Psychological therapy for medically unexplained symptoms

Abstract

The first chapter of this thesis is a systematic review of the literature into factors that influence outcomes for people with medically unexplained symptoms (MUS), treated with cognitive behavioural therapy (CBT). A total of 14 papers were identified that met the inclusion criteria and due to the heterogeneity of results, a narrative synthesis was employed. In terms of participant characteristics, neither age, gender, comorbid depression, comorbid anxiety, or comorbid personality disorder were related to therapeutic outcomes. A greater number and intensity of symptoms were related to better outcomes. Some weak evidence was found for the impact of familial status and social difficulties, however only a limited number of articles examined those variables. In terms of therapeutic factors, individual CBT was identified as having slightly superior outcomes over group CBT and certain cognitive and behavioural factors were also identified as relevant. The findings were less clear about whether clinician profession or the number of sessions offered predict better or worse outcomes. Future research should continue to identify relevant variables involved in CBT’s effectiveness in MUS and, where possible, manipulate variables experimentally. The second chapter of this thesis is an empirical research paper examining the effectiveness of CBT and cognitive analytic therapy (CAT) at improving psychosocial, physical health, and economic outcomes for people with MUS. The paper also sought to consider whether any participant or illness characteristics predicted outcomes after treatment. CBT (N = 31) and CAT (N = 17) were no different across any of the outcomes and they were therefore grouped together as Cognitive Therapy (N = 48). A treatment as usual (TAU, N = 56) group did not receive psychological treatment and were used in analyses of economic outcomes. The Cognitive Therapy group improved significantly across all measures of psychosocial and physical health outcomes at the end of therapy compared to at the start. Neither gender, ethnicity, number of symptoms, or duration of symptoms had any impact on the improvements seen. There was no reduction in inpatient, outpatient or A&E cost at either 6, 12, or 18 months after treatment ended and between those who received cognitive therapy and those who received treatment as usual. Clinical implications and avenues for future research are discussed.

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ORCID for Sarah Kirby: orcid.org/0000-0003-1759-1356

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