What Works in Mindfulness Interventions for Medically Unexplained
Symptoms? A Systematic Review

Background/Purpose: Mindfulness-based interventions (MBIs) have been used in medically unexplained symptoms (MUS). This systematic review describes the literature investigating the general effect of MBIs on MUS and identifies the effects of specific MBIs on specific MUS conditions. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Guidelines (PRISMA) and the modified Oxford Quality Scoring System (Jadad score) were applied to the review, yielding an initial 1,556 articles. The search engines included PubMed, ScienceDirect, Web of Science, Scopus, EMBASE, and PsychINFO using the search terms: mindfulness, or mediations, or mindful or MBCT or MBSR and medically unexplained symptoms or MUS or Fibromyalgia or FMS. A total of 24 articles were included in the final systematic review. Results/Conclusions: MBIs showed large effects on: symptom severity (d = 0.82), pain intensity (d =0.79), depression (d = 0.62), and anxiety (d = 0.67). A manualized MBI that applies the four fundamental elements present in all types of interventions were critical to efficacy. These elements were psycho-education sessions specific to better understand the medical symptoms, the practice of awareness, the nonjudgmental observance of the experience in the moment, and the compassion to ones’ self. The effectiveness of different mindfulness interventions necessitates giving attention to improve the gaps that were identified related to home-based practice monitoring, competency training of mindfulness teachers, and sound psychometric properties to measure the mindfulness practice.

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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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12 Self-help for medically unexplained symptoms: a systematic review and meta-analysis

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2017-bnpa.72 ◽

2017 ◽

Vol 88 (8) ◽

pp. A32.1-A32

Author(s):

Anne van Gils ◽

Robert A Schoevers ◽

Irma J Bonvanie ◽

Jeannette M Gelauff ◽

Annelieke M Roest ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Medically Unexplained Symptoms ◽

Self Help ◽

Medically Unexplained ◽

Unexplained Symptoms

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Prevalence of medically unexplained symptoms in adults who are high users of health care services: a systematic review and meta-analysis protocol

BMJ Open ◽

10.1136/bmjopen-2018-027922 ◽

2019 ◽

Vol 9 (7) ◽

pp. e027922 ◽

Cited By ~ 4

Author(s):

Ferozkhan Jadhakhan ◽

Oana C Lindner ◽

Amy Blakemore ◽

Elspeth Guthrie

Keyword(s):

Systematic Review ◽

Healthcare Costs ◽

Meta Analysis ◽

Medically Unexplained Symptoms ◽

Cochrane Library ◽

Persistent Symptoms ◽

Study Results ◽

Medically Unexplained ◽

Unexplained Symptoms ◽

The Cochrane Library

IntroductionMedically unexplained symptoms (MUS) are common in primary-care and secondary-care settings. Persistent symptoms of MUS are associated with a variety of poor outcomes including increased disability, poor quality of life and high healthcare costs. The aim of this systematic review is to review the relevant literature to determine the prevalence of MUS in patients who are high users of healthcare and/or who accrue high healthcare costs.Methods and analysisThis review will include studies with cases that are either high users of general healthcare or are patients who accrue high healthcare costs, aged ≥18 years and where a recognised measure of MUS, either a standardised clinical interview or questionnaire, was employed. The following citation databases MEDLINE, PsycINFO, EMBASE, CINAHL, PROSPERO and the Cochrane library will be systematically searched from inception to 30 June 2018. The Cochrane library was included because of the significant proportion of non-observational studies currently published in the database. The prevalence of MUS and associated disorders along with the costs or use of healthcare associated with the presence of MUS will be estimated with 95% CI. If possible, study results will be pooled into a meta-analysis. However, if heterogeneity is high, data analysis will be presented descriptively.Ethics and disseminationEthical approval is not required for this systematic review since only data from existing studies will be used. Results of this review will be disseminated in peer-reviewed publications and at national and international conferences.PROSPERO registration numberCRD42018100388

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Cognitive Behavior Therapy for Medically Unexplained Symptoms: A Systematic Review and Meta-analysis of Published Controlled Trials

Indian Journal of Psychological Medicine ◽

10.4103/ijpsym.ijpsym_17_17 ◽

2017 ◽

Vol 39 (4) ◽

pp. 399-406 ◽

Cited By ~ 7

Author(s):

Vikas Menon ◽

Tess Maria Rajan ◽

Pooja Patnaik Kuppili ◽

Siddharth Sarkar

Keyword(s):

Systematic Review ◽

Behavior Therapy ◽

Cognitive Behavior Therapy ◽

Meta Analysis ◽

Medically Unexplained Symptoms ◽

Controlled Trials ◽

Cognitive Behavior ◽

Medically Unexplained ◽

Unexplained Symptoms

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Medically Unexplained Symptoms Following Childhood Sexual Abuse: Systematic Review

PsycEXTRA Dataset ◽

10.1037/e516662013-259 ◽

2008 ◽

Author(s):

Julie Taylor ◽

Sarah Nelson ◽

Norma Baldwin

Keyword(s):

Systematic Review ◽

Sexual Abuse ◽

Childhood Sexual Abuse ◽

Medically Unexplained Symptoms ◽

Medically Unexplained ◽

Unexplained Symptoms

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Epidemiology and organization of care in medically unexplained symptoms: a systematic review with a focus on cultural diversity and migrants

International Journal of Clinical Practice ◽

10.1111/ijcp.14855 ◽

2021 ◽

Author(s):

Peter Vermeir ◽

An Mariman ◽

Lilla Lucza ◽

Sallay Viola ◽

Anne Weiland ◽

...

Keyword(s):

Systematic Review ◽

Cultural Diversity ◽

Medically Unexplained Symptoms ◽

Organization Of Care ◽

Medically Unexplained ◽

Unexplained Symptoms

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Cost-effectiveness of interventions for medically unexplained symptoms: A systematic review

PLoS ONE ◽

10.1371/journal.pone.0205278 ◽

2018 ◽

Vol 13 (10) ◽

pp. e0205278 ◽

Cited By ~ 3

Author(s):

Margreet S. H. Wortman ◽

Joran Lokkerbol ◽

Johannes C. van der Wouden ◽

Bart Visser ◽

Henriëtte E. van der Horst ◽

...

Keyword(s):

Systematic Review ◽

Cost Effectiveness ◽

Medically Unexplained Symptoms ◽

Medically Unexplained ◽

Unexplained Symptoms

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Medically unexplained symptoms: time to and triggers for diagnosis in primary care consultations

British Journal of General Practice ◽

10.3399/bjgp20x707825 ◽

2020 ◽

Vol 70 (691) ◽

pp. e86-e94 ◽

Cited By ~ 2

Author(s):

Juul Houwen ◽

Peter LBJ Lucassen ◽

Stijn Dongelmans ◽

Hugo W Stappers ◽

Willem JJ Assendelft ◽

...

Keyword(s):

Primary Care ◽

Medically Unexplained Symptoms ◽

Study Data ◽

Specific Pattern ◽

Central Component ◽

Symptom Presentation ◽

Medically Unexplained ◽

Unexplained Symptoms ◽

Symptom Patterns ◽

The Moment

BackgroundIt is currently not known when in the consultation GPs label symptoms as medically unexplained and what triggers this.AimTo establish the moment in primary care consultations when a GP labels symptoms as medically unexplained and to explore what triggers them to do so.Design and settingThis was a qualitative study. Data were collected in the Netherlands in 2015.MethodGPs’ consultations were video-recorded. GPs stated whether the consultation was about medically unexplained symptoms (MUS). The GP was asked to reflect on the video-recorded consultation and to indicate the moment when they labelled symptoms as MUS. Qualitative interviewing and analysis were performed to explore the triggers GPs perceived that caused them to label the symptoms as MUS.ResultsA total of 43 of the 393 video-recorded consultations (11%) were labelled as MUS. The mean time until GPs labelled symptoms as medically unexplained was about 4 minutes for newly presented symptoms and 2 minutes for symptoms for which the patients had already visited the GP before. GPs were triggered to label symptoms as MUS in the consultation by: the way patients presented their symptoms; the symptoms not fitting into a specific pattern; patients attributing the symptoms to a psychosocial context; and a discrepancy between symptom presentation and objective findings.ConclusionMost GPs labelled the presented symptoms as medically unexplained soon after the start of the consultation. GPs are triggered to label symptoms as medically unexplained by patients’ symptom presentation, symptom patterns, and symptom attribution. This suggests that non-analytical reasoning was a central component in their thought process.

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