CBT and Structured Care for Medically Unexplained Symptoms

A paper in the July 2008 issue of the British Journal of Psychiatry looks at interventions for medically unexplained symptoms. Medically unexplained symptoms are a tricky problem. As its name suggests, a patient reports symptoms to the doctor but no underlying cause is found. Research has shown that a number of people that present with such symptoms will continue to see the doctor about such symptoms for many years. In the study in the BJPsych, they trained some General Practitioners in Sri Lanka to be able to use Cognitive Behavioural Therapy for these symptoms. Cognitive Behavioural Therapy is a form of talking therapy which aims to change thinking and behaviour. In the study, 75 patients were given either structured care or CBT.

In structured care, the patient had to see the GP on at least three occasions regarding the symptoms. After this the GP saw them again and used whatever methods they thought appropriate to deal with the symptoms. In the other arm of the trial (patients were randomly assigned to the groups), patients again received 3 mandatory sessions and then the GP used CBT approaches.

A few of the patients dropped out of both parts of the study. However when they analysed the final results, the researchers found that CBT was no better than structured care on a number of measures. They also found that both approaches improved patient’s general health (GHQ scores), complaints of illness symptoms (BSI scores) and number of visits to GP compared to baseline.

The authors gave a number of plausible reasons for why the CBT group did no better. These included the brief training in CBT given to the GP’s, the possibility that the structured care might have also included CBT or that the structured care approaches may have been equally effective. The important finding though, was that if the GP’s focus on dealing with the symptoms in a structured way, it can lead to improvement for the patient.


Sumathipala A, S Siribaddana, M Abeysingha, P De Silva, M Dewey, M Prince and A Mann. Cognitive-behavioural therapy v structured care for medically unexplained symptoms: randomised controlled trial. The British Journal of Psychiatry. 193. 51-9. 2008.


The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor.

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