Tailoring a cognitive behavioural model for unexplained physical symptoms to patient's perspective: a bottom-up approach
✍ Scribed by Lyonne N. L. Zonneveld; Hugo J. Duivenvoorden; Jan Passchier; Adriaan van 't Spijker
- Publisher
- John Wiley and Sons
- Year
- 2010
- Tongue
- English
- Weight
- 143 KB
- Volume
- 17
- Category
- Article
- ISSN
- 1063-3995
- DOI
- 10.1002/cpp.685
No coin nor oath required. For personal study only.
✦ Synopsis
Abstract
The prevalence of unexplained physical symptoms (UPS) in primary care is at least 33%. Cognitive behavioural therapy has shown to be effective. Within cognitive behavioural therapy, three models can be distinguished: reattribution model, coping model and consequences model. The consequences model, labelling psychosocial stress in terms of consequences rather than as causes of UPS, has high acceptance among patients and is effective in academic medical care. This acceptance is lost when applied in primary care. To increase acceptance of the consequences model among patients in primary care, we tailor this model to patient's perspective by approaching the model from bottom‐up instead of top‐down. Subsequently, we use this tailored model in an easily accessible group training. We illustrate our approach using two illustrative cases. Copyright © 2010 John Wiley & Sons, Ltd.
Key Practitioner Message:
• The prevalence of unexplained physical symptoms (UPS) in primary care is at least 33%.
• Cognitive behavioural therapy has shown to be most effective for UPS. The most interesting cognitive behavioural model is the consequences model because 81% of the patients with UPS in secondary care accepts a therapy based on this model.
• The consequences model labels psychosocial stress as consequences rather than as causes of UPS and aims to change the consequences in that UPS reduces.
• The acceptance of the consequences model drops in primary care, making a therapy based on this model not feasible for primary care.
• If the acceptance of the consequences model in primary care could be raised by tailoring this model more closely to patients' perspective of their symptoms approaching the model innovatively from bottom‐up, then the opportunity of a positive outcome for patients in primary care could be improved.
Trial registration:
Nederlands Trial Register, NTR1609
http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1609