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An exploratory study of primary-care therapists' perceived competence in providing cognitive behavioural therapy to people with medically unexplained symptoms

Published online by Cambridge University Press:  27 November 2013

Hilary Lewis
Hilary Lewis*
Affiliation:
Leeds and York Partnership NHS Foundation Trust, Department of Liaison Psychiatry, Leeds, UK
*
*Address for correspondence: Ms. H. Lewis, Leeds and York Partnership NHS Foundation Trust, Department of Liaison Psychiatry, The Becklin Centre, Alma Street, Leeds LS9 7BE, UK (email: hilarylewis1@nhs.net).
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Abstract

The scope of the Improving Access to Psychological Therapies (IAPT) initiative has been extended to include the treatment of medically unexplained symptoms (MUS). However, MUS was not one of the original common mental health problems that the therapists were trained to treat. No studies have explored whether primary-care cognitive behavioural therapists feel competent to treat people with MUS. This paper aimed to explore and gain an understanding of primary-care therapists’ perceived competence in providing cognitive behavioural therapy (CBT) to people with MUS. Eight CBT therapists working in primary care participated in semi-structured interviews; the Framework approach was used to analyse the data. Five themes were generated by the data analysis, regarding the therapists’ perceived competence. The therapists described unfamiliarity with MUS. They also described some issues in engaging clients in therapy and that progress in therapy could sometimes be slow. Participants often used more general CBT skills and techniques, rather than models and interventions designed specifically for MUS. They had a number of different emotional reactions to this work. CBT therapists in primary care described unfamiliarity with MUS, in comparison to common mental health problems. They identified some difficulties in treatment, but most did not see this group as being more complex to treat. All were interested in receiving training about this client group.

Keywords

Cognitive behavioural therapyprimary caresomatizationtraining
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 6 , 2013 , e16
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2013 

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References

Recommended follow-up reading

Brown, RJ (2006). Medically unexplained symptoms. In: Case Formulation in Cognitive Behavioural Therapy: The Treatment of Challenging and Complex Cases (ed. Tarrier, N.), pp. 263–292. Hove: Routledge.Google Scholar
IAPT (2008). Medically unexplained symptoms: positive practice guide (www.iapt.nhs.uk/silo/files/medically-unexplained-symptoms-positive-practice-guide.pdf).Google Scholar
Kroenke, K (2007). Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosomatic Medicine 69, 881–888.Google Scholar
Woolfolk, RL, Allen, LA (2007). Treating Somatization: A Cognitive-Behavioural Approach. New York: Guilford.Google Scholar

References

Ahern, L, Stone, J, Sharpe, MC (2009). Attitudes of neuroscience nurses toward patients with conversion symptoms. Psychosomatics: Journal of Consultation Liaison Psychiatry 50, 336–339.CrossRefGoogle ScholarPubMed
Allen, LA, Woolfolk, RL (2010). Cognitive behavioral therapy for somatoform disorders. Psychiatric Clinics of North America 33, 579–593.CrossRefGoogle ScholarPubMed
Brown, RJ (2006). Medically unexplained symptoms. In: Case Formulation in Cognitive Behavioural Therapy: The Treatment of Challenging and Complex Cases (ed. Tarrier, N), pp. 263–292. Hove: Routledge.Google Scholar
Creswell, JW (1998). Qualitative Inquiry and Research Design: Choosing among Five Designs. Thousand Oaks, CA: SageGoogle Scholar
Department of Health (2011). Talking therapies: a four year plan of action (http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_123985.pdf).Google Scholar
Fjorback, LO, Arendt, M, Ornbol, E, Walach, H, Rehfeld, E, Schroder, A, Fink, P (2013). Mindfulness therapy for somatization disorder and functional somatic syndromes: randomized trial with one-year follow-up Journal of Psychosomatic Research 74, 31–40CrossRefGoogle ScholarPubMed
Hatcher, S, Arroll, B (2008). Assessment and management of medically unexplained symptoms British Medical Journal 336, 1124–1128.CrossRefGoogle ScholarPubMed
IAPT (2008). Medically unexplained symptoms: positive practice guide (www.iapt.nhs.uk/silo/files/medically-unexplained-symptoms-positive-practice-guide.pdf).Google Scholar
Kent, C, Macmillan, G (2009). A CBT-based approach to medically unexplained symptoms. Advances in Psychiatric Treatment 15, 146–151.Google Scholar
Khan, AA, Khan, A, Harezlak, J, Tu, W, Kroenke, K (2003). Somatic symptoms in primary care: etiology and outcome. Psychosomatics 44, 471–478.Google Scholar
Kroenke, K (2007). Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosomatic Medicine 69, 881–888.CrossRefGoogle ScholarPubMed
Kroenke, K, Swindle, R (2000). Cognitive-behavioral therapy for somatization and symptom syndromes: a critical review of controlled clinical trials. Psychotherapy and Psychosomatics 69, 205–215.CrossRefGoogle ScholarPubMed
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
Pridmore, S, Skerritt, P, Ahmadi, J (2004). Why do doctors dislike treating people with somatoform disorder? Australasian Psychiatry 12, 134–138.CrossRefGoogle ScholarPubMed
Reid, S, Whooley, D, Crayford, T, Hotopf, M (2001). Medically unexplained symptoms – GPs’ attitudes towards their cause and management. Family Practice 18, 519–523.Google Scholar
Rief, W (2007). Analysing the problems in managing patients with medically unexplained symptoms. Journal of General Internal Medicine 22, 704–706.CrossRefGoogle Scholar
Ritchie, J, Spencer, L (1994). Qualitative data analysis for applied policy research. In: Analysing Qualitative Data (ed. Bryman, A. and Burgess, R. G.), pp. 173–194. London: Routledge.CrossRefGoogle Scholar
Silverman, D (2005). Doing Qualitative Research. London: Sage.Google Scholar
Speckens, AE, van Hemert, AM, Spinhoven, P, Hawton, KE, Bolk, JH, Rooijmans, HG (1995). Cognitive behavioural therapy for medically unexplained physical symptoms: a randomised controlled trial British Medical Journal 311, 1328–1332.CrossRefGoogle ScholarPubMed
Sumathipala, A, Siribaddana, S, Abeysingha, MR, De Silva, P, Dewey, M, Prince, M, Mann, AH (2008). Cognitive-behavioural therapy v. structured care for medically unexplained symptoms: randomised controlled trial. British Journal of Psychiatry 193, 51–59.Google Scholar
Tazaki, M, Landlaw, K (2006). Behavioural mechanisms and cognitive-behavioural interventions of somatoform disorders. International Review of Psychiatry 18, 67–73.CrossRefGoogle ScholarPubMed
University of Surrey (2013). IAPT LTC/MUS Pathfinder Evaluation Project: Interim Report (www.iapt.nhs.uk/ltcmus/ltcmus-interim-evaluation-report-from-the-university-of-surrey).Google Scholar
Wileman, L, May, C, Chew-Graham, CA (2002). Medically unexplained symptoms and the problem of power in the primary care consultation: a qualitative study. Family Practice 19, 178–182.CrossRefGoogle ScholarPubMed
Woolfolk, RL, Allen, LA (2007). Treating Somatization: A Cognitive-Behavioural Approach. New York: Guilford.Google Scholar
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