Mindfulness-Based Cognitive Therapy for Patients with Medically Unexplained Symptoms: A Randomized Controlled Trial

Abstract

Background: Patients with medically unexplained symptoms make heavy demands on the health care system. An offer for psychological treatment is often declined. There is a need for acceptable and effective treatments. We assessed the acceptability and effectiveness of mindfulness-based cognitive therapy (MBCT) for patients with persistent medically unexplained symptoms. Method: A randomized controlled trial comparing MBCT (n = 64) to enhanced usual care (EUC; n = 61). Participants were the 10% most frequently attending patients in primary care. The primary outcome measure was general health status at the end of treatment. Secondary outcome measures were mental and physical functioning. Assessments took place at the end of treatment and at the 9-month follow-up. Results: Health status and physical functioning did not significantly differ between groups. However, participants in the MBCT group reported a significantly greater improvement in mental functioning at the end of treatment (adjusted mean difference, 3.9; 95% CI, 0.24-7.6), in particular with regard to vitality and social functioning. In addition, at 9 months of follow-up, the mindfulness skills ‘observing' and ‘describing' were significantly higher in the MBCT group. Within the MBCT group, almost half of the outcome measures had significantly improved at the end of treatment, whereas in the EUC group none had. Conclusions: MBCT was feasible for frequently attending patients with persistent medically unexplained symptoms in primary care. Although MBCT did not lead to a significant difference in general health status between the two groups, it did result in a significant improvement in mental functioning.

A Randomized Controlled Pilot Study on Mindfulness-Based Cognitive Therapy for Unipolar Depression in Patients With Chronic Pain

“…This finding is in line with the treatment goal of our MBCT program and psychotherapeutic interventions of CP in general, which is not to remove or reduce the pain itself, but rather to find ways of managing the pain and the adverse consequences on mental health and quality of life. Interestingly, a recent randomized controlled trial from van Ravesteijn et al (2013) focusing on MBCT for patients with medically unexplained symptoms, including CP, also found significant improvement on mental health functioning, in particular with regard to vitality, but no significant findings on physical health and bodily pain.…”

The Efficacy of Mindfulness-Based Interventions in Primary Care: A Meta-Analytic Review

“…Intervention vs AC Combined Combined Plews-Ogan et al, 37 2005 Combined C ombined C ombined Van Ravesteijn et al, 35 2013 Intervention vs AC Combined Combined de Vibe and Moum, 39 2006 Intervention vs PC Combined Posttest Mental Health Intervention: n = 295 Control: n = 234…”

“…Intervention vs AC Combined Combined Plews-Ogan et al, 37 2005 Combined C ombined C ombined Van Ravesteijn et al, 35 2013 Intervention vs AC Combined Combined de Vibe and Moum, 39 observed a moderate effect size when comparing MBIs with wait list controls, but this effect was small when compared with active controls, and even smaller when including psychotherapy. The authors concluded that MBIs did not differ from cognitive behavior therapies or pharmacotherapy.…”

The implementation of mindfulness in healthcare systems: a theoretical analysis

“…Furthermore, van Ravesteijn et al [20,21] studied the effect of MBCT on somatizers (patients with persistent unexplained physical symptoms) in a sample of primary care patients. The authors observed that although there was no difference in overall health within this sample compared to patients who followed standard treatments, mindfulness improved psychological functioning without increasing costs.…”