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Cognitive-behavioural therapy v. structured care for medically unexplained symptoms: randomised controlled trial.
A Sumathipala1, S Siribaddana, M R N Abeysingha
1Section of Epidemiology, Institute of Psychiatry, De Crespigny Park, London, UK. spjuats@iop.kcl.ac.uk
Summary
Cognitive-behavioural therapy (CBT) delivered by primary care physicians showed no additional benefit over structured care for medically unexplained symptoms. Both interventions led to similar improvements in patient health outcomes.
Area of Science:
- Psychiatry
- General Practice
- Health Services Research
Background:
- Pilot studies indicated cognitive-behavioural therapy (CBT) administered by psychiatrists is effective for medically unexplained symptoms.
- Medically unexplained symptoms represent a significant challenge in primary care settings.
Purpose of the Study:
- To assess the efficacy of CBT delivered by primary care physicians compared to structured care.
- To evaluate the effectiveness of a brief training program for primary care physicians in delivering CBT.
Main Methods:
- A randomized controlled trial involving 150 patients (75 per arm).
- Interventions included six 30-minute sessions of either structured care or CBT.
- Outcomes were assessed at 3, 6, 9, and 12 months post-intervention.
Main Results:
- 85% of participants completed the minimum required sessions in both groups.
- No significant differences were found between CBT and structured care on the General Health Questionnaire, Bradford Somatic Inventory, number of complaints, or consultations at 3 months.
- Both groups demonstrated improvement in all outcome measures by 3 months, with sustained effects at follow-up.
Conclusions:
- Cognitive-behavioural therapy provided by primary care physicians, following brief training, was not superior to structured care for patients with chronic medically unexplained symptoms.
- While natural remission is unlikely, the study design limits definitive conclusions due to the absence of a 'treatment as usual' control group.
- Future research should explore enhanced structured care, medical assessment, and structured care integrating basic CBT principles.
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