Group training for patients with Unexplained Physical Symptoms.

After medical examination, physicians classify 20 to 74% of patients’ symptoms as Unexplained Physical Symptoms (UPS). When UPS persists, cognitive-behavioural therapy may be considered. The cognitive-behavioural therapy based on the consequences model, in which various forms of psychosocial stress are labelled as consequences rather than causes of UPS, has shown to be more acceptable for patients than a therapy based on a causal model. Eighty percent of the patients with UPS accepted an individual therapy based on this model and effectiveness has been shown when applied in secondary medical care, while only 10% of the mental health referrals leads to treatment. However, when the applicability of this model is examined in primary medical care, the high acceptance showed a drastic drop. We modified the implementation of the consequences model into a standardized training program conducted by Riagg Rijnmond, a mental health institution. In this modified program, we standardised the protocol for the individual therapy suitable for patients’ personal needs into a group training, in which the consequences model is used bottom-up instead of top-down. We assume that this innovative implementation is acceptable to patients, as it legitimates the existence of consequences, in other words, the patients are exonerated. The objective of this randomised controlled study is to assess applicability and (cost-)effectiveness of this particular cognitive behavioural group training. If we show that this group training is applicable and (cost-)effective, more patients with UPS could be served on a (cost-)effective basis.

The cognitive behavioural group training:

1. increases quality of life;

2. decreases direct costs due to health care utilization;

3. decreases indirect costs due to productivity loss;

4. decreases overall psychological distress.

T1: baseline assessment;

(inclusion: up to September 2008);

T2: assessment after training/waiting list;

T3: assessment three month after training;

T4: assessement one year after training.

The experimental condition is a cognitive behavioural group training consisting of thirteen ad verbatim protocollised weekly sessions of two hours each.



The control condition is a waiting list.