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Development and feasibility of a modified reattribution model for somatising patients, applied by their own general
Annette H Blankenstein1, Henriëtte E van der Horst, Albert F Schilte
1Department of General Practice, Faculty of Medicine, EMGO Institute, Vrije Universiteit, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. ah.blankenstein.emgo@med.vu.nl
Abstract:
Reattribution has been developed as a cognitive-behavioural treatment model for somatisation in general practice. Our objective is to make reattribution suitable for application on patients with long-standing somatisation, including hypochondria, and to evaluate feasibility. Three modifications were developed: (1) dealing with persistent illness worry, (2) adjustment of the doctor's speed to that of the patient, and (3) the use of symptom diaries. Performance of ten experienced general practitioners (GPs), after a 20h training programme (six sessions of variable length), was measured by self-registrations and audio-taped consultations. GPs were interviewed on factors interfering with performance. Nine GPs completed the course. Reattribution was applied to 51 out of 75 indicated somatising patients, which required on average three consultations of 10-30min duration. We conclude that the modified reattribution model offers a feasible approach to the broad spectrum of somatisation seen in general practice; only the modification 'dealing with illness worry' showed limited feasibility.