Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-19T03:39:30.841Z Has data issue: false hasContentIssue false
  • English
  • Français

Patients with medically unexplained physical symptoms experience of receiving treatment in a primary-care psychological therapies service: a qualitative study

Published online by Cambridge University Press:  30 June 2015

Chloe Gerskowitch ,
Ian Norman  and
Katharine A. Rimes
Chloe Gerskowitch*
Affiliation:
King's College London and South London and Maudsley NHS Trust, London, UK
Ian Norman
Affiliation:
King's College London, Florence Nightingale School of Nursing & Midwifery, London, UK
Katharine A. Rimes
Affiliation:
King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
*
*Author for correspondence: C. Gerskowitch, King's College London and South London and Maudsley NHS Trust, London, UK. (email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

As a pilot site under the primary-care Increasing Access to Psychological Therapies (IAPT) Long Term Condition/Medically Unexplained Physical Symptoms (MUPS) project, patients with MUPS were offered cognitive behaviour therapy (CBT)-based treatments or attendance at a mindfulness-based stress reduction (MBSR) programme. This study aimed to gain an understanding of the views and experiences of MUPS patients that received CBT-based therapy or MBSR within an IAPT service and to investigate the relationship between their experiences and health outcomes measured on self-report questionnaires. Thematic analysis was used to analyse data gathered via semi-structured interviews with 11 patients. Data collected from three self-report measures were considered in relation to key features of participants’ reported experiences and patterns identified. Four main themes emerged: (1) something needs to change; (2) making connections between physical symptoms and mood, thoughts or activities; (3) sharing experiences and feeling understood; and (4) reflections on treatment experience. Participants generally reported a positive experience of treatment and felt better able to cope with their symptoms, although treatment did not necessarily result in reliable change in symptoms as measured by the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7) and Work and Social Adjustment Scale (WSAS). This novel model of treatment appears to be acceptable for this patient group although evaluation of the pilot should consider the ability of routinely used measures to capture the value of treatment to patients, including improved coping with symptoms.

Keywords

CBTprimary careMBSRmedically unexplained physical symptoms (MUPS)qualitative
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 8 , 2015 , e12
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Recommended follow-up reading

DoH (2008). Medically unexplained symptoms positive practice guide (www.iapt.nhs.uk). Department of Health, London.Google Scholar
University of Surrey Evaluation Team (2013). IAPT LTC/MUS pathfinder evaluation project – phase 1 (www.iapt.nhs.uk).Google Scholar

References

Braun, V, Clark, V (2006). Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77–101.CrossRefGoogle Scholar
Chalder, T, Wallace, P, Wessely, S (1997). Self-help treatment of chronic fatigue in the community: a randomized controlled trial. British Journal of Health Psychology 2, 189–197.Google Scholar
Chew-Graham, C, Brooks, J, Wearden, A, Dowrick, C, Peters, S (2011). Factors influencing engagement of patients in a novel intervention for CFS/ME: a qualitative study. Primary Health Care Research and Development 12, 112–122.CrossRefGoogle Scholar
Creed, F, Henningsen, P, Fink, P (eds) (2011). Medically Unexplained Symptoms, Somatisation and Bodily Distress. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Dennison, L, Stanbrook, R, Moss-Morris, R, Yardley, L, Chalder, T (2010). Cognitive behavioural therapy and psycho-education for chronic fatigue syndrome in young people: Reflections from the families’ perspective. British Journal of Health Psychology 15, 167–183.Google Scholar
DoH (2008). Medically unexplained symptoms positive practice guide (www.iapt.nhs.uk). Department of Health, London.Google Scholar
DoH (2011 a). Talking therapies: a four year plan (www.iapt.nhs.uk). Department of Health, London.Google Scholar
DoH (2011 b). Talking Therapies: The IAPT Data Handbook – Guidance on Monitoring Outcomes to Support Local Evidence-based Practice (www.iapt.nhs.uk). Department of Health, London.Google Scholar
Dreary, V, Chalder, T, Sharpe, M (2007). The cognitive behavioural model of medically unexplained symptoms: a theoretical and empirical review. Clinical Psychology Review 27, 781–797.CrossRefGoogle Scholar
Escobar, JI, Gara, MA, Diaz-Martinez, AM, Interian, A (2007). Effectiveness of a time-limited cognitive behavior therapy-type intervention among primary care patients with medically unexplained symptoms. Annals of Family Medicine 5, 328–335.CrossRefGoogle ScholarPubMed
Grossman, P, Niemann, L, Schmidt, S, Walach, H (2004). Mindfulness-based stress reduction and health benefits. Journal of Psychosomatic Research 57, 35–43.Google Scholar
Grossman, P, Tiefenthaler-Gilmer, U, Raysz, A, Kesper, U (2007). Mindfulness training as an intervention for fibromyalgia: evidence of post-intervention and 3-year follow-up benefits in well-being. Psychotherapy and Psychosomatics 76, 226–233.Google Scholar
Hakanson, C, Sahlberg-Blom, E, Ternestedt, B, Nyhlin, H (2012). Learning about oneself through others: experiences of a group-based patient education programme about irritable bowel syndrome. Scandinavian Journal of Caring Sciences 26, 738–746.CrossRefGoogle ScholarPubMed
Hamnes, B, Hauge, MI, Kjeken, I, Hagen, KB (2011). ‘I have come here to learn how to cope with my illness, not to be cured’: a qualitative study of patient expectations prior to a one-week self-management programme. Musculoskeletal Pain 9, 200–210.Google Scholar
Henningsen, P, Zimmerman, T, Satttel, H (2003). Medically unexplained physical symptoms, anxiety and depression: a meta-analytic review. Psychosomatic Medicine 65, 528–533.CrossRefGoogle ScholarPubMed
Kabat-Zinn, J (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. General Hospital Psychiatry 4, 33–42.Google Scholar
Kazdin, AE (1999). The meaning and measurement of clinical significance. Journal of Consulting and Clinical Psychology 67, 332–339.CrossRefGoogle ScholarPubMed
Kroenke, K, Spitzer, R, Williams, J (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 16, 606–613.CrossRefGoogle ScholarPubMed
Martin, A, Rauh, E, Fichter, M, Rief, W (2007). A one-session treatment for patients suffering from medically unexplained symptoms in primary care: a randomized clinical trial. Psychosomatics 48, 294–303.Google Scholar
McDermott, C, Lynch, J, Leydon, GM (2011). Patients’ hopes and expectations of a specialist chronic fatigue syndrome/ME service: a qualitative study. Family Practice 28, 572–578.Google Scholar
Morone, NM, Lynch, CS, Greco, CM, Tindle, HA, Weiner, DK (2008). ‘I felt like a new person.’ The effects of mindfulness meditation on older adults with chronic pain: qualitative narrative analysis of diary entries. Journal of Pain 9, 841–848.CrossRefGoogle Scholar
Moss-Moriss, R, McAlpine, L, Didsbury, LP, Spence, MJ (2010). A randomized controlled trial of a cognitive behavioural therapy-based self-management intervention for irritable bowel syndrome in primary care. Psychological Medicine 40, 85–94.Google Scholar
Mundt, JC, Marks, IM, Shear, MK, Greist, J (2002). The Work and Social Adjustment Scale: a simple measure of impairment in functioning. British Journal of Psychiatry 180, 461–464.CrossRefGoogle Scholar
NICE (2007). Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and management of CFS/ME in adults and children (CG53). London: National Institute for Health and Clinical Excellence.Google Scholar
NICE (2008). Irritable bowel syndrome in adults: diagnosis and management of irritable bowel syndrome in primary care (CG61). London: National Institute for Health and Clinical Excellence.Google Scholar
Nezu, AM, Nezu, CM, Lombardo, ER (2001). Cognitive-behavior therapy for medically unexplained symptoms: a critical review of the treatment literature. Behavior Therapy 32, 537–583.Google Scholar
Noblit, GW, Hare, RW (1988). Meta-ethnography: Synthesising Qualitative Studies. Newbury Park, CA: Sage.Google Scholar
Public Health Resource Unit, England (2006). CASP quality assessment questions [last update] (http://sph.nhs.uk/what-we-do/public-health-workforces/critical-appraisal-skills-programme/?searchterm=casp).Google Scholar
Rosenzweig, S, Greson, JM, Reibel, DK, Green, JS, Jasser, SA, Beasley, D (2010). Mindfulness-based stress reduction for chronic pain conditions: variation in treatment outcomes and role of home meditation practice. Journal of Psychosomatic Research 68, 29–36.Google Scholar
Sallinen, M, Kukkurainen, ML, Peltokallio, S (2011). Finally heard, believed and accepted – peer support in the narratives of women with fibromyalgia. Patient Education and Counselling 85, 126–130.Google Scholar
Salmon, P (2007). Conflict, collusion or collaboration in consultations about medically unexplained symptoms: the need for a curriculum of medical explanation. Patient Education and Counselling 67, 246–254.Google Scholar
Seligman, LD, Wuyek, LA, Geers, AL (2009). The effects of inaccurate expectations on experiences with psychotherapy. Cognitive Therapy Research 33, 139–149 Google Scholar
Shaw, J, Creed, F (1991). The cost of somatization. Journal of Psychosomatic Research 35, 307–312 Google Scholar
Spitzer, RL, Kroenke, K, Williams, JB, Löwe, B (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine 166, 1092–1097.CrossRefGoogle ScholarPubMed
Speckens, AEM, Van Hermert, AM, Spinhoven, P, Hawton, KE (1995). Cognitive behavioural therapy for medically unexplained physical symptoms: a randomised controlled trial. British Medical Journal 311, 1328–1332.Google Scholar
Thomas, SP, Pollo, HR (2002). Listening to Patient: A Phenomenological Approach to Nursing Research and Practice. New York: Springer.Google Scholar
Timmer, B, Bleichhardt, G, Rief, W (2006). Importance of psychotherapy motivation in patients with somatization syndrome. Psychotherapy Research 16, 348–356.Google Scholar
Westra, HA, Aviram, A, Barnes, M, Angus, L (2010). Therapy was not what I expected: a preliminary qualitative analysis of concordance between client expectations and experience of cognitive-behavior therapy. Psychotherapy Research 20, 436–446.Google Scholar
Wolfe, FEA (1990). The American College of Rheumatology 1990. Criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis and Rheumatism 33, 160–172.Google Scholar
Submit a response

Comments

No Comments have been published for this article.