A qualitative study of psychodynamic and cognitive behavioural therapists’ conceptualisations of medically unexplained symptoms in their clients

SummaryThis article discusses a cognitive–behavioural therapy (CBT) approach to the treatment of medically unexplained symptoms that is based on the ‘five areas’ model of CBT. We describe a typical course of therapy and some of the common problems encountered during treatment. Emphasis is placed on the practical management of these conditions, and the focus is on symptoms as opposed to cause. We believe that this approach is widely applicable and could be used in a large range of settings to tackle these debilitating conditions. In writing this article we intended to provide an overview of patients with medically unexplained symptoms. The article would be of interest to staff within liaison psychiatry departments looking to set up a medically unexplained symptoms service and general psychiatry teams who may have contact with patients presenting with somatic symptoms. Psychiatric teams without access to a liaison department may also find this article interesting.

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Medically unexplained symptoms and the problem of power in the primary care consultation: a qualitative study

Family Practice ◽

10.1093/fampra/19.2.178 ◽

2002 ◽

Vol 19 (2) ◽

pp. 178-182 ◽

Cited By ~ 105

Author(s):

L. Wileman

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Medically Unexplained Symptoms ◽

Primary Care Consultation ◽

Medically Unexplained ◽

Care Consultation ◽

Unexplained Symptoms

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Cognitive-behavioural therapyv.structured care for medically unexplained symptoms: randomised controlled trial

The British Journal of Psychiatry ◽

10.1192/bjp.bp.107.043190 ◽

2008 ◽

Vol 193 (1) ◽

pp. 51-59 ◽

Cited By ~ 36

Author(s):

A. Sumathipala ◽

S. Siribaddana ◽

M. R. N. Abeysingha ◽

P. De Silva ◽

M. Dewey ◽

...

Keyword(s):

Primary Care ◽

Cognitive Behavioural Therapy ◽

Primary Care Physicians ◽

Medically Unexplained Symptoms ◽

Behavioural Therapy ◽

Randomised Control Trial ◽

Structured Care ◽

Cognitive Behavioural ◽

Medically Unexplained ◽

Unexplained Symptoms

BackgroundA pilot trial in Sri Lanka among patients with medically unexplained symptoms revealed that cognitive-behavioural therapy (CBT) administered by a psychiatrist was efficaciousAimsTo evaluate CBT provided by primary care physicians in a comparison with structured careMethodA randomised control trial (n=75 in each arm) offered six 30 min sessions of structured care or therapy. The outcomes of the two interventions were compared at 3 months, 6 months, 9 months and 12 monthsResultsIn each arm, 64 patients (85%) completed the three mandatory sessions. No difference was observed between groups in mean scores on the General Health Questionnaire or the Bradford Somatic Inventory, or in number of complaints or patient-initiated consultations at 3 months. For both groups, all outcome measures improved at 3 months, and remained constant in the follow-up assessmentsConclusionsCognitive–behavioural therapy given by primary care physicians after a short course of training is no more efficacious than structured care. Natural remission is an unlikely explanation for improvements in people with chronic medically unexplained symptoms, but lack of a ‘treatment as usual’ arm limits further conclusions. Further research on enhanced structured care, medical assessment and structured care incorporating simple elements of CBT principles is worthy of consideration

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CBT to reduce healthcare use for medically unexplained symptoms: systematic review and meta-analysis

British Journal of General Practice ◽

10.3399/bjgp19x701273 ◽

2019 ◽

Vol 69 (681) ◽

pp. e262-e269 ◽

Cited By ~ 5

Author(s):

Brittni Jones ◽

Amanda C de C Williams

Keyword(s):

Systematic Review ◽

Healthcare Costs ◽

Meta Analysis ◽

Medically Unexplained Symptoms ◽

Psychological Interventions ◽

Healthcare Use ◽

Cognitive Behavioural ◽

Medically Unexplained ◽

Unexplained Symptoms ◽

Medical Investigations

BackgroundStudies have reported that medically unexplained symptoms (MUS) tend to be associated with increased healthcare use, which is demanding of resources and potentially harmful to patients. This association is often used to justify the funding and study of psychological interventions for MUS, yet no systematic review has specifically examined the efficacy of psychological interventions in reducing healthcare use.AimTo conduct a systematic review and meta-analysis to evaluate the effectiveness of cognitive behavioural therapies (CBT) for MUS in reducing healthcare use.Design and settingSystematic review and meta-analysis.MethodThe search from a previous systematic review was updated and expanded. Twenty-two randomised controlled trials reported healthcare use, of which 18 provided data for meta-analysis. Outcomes were healthcare contacts, healthcare costs, medication, and medical investigations.ResultsSmall reductions in healthcare contacts and medication use were found for CBT compared with active controls, treatment as usual, and waiting list controls, but not for medical investigations or healthcare costs.ConclusionCognitive behavioural interventions show weak benefits in reducing healthcare use in people with MUS. The imprecise use of MUS as a diagnostic label may impact on the effectiveness of interventions, and it is likely that the diversity and complexity of these difficulties may necessitate a more targeted approach.

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How do hospital doctors manage patients with medically unexplained symptoms: a qualitative study of physicians

Journal of the Royal Society of Medicine ◽

10.1177/0141076816686348 ◽

2017 ◽

Vol 110 (2) ◽

pp. 65-72 ◽

Cited By ~ 10

Author(s):

Alex Warner ◽

Kate Walters ◽

Kethakie Lamahewa ◽

Marta Buszewicz

Keyword(s):

Qualitative Study ◽

Role Models ◽

Service Use ◽

Medical Training ◽

Management Strategies ◽

Medically Unexplained Symptoms ◽

Medical Specialty ◽

Medically Unexplained ◽

Unexplained Symptoms ◽

And Training

Objective Medically unexplained symptoms are a common presentation in medical practice and are associated with significant morbidity and high levels of service use. Most research exploring the attitudes and training of doctors in treating patients with unexplained symptoms has been conducted in primary care. This study aims to explore the ways in which doctors working in secondary care approach and manage patients with medically unexplained symptoms. Design A qualitative study using in-depth interviews and thematic analysis. Setting Three hospitals in the North Thames area. Participants Twenty consultant and training-grade physicians working in cardiology, gastroenterology, rheumatology and neurology. Main outcome measure Physicians' approach to patients with medically unexplained symptoms and their views on managing these patients. Results There was considerable variation in how the physicians approached patients who presented with medically unexplained symptoms. Investigations were often ordered without a clear rationale and the explanations given to patients when results of investigations were normal were highly variable, both within and across specialties. The doctor’s level of experience appeared to be a more important factor in their investigation and management strategies than their medical specialty. Physicians reported little or no formal training in how to manage such presentations, with no apparent consistency in how they had developed their approach. Doctors described learning from their own experience and from senior role models. Organisational barriers were identified to the effective management of these patients, particularly in terms of continuity of care. Conclusions Given the importance of this topic, there is a need for serious consideration as to how the management of patients with medically unexplained symptoms is included in medical training and in the planning and delivery of services.

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