scholarly journals Psychological approaches to somatisation in developing countries

2006 ◽  
Vol 12 (1) ◽  
pp. 54-62 ◽  
Author(s):  
Vikram Patel ◽  
Athula Sumathipala
Keyword(s):  
Primary Care ◽  
Developing Countries ◽  
Somatoform Disorders ◽  
Common Mental Disorders ◽  
Behavioural Therapy ◽  
Cognitive Behavioural ◽  
Clinical Presentations ◽  
Proven Efficacy ◽  
Medically Unexplained ◽  
Main Components

Medically unexplained somatic complaints are among the most common clinical presentations in primary care in developing countries and they are a considerable burden for patients and the healthcare system. They are assumed to be the result of psychosocial factors, and the process by which symptoms are experienced is termed somatisation. Common mental disorders, somatoform disorders and socio-economic adversities are the major risk factors for these complaints. There is evidence suggesting that cognitive–behavioural therapy, which has proven efficacy for somatoform disorders in the developed world, can be used in developing countries with some adaptations (e.g. by simplifying the content so that it can be applied in primary care by non-specialist health practitioners; using culturally appropriate analogies; and delivering the intervention over fewer and shorter sessions). The main components of such an intervention are presented in this article.

scholarly journals Cognitive-behavioural therapyv.structured care for medically unexplained symptoms: randomised controlled trial

2008 ◽  
Vol 193 (1) ◽  
pp. 51-59 ◽  
Author(s):  
A. Sumathipala ◽  
S. Siribaddana ◽  
M. R. N. Abeysingha ◽  
P. De Silva ◽  
M. Dewey ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Behavioural Therapy ◽  
Primary Care Physicians ◽  
Medically Unexplained Symptoms ◽  
Behavioural Therapy ◽  
Randomised Control Trial ◽  
Structured Care ◽  
Cognitive Behavioural ◽  
Medically Unexplained ◽  
Unexplained Symptoms

BackgroundA pilot trial in Sri Lanka among patients with medically unexplained symptoms revealed that cognitive-behavioural therapy (CBT) administered by a psychiatrist was efficaciousAimsTo evaluate CBT provided by primary care physicians in a comparison with structured careMethodA 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 monthsResultsIn 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 assessmentsConclusionsCognitive–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

Idiopathic Physical Symptoms: A Common Manifestation of Psychiatric Disorders in Primary Care

CNS Spectrums ◽  
2006 ◽  
Vol 11 (3) ◽  
pp. 201-210 ◽  
Author(s):  
Javier I. Escobar ◽  
Angelica Dìaz-Martínez ◽  
Michael Gara
Keyword(s):  
Primary Care ◽  
Mental Disorders ◽  
Psychiatric Disorders ◽  
Somatoform Disorders ◽  
Common Mental Disorders ◽  
Psychiatric Patients ◽  
Physical Symptoms ◽  
Medical Specialties ◽  
Assessment And Treatment ◽  
Medically Unexplained

ABSTRACTWorldwide, patients with common mental disorders, such as depression and anxiety, have a tendency to present first to primary care exhibiting idiopathic physical symptoms. Typically, these symptoms consist of pain and other physical complaints that remain medically unexplained. While in the past, traditional psychopathology emphasized the relevance of somatic presentations for disorders, such as depression, in the last few decades, the “somatic component” has been neglected in the assessment and treatment of psychiatric patients. Medical specialties have come up with a variety of “fashionable” labels to characterize these patients and the new psychiatric nomenclatures, such as the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, attempt to classify these patients into a separate “somatoform disorders” category. These efforts fall short, and revisionists are asking altogether for the elimination of “somatoform disorders” from future nomenclatures.This review emphasizes the importance of idiopathic physical symptoms to the clinical phenomenology of many psychiatric disorders, offers suggestions to the diagnostic conundrum, and provides some hints for the proper assessment and management of patients with these common syndromes.

Stepped care in primary care – guided self-help and face-to-face cognitive behavioural therapy for common mental disorders: a randomized controlled trial

2017 ◽  
Vol 48 (10) ◽  
pp. 1644-1654 ◽  
Author(s):  
Sigrid Salomonsson ◽  
Fredrik Santoft ◽  
Elin Lindsäter ◽  
Kersti Ejeby ◽  
Brjánn Ljótsson ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Disorders ◽  
Common Mental Disorders ◽  
Behavioural Therapy ◽  
Stepped Care ◽  
Care Model ◽  
Face To Face ◽  
Self Help ◽  
Cognitive Behavioural ◽  
Remission Rates

AbstractBackgroundCommon mental disorders (CMD) cause large suffering and high societal costs. Cognitive behavioural therapy (CBT) can effectively treat CMD, but access to treatment is insufficient. Guided self-help (GSH) CBT, has shown effects comparable with face-to-face CBT. However, not all patients respond to GSH, and stepping up non-responders to face-to-face CBT, could yield larger response rates. The aim was to test a stepped care model for CMD in primary care by first evaluating the effects of GSH-CBT and secondly, for non-responders, evaluating the additional effect of face-to-face CBT.MethodsConsecutive patients (N = 396) with a principal disorder of depression, anxiety, insomnia, adjustment or exhaustion disorder were included. In Step I, all patients received GSH-CBT. In Step II, non-responders were randomized to face-to-face CBT or continued GSH. The primary outcome was remission status, defined as a score below a pre-established cutoff on a validated disorder-specific scale.ResultsAfter GSH-CBT in Step I, 40% of patients were in remission. After Step II, 39% of patients following face-to-face CBT were in remission compared with 19% of patients after continued GSH (p = 0.004). Using this stepped care model required less than six therapy sessions per patient and led to an overall remission rate of 63%.ConclusionsStepped care can be effective and resource-efficient to treat CMD in primary care, leading to high remission rates with limited therapist resources. Face-to-face CBT speeded up recovery compared with continued GSH. At follow-ups after 6 and 12 months, remission rates were similar in the two groups.

An exploratory study of primary-care therapists' perceived competence in providing cognitive behavioural therapy to people with medically unexplained symptoms

2013 ◽  
Vol 6 ◽  
Author(s):  
Hilary Lewis
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Problems ◽  
Medically Unexplained Symptoms ◽  
Perceived Competence ◽  
Behavioural Therapy ◽  
Cognitive Behavioural ◽  
Common Mental Health Problems ◽  
Medically Unexplained ◽  
Unexplained Symptoms

AbstractThe scope of the Improving Access to Psychological Therapies (IAPT) initiative has been extended to include the treatment of medically unexplained symptoms (MUS). However, MUS was not one of the original common mental health problems that the therapists were trained to treat. No studies have explored whether primary-care cognitive behavioural therapists feel competent to treat people with MUS. This paper aimed to explore and gain an understanding of primary-care therapists’ perceived competence in providing cognitive behavioural therapy (CBT) to people with MUS. Eight CBT therapists working in primary care participated in semi-structured interviews; the Framework approach was used to analyse the data. Five themes were generated by the data analysis, regarding the therapists’ perceived competence. The therapists described unfamiliarity with MUS. They also described some issues in engaging clients in therapy and that progress in therapy could sometimes be slow. Participants often used more general CBT skills and techniques, rather than models and interventions designed specifically for MUS. They had a number of different emotional reactions to this work. CBT therapists in primary care described unfamiliarity with MUS, in comparison to common mental health problems. They identified some difficulties in treatment, but most did not see this group as being more complex to treat. All were interested in receiving training about this client group.

scholarly journals Predictors of outcome in guided self-help cognitive behavioural therapy for common mental disorders in primary care

2019 ◽  
Vol 49 (6) ◽  
pp. 455-474
Author(s):  
Sigrid Salomonsson ◽  
Fredrik Santoft ◽  
Elin Lindsäter ◽  
Kersti Ejeby ◽  
Martin Ingvar ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Disorders ◽  
Cognitive Behavioural Therapy ◽  
Common Mental Disorders ◽  
Behavioural Therapy ◽  
Predictors Of Outcome ◽  
Self Help ◽  
Cognitive Behavioural

An investigation into the efficacy of a cognitive behavioural therapy group for low self-esteem in a primary care setting

2018 ◽  
Vol 11 ◽  
Author(s):  
Sarah Beattie ◽  
David Beattie
Keyword(s):  
Primary Care ◽  
Cognitive Behavioural Therapy ◽  
Care Setting ◽  
Primary Care Setting ◽  
Therapy Group ◽  
Self Esteem ◽  
Behavioural Therapy ◽  
Cognitive Behavioural ◽  
Mood Group ◽  
Group Programme

AbstractSelf-esteem refers to how an individual appraises themselves and is associated with good mental health. A number of studies have identified the efficacy of cognitive behavioural therapy (CBT) in the treatment of low self-esteem based on the formulation and treatment trajectory developed by Fennell (1999). However, there has been little empirical enquiry into the efficacy of the programme delivered in primary care. The current study investigated the effectiveness of a CBT programme for low self-esteem delivered within primary care. Fifty-four participants attended a 9-week ‘Boost Your Mood’ group programme. Paired sample t-tests were conducted on pre- and post-group scores on measures of depression, anxiety and self-esteem. Results indicated that there were statistically significant improvements in levels of depression, anxiety and self-esteem post-treatment. Findings are consistent with the suggestion that group CBT may be effective at increasing levels of self-esteem and reducing levels of depression and anxiety when delivered in a primary care setting.

scholarly journals Digital cognitive behavioural therapy for insomnia and primary care costs in England: an interrupted time series analysis

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0146
Author(s):  
Chris Sampson ◽  
Eleanor Bell ◽  
Amanda Cole ◽  
Christopher B Miller ◽  
Tracey Marriott ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Cognitive Behavioural Therapy ◽  
Interrupted Time Series ◽  
Behavioural Therapy ◽  
Interrupted Time Series Analysis ◽  
Cognitive Behavioural ◽  
Before And After ◽  
Quasi Experimental ◽  
Care Costs

BackgroundSleepio is an automated digital programme that delivers cognitive behavioural therapy for insomnia (dCBT-I). Sleepio has been proven effective in improving sleep difficulties. However, evidence for the possible impact of Sleepio use on health care costs in the United Kingdom has not previously been developed.AimWe sought to identify the effect of a population-wide rollout of Sleepio in terms of primary care costs in the National Health Service (NHS) in England.Design & settingThe study was conducted in the Thames Valley region of England, where access to Sleepio was made freely available to all residents between October 2018 and January 2020. The study relies on a quasi-experimental design, using an interrupted time series to compare the trend in primary care costs before and after the rollout of Sleepio.MethodWe use primary care data for people with relevant characteristics from nine general practices in Buckinghamshire. Primary care costs include general practice contacts and prescriptions. Segmented regression analysis was used to estimate primary and secondary outcomes.ResultsFor the 10,704 patients included in our sample, the total saving over the 65-week follow-up period was £71,027. This corresponds to £6.64 per person in our sample or around £70.44 per Sleepio user. Secondary analyses suggest that savings may be driven primarily by reductions in prescribing.ConclusionSleepio rollout reduced primary care costs. National adoption of Sleepio may reduce primary care costs by £20 million in the first year. The expected impact on primary care costs in any particular setting will depend on the uptake of Sleepio.

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