Effectiveness of psychotherapy for Hwa-Byung: A systematic review of interventional studies

This systematic review aimed to review and synthesize the effects of different psychotherapies on Hwa-Byung (HB), a Korean culture-bound syndrome.

Ten electronic databases were comprehensively searched for interventional studies on psychotherapy, including language-based communication, for patients with HB, published until July 2023. The Cochrane risk-of-bias assessment tool and risk-of-bias in non-randomized studies of interventions were used to assess the methodological quality of the included studies.

Nine studies including 7 controlled clinical trials were included. Interventions encompassed 6 types: acceptance and commitment therapy, Adlerian counseling, integrated counseling, emotional freedom technique, art therapy, and psychotherapeutic programs for HB treatment. Except for the 2 types of counseling, all interventions were implemented in a group format, with total sessions ranging from 4 to 15 (average 8.11). Most interventions significantly improved HB symptoms compared to the waitlist or before-and-after comparisons. In the before-after comparison, the most frequently reported outcome of effectiveness was the HB Scale total score (100%, 6/6), followed by state anger (50%, 3/6), and state anxiety (50%, 2/4). For other outcomes, statistically significant positive results were reported in less than half of the cases, or there were only a small number of reported cases.

To our knowledge, this systematic review comprehensively investigated the effectiveness of psychotherapy for HB and found evidence for some psychotherapies not previously presented in the clinical practice guidelines for HB. However, methodological limitations, including the lack of an appropriate control group, make it difficult to obtain high-quality evidence on psychotherapy for HB.