Brief multimodal psychosomatic therapy in patients with medically unexplained symptoms: feasibility and treatment effects

Fam Pract. 2016 Aug;33(4):346-53. doi: 10.1093/fampra/cmw023. Epub 2016 Apr 13.

Abstract

Background: Patients repeatedly presenting with medically unexplained symptoms (MUS) to their GPs, suffer from their symptoms. Experts in the field suggest a multicomponent approach for these patients. Brief multimodal psychosomatic therapy (BMPT) is such an intervention.

Objectives: To test the systematic identification of eligible patients, acceptability of BMPT and potential treatment effects of BMPT.

Methods: The participants in this randomized pilot trial, patients consulting their GPs more than once with MUS, were randomized to intervention [usual care (UC) and additional BMPT] or control condition (UC alone).We monitored the number of patients identified and recruited, trial recruitment and retention. Potential treatment effects were measured with perceived symptom severity [Visual Analogue Scale (VAS)]; patients' self-rated symptoms of distress, depression, anxiety and somatization [Four-Dimensional Symptom Questionnaire (4DSQ)]; symptoms of hyperventilation [Nijmegen Hyperventilation List (NHL)]; physical and mental health status and quality of life [Short-Form Health Survey-36 items (SF-36)]; and level of functioning (measure of general functioning). Follow-up was 1 year.

Results: A total of 42 patients could be included in the trial. Four patients withdrew after randomization and two patients were lost to follow-up, resulting in 36 patients (86%). During the 12-month follow-up after BMPT, there was an improvement in perceived symptom severity [adjusted mean difference -2.0, 95% confidence interval (CI) -3.6 to -0.3], in somatization (adjusted mean difference -4.4, 95% CI -7.5 to -1.4) and in symptoms of hyperventilation (adjusted mean difference -5.7, 95% CI -10.5 to -0.8).

Conclusions: This randomized pilot study shows that a larger trial studying the effectiveness of BMPT in patients with MUS in primary care is feasible and useful.

Trial registration: ClinicalTrials.gov NCT01935258.

Keywords: Medically unexplained symptoms; physical activity/exercise; primary health care; psychosomatic therapy; somatoform disorders..

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anxiety / psychology*
  • Depression / psychology*
  • Exercise
  • Female
  • Health Status
  • Humans
  • Male
  • Medically Unexplained Symptoms*
  • Middle Aged
  • Netherlands
  • Pilot Projects
  • Primary Health Care
  • Psychophysiologic Disorders / therapy*
  • Psychotherapy, Brief / methods*
  • Quality of Life
  • Surveys and Questionnaires

Associated data

  • ClinicalTrials.gov/NCT01935258