Skip to main content

Main menu

  • Home
  • Content
    • Current Issue
    • Online First
    • Multimedia
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • The Issue in Brief (Plain Language Summaries)
    • Call for Papers
  • Info for
    • Authors
    • Reviewers
    • Media
    • Job Seekers
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • RSS
    • Email Alerts
    • Journal Club
  • Contact
    • Feedback
    • Contact Us
  • Careers

User menu

  • My alerts

Search

  • Advanced search
Annals of Family Medicine
  • My alerts
Annals of Family Medicine

Advanced Search

  • Home
  • Content
    • Current Issue
    • Online First
    • Multimedia
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • The Issue in Brief (Plain Language Summaries)
    • Call for Papers
  • Info for
    • Authors
    • Reviewers
    • Media
    • Job Seekers
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • RSS
    • Email Alerts
    • Journal Club
  • Contact
    • Feedback
    • Contact Us
  • Careers
  • Follow annalsfm on Twitter
  • Visit annalsfm on Facebook
Research ArticleOriginal Research

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

Javier I. Escobar, Michael A. Gara, Angelica M. Diaz-Martinez, Alejandro Interian, Melissa Warman, Lesley A. Allen, Robert L. Woolfolk, Eric Jahn and Denise Rodgers
The Annals of Family Medicine July 2007, 5 (4) 328-335; DOI: https://doi.org/10.1370/afm.702
Javier I. Escobar
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Michael A. Gara
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Angelica M. Diaz-Martinez
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Alejandro Interian
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Melissa Warman
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Lesley A. Allen
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Robert L. Woolfolk
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Eric Jahn
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Denise Rodgers
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • eLetters
  • PDF
Loading

Article Figures & Data

Figures

  • Tables
  • Additional Files
  • Figure 1.
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 1.

    Patient flow.

  • Figure 2.
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 2.

    Percentage of patients with an improvement in physical symptoms.

    Note: Improvement was defined by a rating of “very much improved” or “much improved” by blinded evaluators on the Clinical Global Impressions improvement (CGI-improvement) scale. P values were derived from logistical regression analyses wherein time and treatment condition were evaluated for their ability to predict responder status.

Tables

  • Figures
  • Additional Files
    • View popup
    Table 1.

    Baseline Characteristics of the Study Patients

    CharacteristicIntervention Patients (n=87)Control Patients (n=85)P Value
    DSM IV = Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.
    Note: P values for age were determined by t tests. P values for all remaining variables were determined by χ2 tests.
    * Race/ethnicity was missing for 1 patient in the intervention group.
    Age, mean±SD, y40.97±12.7239.58±13.37.49
    Female, No. (%)75 (86.2)76 (89.4).52
    Race/ethnicity, No. (%)*
        White20 (23.0)16 (18.8)
        Hispanic59 (67.8)58 (68.2)
        African American3 (3.4)2 (2.4).73
        Asian2 (2.3)5 (5.9)
        Other3 (3.4)4 (4.7)
    Education, No. (%)
        7th grade or less18 (20.9)30 (35.3)
        Junior high school or some high school17 (19.8)11 (12.9)
        High school degree12 (14.0)13 (15.3).24
        Some college or a 2-year college degree21 (24.4)17 (20.0)
        4-year college degree9 (10.5)10 (11.8)
        Graduate college degree9 (10.5)4 (4.7)
    Married, No. (%)40 (46.0)32 (37.6).27
    Current comorbid DSM-IV Axis I disorder, No. (%)80 (92.0)78 (91.8).96
    • View popup
    Table 2.

    Changes in Secondary Outcomes by Study Group

    Intervention Patients (n=87)Control Patients (n=85)
    InstrumentMean (SE) [95% CI]nMean (SE) [95% CI]nP Value, Time, Intervention vs ControlP Value, Group x Time Interaction
    Note: MOS-10 denotes the physical functioning subscale from the RAND Medical Outcomes Study scale’s Short-Form Health Survey (scores range from 0 to 100; higher scores indicate better physical functioning). PHQ-15 denotes the somatic complaints module of the Patient Health Questionnaire (scores range from 0 to 30; higher scores indicate higher levels of somatic complaints in the preceding month). HAM-D denotes the 17-item Hamilton Depression Rating Scale (scores range from 0 to 48; higher scores indicate greater depression severity). HAM-A denotes the Hamilton Anxiety Rating Scale (scores range from 0 to 56; higher scores indicate greater anxiety severity). VAS denotes the visual analog scale used to assess medically unexplained symptoms (scores range from 0 to 100; higher scores represent a greater severity of symptoms).
    CI = confidence interval; NS = not siginificant.
    MOS-10
        Baseline63.28 (2.67) [58.00–68.55]8761.41 (2.71) [56.07–66.75]85NSNS
        End of treatment72.19 (2.95) [66.37–78.01]6369.71 (2.95) [63.89–75.54]63NS.92
        Follow-up73.22 (3.36) [66.60–79.85]4869.41 (3.45) [62.60–76.22]44NSNS
    PHQ-15
        Baseline14.17 (0.58) [13.03–15.32]8713.98 (0.59) [12.82–15.13]85NSNS
        End of treatment9.32 (0.67) [8.01–10.64]6311.50 (0.66) [10.19–12.81]64.01.03
        Follow-up9.11(0.59) [7.95–10.28]5010.91 (0.62) [9.69–12.12]44.03NS
    HAM-D
        Baseline18.25 (0.64) [16.98–19.52]8717.41 (0.65) [16.13–18.70]85NSNS
        End of treatment12.85 (0.85) [11.17–14.52]6314.60 (0.84) [12.94–16.25]65.02.05
        Follow-up12.88 (0.88) [11.14–14.63]5114.29 (0.93) [12.44–16.13]44.07NS
    HAM-A
        Baseline20.46 (0.75) [18.98–21.94]8720.99 (0.76) [19.49–22.48]85NSNS
        End of treatment15.89 (1.08) [13.76–18.02]6318.47 (1.07) [16.36–20.57]65NS.19
        Follow-up14.85 (0.94) [12.99–16.70]5117.58 (1.00) [15.61–19.54]44NSNS
    VAS
        Baseline42.34 (1.94) [38.51–46.18]8739.62 (1.97) [35.74–43.50]85NSNS
        End of treatment23.47 (1.77) [19.97–26.96]6227.94 (1.75) [24.48–31.39]64.01.05
        Follow-up23.72 (1.67) [20.43–27.01]5025.25 (1.77) [21.76–28.73]44.22NS

Additional Files

  • Figures
  • Tables
  • The Article in Brief

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

    Javier I. Escobar, MD, and colleagues

    Background Patients with medically unexplained physical symptoms are often seen in primary care. This study tests the effectiveness of a 10-session mental health program for primary care patients with medically unexplained symptoms that are not highly severe. The program is administered by trained psychologists and aims to reduce the patient�s physical distress and preoccupation with physical symptoms.

    What This Study Found The mental health program was effective in managing an ethnically diverse sample of patients with unexplained physical symptoms in the primary care setting. About 60% of the patients who completed the treatment had significant relief of medically unexplained physical symptoms. This improvement continued months after the intervention, although the degree of improvement gradually decreased. The program also led to a decrease in depression symptoms, but this effect was less likely to continue with time.

    Implications

    • This program may be relatively easy to implement in primary care offices in which mental health consultants are available.
    • Some patients may require fewer sessions or a less-intensive program while others may require more. Therefore, a staged approach to treatment should be considered.
PreviousNext
Back to top

In this issue

The Annals of Family Medicine: 5 (4)
The Annals of Family Medicine: 5 (4)
Vol. 5, Issue 4
1 Jul 2007
  • Table of Contents
  • Index by author
  • In Brief
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Annals of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Effectiveness of a Time-Limited Cognitive Behavior Therapy–Type Intervention Among Primary Care Patients With Medically Unexplained Symptoms
(Your Name) has sent you a message from Annals of Family Medicine
(Your Name) thought you would like to see the Annals of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
14 + 4 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Effectiveness of a Time-Limited Cognitive Behavior Therapy–Type Intervention Among Primary Care Patients With Medically Unexplained Symptoms
Javier I. Escobar, Michael A. Gara, Angelica M. Diaz-Martinez, Alejandro Interian, Melissa Warman, Lesley A. Allen, Robert L. Woolfolk, Eric Jahn, Denise Rodgers
The Annals of Family Medicine Jul 2007, 5 (4) 328-335; DOI: 10.1370/afm.702

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Get Permissions
Share
Effectiveness of a Time-Limited Cognitive Behavior Therapy–Type Intervention Among Primary Care Patients With Medically Unexplained Symptoms
Javier I. Escobar, Michael A. Gara, Angelica M. Diaz-Martinez, Alejandro Interian, Melissa Warman, Lesley A. Allen, Robert L. Woolfolk, Eric Jahn, Denise Rodgers
The Annals of Family Medicine Jul 2007, 5 (4) 328-335; DOI: 10.1370/afm.702
del.icio.us logo Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • INTRODUCTION
    • METHODS
    • RESULTS
    • DISCUSSION
    • Footnotes
    • REFERENCES
  • Figures & Data
  • Info & Metrics
  • eLetters
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • Cognitive behaviour therapy for long-term frequent attenders in primary care: a feasibility case series and treatment development study
  • Comparing cognitive-behavioural psychotherapy and psychoeducation for non-specific symptoms associated with indoor air: a randomised control trial protocol
  • Somatoform disorders in litigation: causation and prognosis
  • Somatic symptom count scores do not identify patients with symptoms unexplained by disease: a prospective cohort study of neurology outpatients
  • Effectiveness research on psychosocial interventions among high-utilising patients in primary care
  • Effectiveness of Group Versus Individual Cognitive-Behavioral Therapy in Patients With Abridged Somatization Disorder: A Randomized Controlled Trial
  • Role of mental health professionals in the management of functional somatic symptoms in primary care
  • Guided self-help for functional (psychogenic) symptoms: A randomized controlled efficacy trial
  • 'You Complete Me'
  • In This Issue: Clinical Diagnosis and Management
  • Google Scholar

More in this TOC Section

  • Disparities in Shared Decision-Making Research and Practice: The Case for Black American Patients
  • Building a Data Bridge: Policies, Structures, and Governance Integrating Primary Care Into the Public Health Response to COVID-19
  • Adaptation and External Validation of Pathogenic Urine Culture Prediction in Primary Care Using Machine Learning
Show more Original Research

Similar Articles

Subjects

  • Domains of illness & health:
    • Chronic illness
    • Mental health
  • Methods:
    • Quantitative methods
  • Other topics:
    • Quality improvement

Content

  • Current Issue
  • Past Issues
  • Past Issues in Brief
  • Multimedia
  • Articles by Type
  • Articles by Subject
  • Multimedia
  • Supplements
  • Online First
  • Calls for Papers

Info for

  • Authors
  • Reviewers
  • Media
  • Job Seekers

Engage

  • E-mail Alerts
  • e-Letters (Comments)
  • RSS
  • Journal Club
  • Submit a Manuscript
  • Subscribe
  • Family Medicine Careers

About

  • About Us
  • Editorial Board & Staff
  • Sponsoring Organizations
  • Copyrights & Permissions
  • Contact Us
  • eLetter/Comments Policy

© 2023 Annals of Family Medicine