Effectiveness of a Time-Limited Cognitive Behavior Therapy Type Intervention Among Primary Care Patients With Medically Unexplained Symptoms

Abstract

PURPOSE Patients seeking care for medically unexplained physical symptoms pose a major challenge at primary care sites, and there are very few wellaccepted and properly evaluated interventions to manage such patients. METHODSWe tested the effectiveness of a cognitive behavior therapy (CBT)-type intervention delivered in primary care for patients with medically unexplained physical symptoms. Patients were randomly assigned to receive either the intervention plus a consultation letter or usual clinical care plus a consultation letter. Physical and psychiatric symptoms were assessed at baseline, at the end of treatment, and at a 6-month follow-up. All treatments and assessments took place at the same primary care clinic where patients sought care.RESULTS A signifi cantly greater proportion of patients in the intervention group had physical symptoms rated by clinicians as "very much improved" or "much improved" compared with those in the usual care group (60% vs 25.8%; odds ratio = 4.1; 95% confi dence interval, 1.9-8.8; P <.001). The intervention's effect on unexplained physical symptoms was greatest at treatment completion, led to relief of symptoms in more than one-half of the patients, and persisted months after the intervention, although its effectiveness gradually diminished. The intervention also led to signifi cant improvements in patient-reported levels of physical symptoms, patient-rated severity of physical symptoms, and clinician-rated depression, but these effects were no longer noticeable at follow-up.CONCLUSIONS This time-limited, CBT-type intervention signifi cantly ameliorated unexplained physical complaints of patients seen in primary care and offers an alternative for managing these common and problematic complaints in primary care settings.

Cognitive Behavioral Therapy for Somatoform Disorders

“…In both studies patients were identified and treated with CBT in primary care. Treatment protocols were similar to that of Lidbeck (1997) and Speckens et al, (1995) with the addition of involving the patient's spouse or other family member in treatment (Escobar et al, 2007;Sumathipala et al, 2000). Findings from both trials show individual CBT coincided with greater reductions in somatic complaints than did standard medical care (Escobar et al, 2007;Sumathipala et al, 2000).…”

“…One study required participants meet Escobar's criteria of abridged somatization. That is, men were required to experience at least four somatization symptoms and women were required to experience at least six somatization symptoms (Escobar et al, 2007). The other trial enrolled participants who complained of five or more unexplained physical symptoms (Sumathipala, Hewege, Hanwella, & Mann, 2000).…”

Guided self-help for functional (psychogenic) symptoms

“…tients with functional symptoms who seek it, 24,25 we have found that CBT based on a functional explanation can be acceptable to relatively unselected neurology patients. Second, where should treatment be delivered?…”

Family Physicians May Benefit From Cognitive Behavioral Therapy Skills in Primary Care Setting.

“…Physicians may benefit from CBT skills to manage this widely seen issue. In a study, time-limited CBTtype intervention ameliorated unexplained physical complaints of patients seen in primary care setting (Escobar et al, 2007). In another study; with bearing in mind that medical specialists often find patients without underlying pathology difficult to deal with, an 14 hour training program using techniques from cognitive behavioral therapy increased the interviewing and information-giving skills of participant medical specialists (Weiland et al, 2015).…”