scholarly journals The ‘medically unexplained symptoms’ syndrome concept and the cognitive-behavioural treatment model

2021 ◽  
pp. 135910532110380
Author(s):  
Michael J Scott ◽  
Joan S Crawford ◽  
Keith J Geraghty ◽  
David F Marks
Keyword(s):  
Medically Unexplained Symptoms ◽  
Chronic Fatigue ◽  
Behavioural Therapy ◽  
Routine Practice ◽  
Treatment Model ◽  
Behavioural Treatment ◽  
Cognitive Behavioural ◽  
Practitioner Training ◽  
Medically Unexplained ◽  
Unexplained Symptoms

The American Psychiatric Association’s, 2013 DSM-5 abandoned the use of the term ‘medically unexplained symptoms’ for non-neurological disorders. In the UK, treatments for various medical illnesses with unexplained aetiology, such as chronic fatigue syndrome, irritable bowel syndrome and fibromyalgia, continue to fall under an MUS umbrella with cognitive behavioural therapy promoted as a primary therapeutic approach. In this editorial, we comment on whether the MUS concept is a viable diagnostic term, the credibility of the cognitive-behavioural MUS treatment model, the necessity of practitioner training and the validity of evidence of effectiveness in routine practice.

scholarly journals A CBT-based approach to medically unexplained symptoms

2009 ◽  
Vol 15 (2) ◽  
pp. 146-151 ◽  
Author(s):  
Catriona Kent ◽  
Graham McMillan
Keyword(s):  
Medically Unexplained Symptoms ◽  
Behavioural Therapy ◽  
Liaison Psychiatry ◽  
General Psychiatry ◽  
Cognitive Behavioural ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
The Common ◽  
Common Problems ◽  
Set Up

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.

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

2008 ◽  
Vol 193 (1) ◽  
pp. 51-59 ◽  
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

An exploratory study of primary-care therapists' perceived competence in providing cognitive behavioural therapy to people with medically unexplained symptoms

2013 ◽  
Vol 6 ◽  
Author(s):  
Hilary Lewis
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Problems ◽  
Medically Unexplained Symptoms ◽  
Perceived Competence ◽  
Behavioural Therapy ◽  
Cognitive Behavioural ◽  
Common Mental Health Problems ◽  
Medically Unexplained ◽  
Unexplained Symptoms

AbstractThe scope of the Improving Access to Psychological Therapies (IAPT) initiative has been extended to include the treatment of medically unexplained symptoms (MUS). However, MUS was not one of the original common mental health problems that the therapists were trained to treat. No studies have explored whether primary-care cognitive behavioural therapists feel competent to treat people with MUS. This paper aimed to explore and gain an understanding of primary-care therapists’ perceived competence in providing cognitive behavioural therapy (CBT) to people with MUS. Eight CBT therapists working in primary care participated in semi-structured interviews; the Framework approach was used to analyse the data. Five themes were generated by the data analysis, regarding the therapists’ perceived competence. The therapists described unfamiliarity with MUS. They also described some issues in engaging clients in therapy and that progress in therapy could sometimes be slow. Participants often used more general CBT skills and techniques, rather than models and interventions designed specifically for MUS. They had a number of different emotional reactions to this work. CBT therapists in primary care described unfamiliarity with MUS, in comparison to common mental health problems. They identified some difficulties in treatment, but most did not see this group as being more complex to treat. All were interested in receiving training about this client group.

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

2019 ◽  
Vol 69 (681) ◽  
pp. e262-e269 ◽  
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.

scholarly journals Extending Cognitive-Behavioural Theory and Therapy to Medically Unexplained Symptoms and Long-Term Physical Conditions: A Hybrid Transdiagnostic/Problem Specific Approach

2016 ◽  
Vol 33 (4) ◽  
pp. 172-192 ◽  
Author(s):  
Paul M. Salkovskis ◽  
James D. Gregory ◽  
Alison Sedgwick-Taylor ◽  
Julie White ◽  
Simon Opher ◽  
...  
Keyword(s):  
Belief Change ◽  
Medically Unexplained Symptoms ◽  
Long Term Conditions ◽  
Treatment Protocols ◽  
Specific Approach ◽  
Cognitive Behavioural ◽  
Wide Range ◽  
Medically Unexplained ◽  
Unexplained Symptoms

Medically unexplained symptoms (MUS) are not only common and distressing, but are also typically poorly managed in general medical settings. Those suffering from these problems tend to incur significantly higher health costs than the general population. There are many effective treatments for different MUS; these are almost entirely based on cognitive-behavioural approaches. However, the wide range of treatment protocols tend to be ‘syndrome specific’. As such, they do not generalise well in terms of training and application, making them expensive and difficult to disseminate, suggesting the desirability of developing a transdiagnostic approach. The general basis of such a CBT grounded transdiagnostic approach is considered, and the particular need to incorporate cognitive elements of both anxiety or health anxiety (threat) and depression (loss) is highlighted. Key empirically grounded and evidence-based processes (both specific and general) previously identified as underpinning the maintenance of MUS are delineated. The way in which these can be combined in a transdiagnostic model that accounts for most MUS presentations is presented and linked to a formulation-driven transdiagnostic treatment strategy, which is described. However, the need to take more syndrome-specific issues into account in treatment is identified, suggesting that the optimum treatment may be a hybrid transdiagnostic/specific approach with formulation, shared understanding, belief change strategies, and behavioural experiments at its heart. The generalisation of such approaches to psychological problems occurring in the context of ‘long-term conditions’ is identified as a further important development that is now within reach.

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