HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) In Brief TRACK Comments: Submit a response TRACK Comments: View responses Alert me when this article is cited Alert me when TRACK Comments are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Escobar, J. I. Articles by Rodgers, D. Search for Related Content PubMed PubMed Citation Articles by Escobar, J. I. Articles by Rodgers, D.

Effectiveness of a Time-Limited Cognitive Behavior Therapy–Type Intervention Among Primary Care Patients With Medically Unexplained Symptoms

¹ Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, Piscataway, NJ
² UMDNJ-University Behavioral Health Care, Piscataway, NJ
³ Department of Psychology, Rutgers University, Piscataway, NJ
⁴ Department of Internal Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ

CORRESPONDING AUTHOR: Javier I. Escobar, MD, Department of Psychiatry, UMDNJ-Robert Wood Johnson, Medical School, 675 Hoes Ln, Piscataway, NJ 08854-5635, escobaja{at}umdnj.edu

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.

Key Words: Mental health • somatization disorder • chronic pain • pain management • health care delivery/health services research • primary care • disadvantaged • access to health care • Hispanics • Latinos • psychotherapy, brief

This article has been cited by other articles:

				K. C. Stange 'You Complete Me' Ann. Fam. Med, September 1, 2007; 5(5): 462 - 463. [Full Text] [PDF]

				K. C. Stange In This Issue: Clinical Diagnosis and Management Ann. Fam. Med, July 1, 2007; 5(4): 290 - 291. [Full Text] [PDF]

TRACK Comments: