Efficacy of therapist-delivered transdiagnostic CBT for patients with persistent physical symptoms in secondary care: a randomised controlled trial

Trudie Chalder*, Meenal Patel, Matthew Hotopf, Rona Moss-Morris, Mark Ashworth, Katie Watts, Anthony S. David, Paul Mccrone, Mujtaba Husain, Toby Garrood, Kirsty James, Sabine Landau, Study team, Alisia Carnemolla, Sorina Armeanca, Elyse Couch, Meenal Patel, Katie Watts, Nicola Ferreira, Jennifer RobertsonShinal Patel, Paige Fisher-Smith, Abigale Childs, Richard Turner, David Mccormack, Claire Willis, Fabio Simiao, Tom Britton, Biba Stanton, Nora Ng, Toby Garrood, Andy Cope, Sujith Subesinghe, Sardar Bahadur, Ingvar Bjarnason, Guy Chung-Faye, Sukh Chatu, Kumar Pathmanathan, Bruce Kirkham, Alexandra Kent, Surrinder Birring, Geoffrey Warwick, Giovanni Sanna, Luay Zebouni, Dobrina Hull, Catherine Hughes, Patrick Dubois, Bu Hayee, Iona Coltart, Richard Turner, Andrea Bardsley-Ball

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)

Abstract

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.

Original languageEnglish
JournalPsychological Medicine
DOIs
Publication statusAccepted/In press - 2021

Keywords

  • Cognitive behavioural therapy (CBT)
  • medically unexplained symptoms
  • persistent physical symptoms
  • randomised controlled trial (RCT)
  • secondary medical care
  • transdiagnostic

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