervention for FSD. However, few studies have examined the subjective experience of undergoing I-EAET—particularly among those who do not experience improvement. In this study, we conducted semi-structured interviews with ten individuals who had undergone I-EAET, purposely sampling both those whose symptoms increased and decreased from the treatment. We analyzed the interviews using reflexive thematic analysis informed by critical realism. The analysis generated four... (More)
Functional somatic disorders (FSD) are common, debilitating conditions that often leave patients caught between insufficient medical explanations and limited psychological treatment options. Internet-based emotional awareness and expression therapy (I-EAET) is a promising intervention for FSD. However, few studies have examined the subjective experience of undergoing I-EAET—particularly among those who do not experience improvement. In this study, we conducted semi-structured interviews with ten individuals who had undergone I-EAET, purposely sampling both those whose symptoms increased and decreased from the treatment. We analyzed the interviews using reflexive thematic analysis informed by critical realism. The analysis generated four themes: 1) Is This for Me? and its two sub-themes Chipping at the Wrong Rock? and A Diamond in the Rough portray the process of evaluating the fit of the treatment and adapting to its obstacles; 2) Help Me Help Myself captures the need for both autonomy and support during treatment; 3) Navigating Paradoxes narrates the experience of counter-intuitive aspects of the treatment; and 4) The Great Shift illustrates how some experienced a revolutionary change for the better. Notably, even participants who reported worsening symptoms sometimes described meaningful benefits, while others deemed the treatment inapplicable to their lived realities. In light of our results, we argue that meaningful therapeutic change is not irreducible to symptom scores, and that future development of I-EAET should account for patients’ diverse needs and life contexts. This study offers an important complement to statistical evaluations of the treatment, by contributing to the understanding of the subjective experience of I-EAET. (Less)
Abstract (Swedish)
Funktionella somatiska tillstånd (FSD) är vanliga och funktionsnedsättande tillstånd
som ofta lämnar patienter fångade mellan otillräckliga medicinska förklaringar och
begränsade psykologiska behandlingsalternativ. Internetbaserad emotional awareness
and expression therapy (I-EAET) är en lovande intervention för FSD. Få studier har
dock undersökt den subjektiva upplevelsen av att genomgå I-EAET – särskilt bland
dem som inte upplever förbättring. I denna studie genomförde vi semistrukturerade
intervjuer med tio personer som genomgått I-EAET, där vi medvetet rekryterade både
personer vars symtom ökat och minskat från behandlingen. Vi analyserade
intervjuerna med hjälp av reflexiv tematisk analys, med ansats i kritisk realism.
... (More)
Funktionella somatiska tillstånd (FSD) är vanliga och funktionsnedsättande tillstånd
som ofta lämnar patienter fångade mellan otillräckliga medicinska förklaringar och
begränsade psykologiska behandlingsalternativ. Internetbaserad emotional awareness
and expression therapy (I-EAET) är en lovande intervention för FSD. Få studier har
dock undersökt den subjektiva upplevelsen av att genomgå I-EAET – särskilt bland
dem som inte upplever förbättring. I denna studie genomförde vi semistrukturerade
intervjuer med tio personer som genomgått I-EAET, där vi medvetet rekryterade både
personer vars symtom ökat och minskat från behandlingen. Vi analyserade
intervjuerna med hjälp av reflexiv tematisk analys, med ansats i kritisk realism.
Analysen genererade fyra teman: 1) Är detta för mig? och dess två underteman
Hugger jag i fel sten? och En oslipad diamant skildrar processen att utvärdera
behandlingens lämplighet och att anpassa sig till dess hinder; 2) Hjälp mig att hjälpa
mig själv fångar behovet av både självständighet och stöd under behandlingen; 3) Att
navigera paradoxer beskriver upplevelsen av behandlingens kontraintuitiva inslag;
och 4) Det stora skiftet illustrerar hur vissa deltagare upplevde en omvälvande positiv
förändring. Även deltagare som rapporterade försämrade symtom beskrev ibland
behandlingen som hjälpsam, medan andra ansåg att behandlingen inte var tillämpbar
på deras livssituation. Mot bakgrund av våra resultat menar vi att meningsfull
terapeutisk förändring inte kan reduceras till symtomskattningar, och att framtida
utveckling av I-EAET bör ta hänsyn till patienters olika behov och kontexter. Denna
studie utgör ett viktigt komplement till kvantitativa utvärderingar av behandlingen
genom att bidra med förståelse för den subjektiva upplevelsen av I-EAET. (Less)
Please use this url to cite or link to this publication:
author
Lindholm, Adrian LU and Wallseth, Lova LU
supervisor
organization
course
PSPR14 20251
year
type
H3 - Professional qualifications (4 Years - )
subject
keywords
qualitative research, medically unexplained symptoms, somatization, online psychodynamic therapy, emotion-focused interventions, kvalitativ forskning, medicinskt oförklarade symtom, somatisering, internetbaserad psykodynamisk terapi, känslofokuserade interventioner
language
English
id
9192590
date added to LUP
2025-06-17 13:01:37
date last changed
2025-06-17 13:01:37
@misc{9192590,
  abstract     = {{Functional somatic disorders (FSD) are common, debilitating conditions that often leave patients caught between insufficient medical explanations and limited psychological treatment options. Internet-based emotional awareness and expression therapy (I-EAET) is a promising intervention for FSD. However, few studies have examined the subjective experience of undergoing I-EAET—particularly among those who do not experience improvement. In this study, we conducted semi-structured interviews with ten individuals who had undergone I-EAET, purposely sampling both those whose symptoms increased and decreased from the treatment. We analyzed the interviews using reflexive thematic analysis informed by critical realism. The analysis generated four themes: 1) Is This for Me? and its two sub-themes Chipping at the Wrong Rock? and A Diamond in the Rough portray the process of evaluating the fit of the treatment and adapting to its obstacles; 2) Help Me Help Myself captures the need for both autonomy and support during treatment; 3) Navigating Paradoxes narrates the experience of counter-intuitive aspects of the treatment; and 4) The Great Shift illustrates how some experienced a revolutionary change for the better. Notably, even participants who reported worsening symptoms sometimes described meaningful benefits, while others deemed the treatment inapplicable to their lived realities. In light of our results, we argue that meaningful therapeutic change is not irreducible to symptom scores, and that future development of I-EAET should account for patients’ diverse needs and life contexts. This study offers an important complement to statistical evaluations of the treatment, by contributing to the understanding of the subjective experience of I-EAET.}},
  author       = {{Lindholm, Adrian and Wallseth, Lova}},
  language     = {{eng}},
  note         = {{Student Paper}},
  title        = {{“I Had to Force Myself to Learn How to Feel”: A Reflexive Thematic Analysis of Participants’ Experiences of Internet-delivered Emotional Awareness and Expression Therapy for Functional Somatic Disorders}},
  year         = {{2025}},
}