Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2008 Jul;193(1):51-9.
doi: 10.1192/bjp.bp.107.043190.

Cognitive-behavioural therapy v. structured care for medically unexplained symptoms: randomised controlled trial

A Sumathipala  1 , S Siribaddana, M R N Abeysingha, P De Silva, M Dewey, M Prince, A H Mann
Affiliations
Randomized Controlled Trial

Cognitive-behavioural therapy v. structured care for medically unexplained symptoms: randomised controlled trial

A Sumathipala et al. Br J Psychiatry. 2008 Jul.

Abstract

Background: A pilot trial in Sri Lanka among patients with medically unexplained symptoms revealed that cognitive-behavioural therapy (CBT) administered by a psychiatrist was efficacious.

Aims: To evaluate CBT provided by primary care physicians in a comparison with structured care.

Method: A randomised control trial (n=75 in each arm) offered six 30 min sessions of structured care or therapy. The outcomes of the two interventions were compared at 3 months, 6 months, 9 months and 12 months.

Results: In each arm, 64 patients (85%) completed the three mandatory sessions. No difference was observed between groups in mean scores on the General Health Questionnaire or the Bradford Somatic Inventory, or in number of complaints or patient-initiated consultations at 3 months. For both groups, all outcome measures improved at 3 months, and remained constant in the follow-up assessments.

Conclusions: Cognitive-behavioural therapy given by primary care physicians after a short course of training is no more efficacious than structured care. Natural remission is an unlikely explanation for improvements in people with chronic medically unexplained symptoms, but lack of a 'treatment as usual' arm limits further conclusions. Further research on enhanced structured care, medical assessment and structured care incorporating simple elements of CBT principles is worthy of consideration.

PubMed Disclaimer

Figures

Fig 1
Fig 1
Flow of participants through the trial.
Fig. 2
Fig. 2
Study outcomes for the cognitive–behavioural group (group 1) and the structured care group (group 2). BSI, Bradford Somatic Inventory; GHQ, General Health Questionnaire.
See this image and copyright information in PMC

References

    1. Kroenke K, Mangelsdorff AD. Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome. Am J Med 1989; 86: 262–6. - PubMed
    1. Jackson JL, Passamonti M. The outcomes among patients presenting in primary care with a physical symptom at 5 years. J Gen Intern Med 2005; 20: 1032–7. - PMC - PubMed
    1. Kroenke K, Price RK. Symptoms in the community: prevalence, classification, and psychiatric co-morbidity. Arch Intern Med 1993; 153: 2474–80. - PubMed
    1. Henningsen P, Zimmermann T, Sattel H. Medically unexplained physical symptoms, anxiety, and depression: a meta-analytic review. Psychosom Med 2003; 65: 528–33. - PubMed
    1. Toft T, Fink P, Oernboel E, Christensen K, Frostholm L, Olesen F. Mental disorders in primary care: prevalence and co-morbidity among disorders. Results from the Functional Illness in Primary care (FIP) study. Psychol Med 2005; 35: 1175–84. - PubMed

Publication types

LinkOut - more resources