TY - JOUR
KW - Academic Medical Centers
KW - Adolescent
KW - Adult
KW - Aged
KW - Ambulatory Care Facilities
KW - Anxiety/ethnology/therapy
KW - Cognitive Therapy/methods
KW - Depression/ethnology/therapy
KW - Family Practice/methods
KW - Female
KW - Humans
KW - Interview, Psychological
KW - Male
KW - Mental Health Services
KW - Middle Aged
KW - New Jersey
KW - Primary Health Care/methods
KW - Psychotherapy, Brief
KW - Referral and Consultation
KW - Severity of Illness Index
KW - Somatoform Disorders/ethnology/therapy
KW - Treatment Outcome
KW - Urban Health Services
AU - J. I. Escobar
AU - M. A. Gara
AU - A. M. Diaz-Martinez
AU - A. Interian
AU - M. Warman
AU - L. A. Allen
AU - R. L. Woolfolk
AU - E. Jahn
AU - D. Rodgers
A1 - 
AB - PURPOSE: Patients seeking care for medically unexplained physical symptoms pose a major challenge at primary care sites, and there are very few well-accepted and properly evaluated interventions to manage such patients. METHODS: We tested the effectiveness of a cognitive behavior therapy (CBT)-type intervention delivered in primary care for patients with medically unexplained physical symptoms. Patients were randomly assigned to receive either the intervention plus a consultation letter or usual clinical care plus a consultation letter. Physical and psychiatric symptoms were assessed at baseline, at the end of treatment, and at a 6-month follow-up. All treatments and assessments took place at the same primary care clinic where patients sought care. RESULTS: A significantly greater proportion of patients in the intervention group had physical symptoms rated by clinicians as "very much improved" or "much improved" compared with those in the usual care group (60% vs 25.8%; odds ratio = 4.1; 95% confidence interval, 1.9-8.8; P<.001). The intervention's effect on unexplained physical symptoms was greatest at treatment completion, led to relief of symptoms in more than one-half of the patients, and persisted months after the intervention, although its effectiveness gradually diminished. The intervention also led to significant improvements in patient-reported levels of physical symptoms, patient-rated severity of physical symptoms, and clinician-rated depression, but these effects were no longer noticeable at follow-up. CONCLUSIONS: This time-limited, CBT-type intervention significantly ameliorated unexplained physical complaints of patients seen in primary care and offers an alternative for managing these common and problematic complaints in primary care settings.
BT - Annals of family medicine
C5 - Medically Unexplained Symptoms
CP - 4
CY - United States
DO - 10.1370/afm.702
IS - 4
JF - Annals of family medicine
N2 - PURPOSE: Patients seeking care for medically unexplained physical symptoms pose a major challenge at primary care sites, and there are very few well-accepted and properly evaluated interventions to manage such patients. METHODS: We tested the effectiveness of a cognitive behavior therapy (CBT)-type intervention delivered in primary care for patients with medically unexplained physical symptoms. Patients were randomly assigned to receive either the intervention plus a consultation letter or usual clinical care plus a consultation letter. Physical and psychiatric symptoms were assessed at baseline, at the end of treatment, and at a 6-month follow-up. All treatments and assessments took place at the same primary care clinic where patients sought care. RESULTS: A significantly greater proportion of patients in the intervention group had physical symptoms rated by clinicians as "very much improved" or "much improved" compared with those in the usual care group (60% vs 25.8%; odds ratio = 4.1; 95% confidence interval, 1.9-8.8; P<.001). The intervention's effect on unexplained physical symptoms was greatest at treatment completion, led to relief of symptoms in more than one-half of the patients, and persisted months after the intervention, although its effectiveness gradually diminished. The intervention also led to significant improvements in patient-reported levels of physical symptoms, patient-rated severity of physical symptoms, and clinician-rated depression, but these effects were no longer noticeable at follow-up. CONCLUSIONS: This time-limited, CBT-type intervention significantly ameliorated unexplained physical complaints of patients seen in primary care and offers an alternative for managing these common and problematic complaints in primary care settings.
PP - United States
PY - 2007
SN - 1544-1717; 1544-1709
SP - 328
EP - 335
EP - 
T1 - Effectiveness of a time-limited cognitive behavior therapy type intervention among primary care patients with medically unexplained symptoms
T2 - Annals of family medicine
TI - Effectiveness of a time-limited cognitive behavior therapy type intervention among primary care patients with medically unexplained symptoms
U1 - Medically Unexplained Symptoms
U2 - 17664499
U3 - 10.1370/afm.702
VL - 5
VO - 1544-1717; 1544-1709
Y1 - 2007
ER -