The British Journal of Psychiatry (2008) 193: 51-59. doi: 10.1192/bjp.bp.107.043190
© 2008 The Royal College of Psychiatrists
OPEN ACCESS ARTICLE
This Article
This is an Open Access article
Right arrow Full text (free)
Right arrow Full Text (PDF)
Right arrow Submit an eLetter
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Related articles in BJP
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Right arrow Citing Articles via Scopus
Google Scholar
Right arrow Articles by Sumathipala, A.
Right arrow Articles by Mann, A. H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Sumathipala, A.
Right arrow Articles by Mann, A. H.

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

A. Sumathipala, MBBS, DFM, MD, MRCPsych, PhD

Institute of Psychiatry, London, UK

S. Siribaddana, MBBS, MD and M. R. N. Abeysingha, MBBS, MSc, MD

Institute for Research and Development, Colombo, Sri Lanka

P. De Silva, BA, MA, MD, MSc, MRCPsych, M. Dewey, M. Prince, MBBchir, BA, MA, MD, MSc, MRCPsych and A. H. Mann, MBBS, MD, FRCP, FRCPsych, FRCGP

Institute of Psychiatry, London, UK

Correspondence: Dr A. Sumathipala, Section of Epidemiology, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. Email: spjuats{at}iop.kcl.ac.uk

Declaration of interest

None. Funding detailed in Acknowledgements.

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.


Related articles in BJP:

Highlights of this issue
Sukhwinder S. Shergill
BJP 2008 193: A3. [Full Text]  



This article has been cited by other articles:


Home page
 Br. J. PsychiatryHome page
H. Seivewright, J. Green, P. Salkovskis, B. Barrett, U. Nur, and P. Tyrer
Cognitive-behavioural therapy for health anxiety in a genitourinary medicine clinic: randomised controlled trial
The British Journal of Psychiatry, October 1, 2008; 193(4): 332 - 337.
[Abstract] [Full Text] [PDF]