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Medically Unexplained Physical Symptoms in Primary Care: A Controlled Study on the Effectiveness of Cognitive-Behavioral Treatment by the Family Physician

Received April 23, 2007; revised July 16, 2007; accepted July 25, 2007. From the Dept. of Public Health and Primary Care and the Dept. of Psychiatry, Leiden University Medical Center, The Netherlands, the University of Leiden, Section of Clinical, and Health and Neuropsychology, The Netherlands; and The Parnassia Bavo Psychiatric Institute Psychomedical Centre, The Hague, The Netherlands. Send correspondence and reprint requests to Ingrid A. Arnold, M.D., Ph.D., Dept. of Public Health and Primary Care, Leiden University Medical Centre, V-O-P; P.O. Box 9600, 2300 RC Leiden, The Netherlands. e-mail: ingridarnold7{at}gmail.com
© 2009 The Academy of Psychosomatic Medicine

BACKGROUND: Disabling medically unexplained physical symptoms occur in 16% of all patients in primary care. OBJECTIVE: The aim of this study was to assess the effectiveness of a cognitive-behavioral intervention by the family physician. METHOD: In a controlled design with detailed information on patient selection, 6,409 patients were screened on somatoform disorder, and 65 participants were allocated to care-as-usual or the experimental condition. RESULTS: After 6 and 12 months, the cognitive-behavioral intervention by trained family physicians was not more effective than care-as-usual. CONCLUSION: Possibly, the intensity of treatment was insufficient for the severe and persistent symptoms that were encountered in primary care.

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