Cognitive behavioural therapy for medically unexplained physical symptoms: a randomised controlled trial
Open accessAbstract
OBJECTIVE: To examine the additional effect of cognitive behavioural therapy for patients with medically unexplained physical symptoms in comparison with optimised medical care. DESIGN: Randomised controlled trial with follow up assessments six and 12 months after the baseline evaluation. SETTING: General medical outpatient clinic in a university hospital. SUBJECTS: An intervention group of 39 patients and a control group of 40 patients. INTERVENTIONS: The intervention group received between six and 16 sessions of cognitive behavioural therapy. Therapeutic techniques used included identification and modification of dysfunctional automatic thoughts and behavioural experiments aimed at breaking the vicious cycles of the symptoms and their consequences. The control group received optimised medical care. MAIN OUTCOME MEASURES: The degree of change, frequency and intensity of the presenting symptoms, psychological distress, functional impairment, hypochondriacal beliefs and attitudes, and (at 12 months of follow up) number of visits to the general practitioner. RESULTS: At six months of follow up the intervention group reported a higher recovery rate (odds ratio 0.40; 95% confidence interval 0.16 to 1.00), a lower mean intensity of the physical symptoms (difference -1.2; -2.0 to -0.3), and less impairment of sleep (odds ratio 0.38; 0.15 to 0.94) than the controls. After adjustment for coincidental baseline differences the intervention and control groups also differed with regard to frequency of the symptoms (0.32; 0.13 to 0.77), limitations in social (0.35; 0.14 to 0.85) and leisure (0.36; 0.14 to 0.93) activities, and illness behaviour (difference -2.5; -4.6 to -0.5). At 12 months of follow up the differences between the groups were largely maintained. CONCLUSION: Cognitive behavioural therapy seems to be a feasible and effective treatment in general medical patients with unexplained physical symptoms.
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Cognitive behavior therapy is an effective treatment for severe health anxiety and has substantial empirical support.
“Cognitive behavior therapy (CBT) has been shown to be an effective treatment for severe health anxiety and has substantial empirical support [6,7,8,9,10].”
From Mediators in Internet-Based Cognitive Behavior Therapy for Severe Health Anxiety (2013) · cites this paper as [9]
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Hedman, E., Andersson, E., Andersson, G., Lindefors, N., Lekander, M., Rück, C., & Ljótsson, B. (2013) · PLoS ONE · doi:10.1371/journal.pone.0077752 · Cited by 43 · see citing works
“Cognitive behavior therapy (CBT) has been shown to be an effective treatment for severe health anxiety and has substantial empirical support [6,7,8,9,10].”
BackgroundWhat do patients with medically unexplained physical symptoms (MUPS) think? A qualitative study.
Nunes, J., Ventura, T., Encarnação, R., Pinto, P. R., & Santos, I. R. (2013) · PubMed Central · Cited by 43 · see citing works
Understanding and Caring for the Distressed Patient With Multiple Medically Unexplained Symptoms
Walker, E. A., Unützer, J., & Katon, W. J. (1998) · The Journal of the American Board of Family Medicine · doi:10.3122/15572625-11-5-347 · Cited by 43 · see citing works
Stress in the workplace: Unfinished business
Hotopf, M. H., & Wessely, S. C. (1997) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(97)00115-3 · Cited by 42 · see citing works
Maiden, N. (2002) · British journal of rheumatology · doi:10.1093/rheumatology/keg043 · Cited by 41 · see citing works
Beek, M. H. C. T. V., Voshaar, R. C. O., Beek, A. M., van Zijderveld, G. A., Visser, S., Speckens, A. E. M., Batelaan, N. M., & van Balkom, A. J. L. M. (2013) · Depression and Anxiety · doi:10.1002/da.22106 · Cited by 41 · see citing works
Self-citationPayne, H., & Stott, D. (2010) · Counselling and Psychotherapy Research · doi:10.1080/14733140903551645 · Cited by 40 · see citing works
Psychological interventions for non-ulcer dyspepsia
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RetractedMenon, V., Rajan, T. M., Kuppili, P. P., & Sarkar, S. (2017) · Indian Journal of Psychological Medicine · doi:10.4103/ijpsym.ijpsym_17_17 · Cited by 40 · see citing works
- Authors
- Speckens, A. E. M., van Hemert, A. M., Spinhoven, P., Hawton, K. E., Bolk, J. H., & Rooijmans, H. G. M.
- Affiliations
- Leiden University Medical Center (NL)
- Warneford Hospital (GB)
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 1995-11-18
- Volume
- 311
- Issue
- 7016
- Pages
- 1328-1332
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC2551242
- OpenAlex
- W2065862867
- Cited by
- 330
- References
- 13
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 1 · 2023: 4 · 2021: 1 · 2020: 1 · 2019: 5 · 2018: 1 · 2017: 11 · 2016: 5 · 2015: 10 · 2014: 12 · 2013: 17 · 2012: 16
- FWCI
- 15.75
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
- Locations
- BMJ (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (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
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Keywords
- cognitive behavioral therapy, medically unexplained physical symptoms, somatic symptoms, health anxiety, behavioural experiments, psychological distress, functional disability, sleep disorders, general practitioner visits, illness behavior
- MeSH terms
- Adolescent, Adult, Chronic Disease, Follow-Up Studies, Humans, Middle Aged, Somatoform Disorders, Stress, Psychological, Cognitive Behavioral Therapy, Treatment Outcome
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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