TY - JOUR
T1 - Efficacy of therapist-delivered transdiagnostic CBT for patients with persistent physical symptoms in secondary care
T2 - a randomised controlled trial
AU - Chalder, Trudie
AU - Patel, Meenal
AU - Hotopf, Matthew
AU - Moss-Morris, Rona
AU - Ashworth, Mark
AU - Watts, Katie
AU - David, Anthony S.
AU - Mccrone, Paul
AU - Husain, Mujtaba
AU - Garrood, Toby
AU - James, Kirsty
AU - Landau, Sabine
AU - Study team
AU - Carnemolla, Alisia
AU - Armeanca, Sorina
AU - Couch, Elyse
AU - Patel, Meenal
AU - Watts, Katie
AU - Ferreira, Nicola
AU - Robertson, Jennifer
AU - Patel, Shinal
AU - Fisher-Smith, Paige
AU - Childs, Abigale
AU - Turner, Richard
AU - Mccormack, David
AU - Willis, Claire
AU - Simiao, Fabio
AU - Britton, Tom
AU - Stanton, Biba
AU - Ng, Nora
AU - Garrood, Toby
AU - Cope, Andy
AU - Subesinghe, Sujith
AU - Bahadur, Sardar
AU - Bjarnason, Ingvar
AU - Chung-Faye, Guy
AU - Chatu, Sukh
AU - Pathmanathan, Kumar
AU - Kirkham, Bruce
AU - Kent, Alexandra
AU - Birring, Surrinder
AU - Warwick, Geoffrey
AU - Sanna, Giovanni
AU - Zebouni, Luay
AU - Hull, Dobrina
AU - Hughes, Catherine
AU - Dubois, Patrick
AU - Hayee, Bu
AU - Coltart, Iona
AU - Turner, Richard
AU - Bardsley-Ball, Andrea
N1 - Publisher Copyright:
© 2021 The Author(s),. Published by Cambridge University Press.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021
Y1 - 2021
N2 - Background Medically unexplained symptoms otherwise referred to as persistent physical symptoms (PPS) are debilitating to patients. As many specific PPS syndromes share common behavioural, cognitive, and affective influences, transdiagnostic treatments might be effective for this patient group. We evaluated the clinical efficacy and cost-effectiveness of a therapist-delivered, transdiagnostic cognitive behavioural intervention (TDT-CBT) plus (+) standard medical care (SMC) v. SMC alone for the treatment of patients with PPS in secondary medical care. Methods A two-arm randomised controlled trial, with measurements taken at baseline and at 9, 20, 40- and 52-weeks post randomisation. The primary outcome measure was the Work and Social Adjustment Scale (WSAS) at 52 weeks. Secondary outcomes included mood (PHQ-9 and GAD-7), symptom severity (PHQ-15), global measure of change (CGI), and the Persistent Physical Symptoms Questionnaire (PPSQ). Results We randomised 324 patients and 74% were followed up at 52 weeks. The difference between groups was not statistically significant for the primary outcome (WSAS at 52 weeks: estimated difference -1.48 points, 95% confidence interval from -3.44 to 0.48, p = 0.139). However, the results indicated that some secondary outcomes had a treatment effect in favour of TDT-CBT + SMC with three outcomes showing a statistically significant difference between groups. These were WSAS at 20 weeks (p = 0.016) at the end of treatment and the PHQ-15 (p = 0.013) and CGI at 52 weeks (p = 0.011). Conclusion We have preliminary evidence that TDT-CBT + SMC may be helpful for people with a range of PPS. However, further study is required to maximise or maintain effects seen at end of treatment.
AB - Background Medically unexplained symptoms otherwise referred to as persistent physical symptoms (PPS) are debilitating to patients. As many specific PPS syndromes share common behavioural, cognitive, and affective influences, transdiagnostic treatments might be effective for this patient group. We evaluated the clinical efficacy and cost-effectiveness of a therapist-delivered, transdiagnostic cognitive behavioural intervention (TDT-CBT) plus (+) standard medical care (SMC) v. SMC alone for the treatment of patients with PPS in secondary medical care. Methods A two-arm randomised controlled trial, with measurements taken at baseline and at 9, 20, 40- and 52-weeks post randomisation. The primary outcome measure was the Work and Social Adjustment Scale (WSAS) at 52 weeks. Secondary outcomes included mood (PHQ-9 and GAD-7), symptom severity (PHQ-15), global measure of change (CGI), and the Persistent Physical Symptoms Questionnaire (PPSQ). Results We randomised 324 patients and 74% were followed up at 52 weeks. The difference between groups was not statistically significant for the primary outcome (WSAS at 52 weeks: estimated difference -1.48 points, 95% confidence interval from -3.44 to 0.48, p = 0.139). However, the results indicated that some secondary outcomes had a treatment effect in favour of TDT-CBT + SMC with three outcomes showing a statistically significant difference between groups. These were WSAS at 20 weeks (p = 0.016) at the end of treatment and the PHQ-15 (p = 0.013) and CGI at 52 weeks (p = 0.011). Conclusion We have preliminary evidence that TDT-CBT + SMC may be helpful for people with a range of PPS. However, further study is required to maximise or maintain effects seen at end of treatment.
KW - Cognitive behavioural therapy (CBT)
KW - medically unexplained symptoms
KW - persistent physical symptoms
KW - randomised controlled trial (RCT)
KW - secondary medical care
KW - transdiagnostic
UR - http://www.scopus.com/inward/record.url?scp=85107350680&partnerID=8YFLogxK
U2 - 10.1017/S0033291721001793
DO - 10.1017/S0033291721001793
M3 - Article
AN - SCOPUS:85107350680
SN - 0033-2917
JO - Psychological Medicine
JF - Psychological Medicine
ER -