Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults

Dessel, Nikki van; Boeft, Madelon den; Wouden, Johannes C. van der; Kleinstäuber, Maria; Leone, Stephanie S.; Terluin, Berend; Numans, Mattijs E.; Horst, Henriëtte E. van der; Marwijk, Harm van

doi:10.1002/14651858.cd011142.pub2

Cited by 156 publications

(135 citation statements)

References 149 publications

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“…Studies of psychological treatments for MUS in general show relatively low effect sizes (Kleinstäuber et al, 2011;Van Dessel et al, 2014) and there is much room for improvement. A major weakness the somatosensory amplification and signal filtering models have in common is that they do not flesh out the process by which conscious symptom experiences come about in the first place.…”

Section: Treatment Implicationsmentioning

confidence: 99%

Symptoms and the body: Taking the inferential leap

Bergh

Witthöft

Petersen

et al. 2017

Neuroscience & Biobehavioral Reviews

357

354

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a b s t r a c tThe relationship between the conscious experience of physical symptoms and indicators of objective physiological dysfunction is highly variable and depends on characteristics of the person, the context and their interaction. This relationship often breaks down entirely in the case of "medically unexplained" or functional somatic symptoms, violating the basic assumption in medicine that physical symptoms have physiological causes. In this paper, we describe the prevailing theoretical approach to this problem and review the evidence pertaining to it. We then use the framework of predictive coding to propose a new and more comprehensive model of the body-symptom relationship that integrates existing concepts within a unifying framework that addresses many of the shortcomings of current theory. We describe the conditions under which a close correspondence between the experience of symptoms and objective physiology might be expected, and when they are likely to diverge. We conclude by exploring some theoretical and clinical implications of this new account.

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Section: Treatment Implicationsmentioning

confidence: 99%

Symptoms and the body: Taking the inferential leap

Bergh

Witthöft

Petersen

et al. 2017

Neuroscience & Biobehavioral Reviews

357

354

View full text Add to dashboard Cite

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“…In contrast to DSM-5, the Diagnostic Criteria for Psychosomatic Research (DCPR) [12] suggest a more fine-grain diagnostic approach with 12 psychosomatic syndromes that capture additional psychosocial variables. The debate on the classification of medically unexplained symptoms (MUS) is ongoing [13,14]. …”

Section: Introductionmentioning

confidence: 99%

“…This behaviour does not relieve the patients' suffering but increases annual health-care costs, which are twice as high for patients with MUS than for patients without [15,16]. Despite the refusal of many patients to be treated by psychological means [17], psychological interventions might be a beneficial treatment option for MUS [14] and could be a promising adjunct to medical treatment [5]. …”

Section: Introductionmentioning

confidence: 99%

Does It Matter Who Provides Psychological Interventions for Medically Unexplained Symptoms? A Meta-Analysis

Gerger

Hlavica

Gaab

et al. 2015

Psychother Psychosom

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Background: Patients with medically unexplained symptoms (MUS) are difficult to treat and cause high health-care costs. Psychological interventions might be a beneficial option for treating patients with MUS, but evidence is inconsistent. This meta-analysis compares the effectiveness of psychological interventions for MUS - delivered either by psychotherapists (PTs) or by general practitioners (GPs) - with that of usual care. Method: We conducted a systematic review and meta-analysis on randomised controlled trials of psychological interventions for MUS. Physical symptoms were the primary outcome, and physical functioning and psychological symptoms were the secondary outcomes. We pooled between-group effect sizes (ESs) after the treatment and at the follow-up in random-effects meta-regressions and stratified meta-analyses. We repeated these analyses with the intervention provider, intervention dose, MUS severity and methodological quality as predictors of relative intervention effects. Results: A total of 3,225 patients in 20 studies were analysed. After the treatment, small and significant ESs were found for all 3 outcome domains (ES range: 0.13-0.19, all p < 0.05). Psychological interventions were more beneficial for physical symptoms when delivered by PTs than by GPs (p = 0.02). There was no difference between PTs and GPs in terms of physical functioning and psychological symptoms. Conclusion: Psychological interventions are effective for patients with MUS, but the effects are small and most likely of short duration. Interventions that are delivered by PTs appear to have larger effects on unexplained physical symptoms than those delivered by GPs. Whether this superiority is due to a larger number of sessions of PT interventions remains unclear from our findings.

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“…This approach is supported by a good evidence base. CBT has demonstrated both short-term and long-term efficacy with small effect sizes for MUS (Van Dessel et al, 2014) yet larger treatment effects are seen in specific syndromes such as CFS (White et al, 2011) and IBS (Altayar et al, 2015).Given the overlap between syndromes and the fact that the stability of diagnoses within individuals is low it is highly probable that a number of core transdiagnostic aetiological factors underlie the disorders and that common processes perpetuate the symptoms and disability. We and others have identified cognitive and behavioural responses to symptoms that are common across MUS conditions.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

“Lumping” and “splitting” medically unexplained symptoms: is there a role for a transdiagnostic approach?

Chalder

Willis²

2017

Journal of Mental Health

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Medically unexplained syndromes (MUS) are defined as persistent bodily symptoms with functional disability but no explanatory pathology. They are highly prevalent in both primary and secondary care. In a meta-analysis of medically unexplained symptoms (not syndromes) in primary care, the percentage of patients complaining of at least one medically unexplained symptom ranged from 40.2 (95% CI 0.9-79.4%; I2 ¼ 98%) to 49% (95% CI 18-79.8%, I2 ¼ 98%) (Haller et al., 2015). MUS are associated with high levels of distress and do not respond easily to reassurance and simple explanation (Barsky & Borus, 1999). They are seen in all medical specialties. Fibromyalgia (FM) is frequently seen in rheumatology, irritable bowel syndrome (IBS) in gastroenterology, non-cardiac chest pain in cardiology, chronic fatigue syndrome (CFS) in infectious diseases, non-cardiac chest pain and functional palpitations in cardiology, hyperventilation syndrome in respiratory medicine, tension headache in neurology and multiple chemical sensitivity in allergy. These syndromes have mostly been studied in isolation. However, research has observed extensive symptom overlap with more than half of patients with one MUS condition fulfilling diagnostic criteria for at least one other MUS condition (Nimnuan et al., 2001). For this reason, Wessely et al. (1999) suggested advantages to redefining MUS as one syndrome. Fink & Schroder (2010) advocated a new overarching term, ''bodily distress syndrome'', to encompass all the different MUS. They submit that there is now substantial evidence that MUS conditions are not clearly distinct disease entities but rather a common phenomenon with different subtypes. They describe similarities in diagnostic criteria, aetiology, pathophysiological, neurobiology, psychological mechanisms, patient characteristics and treatment response. Some years earlier Yunus (2007) had suggested the generic term ''central sensitivity syndrome'' which suggests that the common mechanism underlying various MUS is central sensitisation which is the hyper-excitement of neurons in the central nervous system. However, this ''lumping'' hypothesis triggered much debate due to criticisms that overlap is not present between all the MUS. For instance, there is little symptomatic overlap between IBS and FM. Furthermore, the pathophysiology is not consistent across syndromes in that there is hyperactivity of corticotropin-releasing hormone neurons in FM but hypoactivity in CFS (Neeck & Crofford, 2000). From a cognitive behavioural perspective unhelpful beliefs and behaviours may differ markedly from one syndrome to another.The study of MUS often attracts debate and sometimes controversy. Even the label MUS comes under fire. Persistent physical symptoms (PPS) is a new patient-centred term that refers to MUS. For several reasons, we prefer to use the term PPS. Firstly, two surveys of different populations preferred the term. One group consisted of healthy subjects (Marks & Hunter, 2015) and the other group involved patients with CFS (Picariello et ...

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Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults

Cited by 156 publications

References 149 publications

Symptoms and the body: Taking the inferential leap

Symptoms and the body: Taking the inferential leap

Does It Matter Who Provides Psychological Interventions for Medically Unexplained Symptoms? A Meta-Analysis

“Lumping” and “splitting” medically unexplained symptoms: is there a role for a transdiagnostic approach?

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