Randomized controlled trial of cognitive behaviour therapy for repeated consultations for medically unexplained complaints: a feasibility study in Sri Lanka
Abstract
BACKGROUND: Research on the management and the outcome of treatment of medically unexplained symptoms is very limited. Development of simple but effective techniques for treatment and demonstration of their effectiveness when applied in primary health care are needed. METHODS: A randomized controlled trial was carried out with follow-up assessments at 3 months after baseline assessments using the Short Explanatory Model Interview (SEMI), General Health Questionnaire (GHQ-30), Bradford Somatic Inventory (BSI) and patient satisfaction on a visual analogue scale. The study was carried out in a general out-patient clinic in Sri Lanka. The intervention group received six, 30 min sessions based on the principles of cognitive behavioural therapy over a period of 3 months. The control group received standard clinical care. RESULTS: Eighty patients out of the 110 patients referred, were eligible. Sixty-eight were randomly allocated equally to the control and treatment groups. All 34 in the treatment group accepted the treatment offer and 22 completed between three and six sessions. At 3 months, 24 in the treatment and 21 in the control group completed follow-up assessments. Intention-to-treat analysis revealed significant differences in mean scores of outcome measures (adjusted for baseline scores) between control and intervention groups respectively--complaints 6.1 and 3.8 (P = 0.001), GHQ 10.4 and 6.3 (P = 0.04), BSI score 15.6 and 132 (P < 0-01), visits 7.9 and 3.1 (P = 0.004). CONCLUSIONS: Intervention based on cognitive behavioural therapy is feasible and acceptable to patients with medically unexplained symptoms from a general out-patients clinic in Sri Lanka. It had a significant effective in reducing symptoms, visits and distress, and in increasing patient satisfaction.
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Psychotherapy trials in less affluent countries are sparse and have been clinic-based rather than community-based.
“However, psychotherapy trials in less affluent countries are sparse and have been clinic-based rather than community-based (Sumathipala et al , 2000; Araya et al , 2003; Patel et al , 2003).”
From Group interpersonal psychotherapy for depression in rural Uganda: 6-month outcomes: Randomised controlled trial (2006) · cites this paper as Sumathipala et al, 2000
Cognitive behavior treatment (CBT) has been found effective in treating somatoform disorders and medically unexplained symptoms.
“cognitive behavior treatment (CBT) has been found effective in treating them [10–12].”
From One-session cognitive behavior treatment for long-term frequent attenders in primary care: randomized controlled trial (2019) · cites this paper as [11]
In earlier CBT intervention studies, the proportion of patients with a psychiatric diagnosis has been higher or has not been reported, and patients with no psychiatric disorder have not been analyzed separately.
“In the earlier CBT intervention studies, the proportion of patients with a psychiatric diagnosis has been higher [12,15] or has not been reported [11,13], and patients with no psychiatric disorder have not been analyzed separately.”
From One-session cognitive behavior treatment for long-term frequent attenders in primary care: randomized controlled trial (2019) · cites this paper as [11]
Only two studies have explicitly considered repeated service use in MUS, and only one identified those frequently attending for 2 years.
“Only two studies have explicitly considered repeated service use in MUS, however, and only one identified those frequently attending for 2 years. 16,17”
From Cognitive behaviour therapy for long-term frequent attenders in primary care: A feasibility case series and treatment development study (2016) · cites this paper as [16]
Other studies demonstrate that service use can be reduced using CBT.
“This study sits among other studies demonstrating that service use can be reduced using CBT. 14-16”
From Cognitive behaviour therapy for long-term frequent attenders in primary care: A feasibility case series and treatment development study (2016) · cites this paper as [16]
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Efficacy of Treatment for Somatoform Disorders: A Review of Randomized Controlled Trials
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Tratamiento psicológico en el trastorno de somatización : eficacia y propuestas de intervención
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Identification, assessment and treatment of individual patients
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Capacity building through multi-disciplinary research: a report from Sri Lanka
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Self-citationFrigophobia: A case series from Sri Lanka
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Earthquake 2005: challenges for Pakistani psychiatry
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Psychological Status and Physical Disabilities of Permanently Disabled Sri Lankan Servicemen
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- Authors
- SUMATHIPALA, A., HEWEGE, S., HANWELLA, R., & MANN, A. H.
- Affiliations
- University of London (GB)
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2000-07
- Volume
- 30
- Issue
- 4
- Pages
- 747-757
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W1987776661
- Cited by
- 129
- References
- 24
- Citations by year
- 2022: 2 · 2021: 2 · 2020: 1 · 2019: 2 · 2018: 1 · 2017: 3 · 2016: 3 · 2015: 5 · 2014: 5 · 2013: 13 · 2012: 11
- FWCI
- 3.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- medically unexplained symptoms, somatic symptoms, cognitive behavioral therapy, feasibility, primary care, patient satisfaction, treatment acceptability
- MeSH terms
- Adult, Analysis of Variance, Chronic Disease, Feasibility Studies, Female, Humans, Male, Middle Aged, Outpatients, Primary Health Care, Somatoform Disorders, Sri Lanka, Cognitive Behavioral Therapy, Treatment Outcome, Patient Satisfaction
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