Psychosocial interventions for somatizing patients by the general practitioner

Larisch, Astrid; Schweickhardt, Axel; Wirsching, Michael; Fritzsche, Kurt

doi:10.1016/j.jpsychores.2004.04.372

Cited by 94 publications

(77 citation statements)

References 36 publications

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“…However, evidence for the applicability and effectiveness of so-called reattribution therapy, which consists in encouraging patients to relate their symptoms to psychosocial problems (Goldberg et al, 1989), has remained equivocal Larisch et al, 2004;Morriss et al, 2007;Rief et al, 2006). In fact, cognitive behavioural interventions (Kroenke & Swindle, 2000;Kroenke, 2007;Martin et al, 2007b;Stone et al, 2005b), psychodynamic interpersonal therapy (Sattel et al, 2012), and more generally, improved communication between doctors and patients (Aiarzaguena et al, 2007, Henningsen et al, 2007Kirmayer et al, 2004;Peters et al, 2009;Rosendal et al, 2005;Salmon et al, 2004) have been shown to be most effective in the management of SFDs.…”

Section: Clinical Implications: Diagnosis and Treatmentmentioning

confidence: 99%

Somatoform disorders and causal attributions in patients with suspected allergies: Do somatic causal attributions matter?

Groben¹,

Hausteiner²

2011

Journal of Psychosomatic Research

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Section: Clinical Implications: Diagnosis and Treatmentmentioning

confidence: 99%

Somatoform disorders and causal attributions in patients with suspected allergies: Do somatic causal attributions matter?

Groben¹,

Hausteiner²

2011

Journal of Psychosomatic Research

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“…It has been widely adopted internationally. [7][8][9][10][11][12][13][14] Features of reattribution are that: psychological context can help explain physical symptoms; attributions for symptoms held by patients are unhelpful; broadening patients' attributions will resolve/improve symptoms or enable GPs to treat any underlying psychological or social problems.…”

Section: Introductionmentioning

confidence: 99%

“…[7][8][9][10][11][12][13][14] A recent UK primary care trial (MUST) demonstrated that GPs can be taught by non-expert trainers to deliver reattribution within routine consultations. 5 GPs' communication changed significantly; trained physicians elicited more patient concerns/beliefs and provided richer symptom explanations that linked physical symptoms to psychosocial issues.…”

Section: Introductionmentioning

confidence: 99%

What Do Patients Choose to Tell Their Doctors? Qualitative Analysis of Potential Barriers to Reattributing Medically Unexplained Symptoms

et al. 2008

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BACKGROUND: Despite both parties often expressing dissatisfaction with consultations, patients with medically unexplained symptoms (MUS) prefer to consult their general practitioners (GPs) rather than any other health professional. Training GPs to explain how symptoms can relate to psychosocial problems (reattribution) improves the quality of doctor-patient communication, though not necessarily patient health. OBJECTIVE:To examine patient experiences of GPs' attempts to reattribute MUS in order to identify potential barriers to primary care management of MUS and improvement in outcome.DESIGN: Qualitative study. PARTICIPANTS:Patients consulting with MUS whose GPs had been trained in reattribution. A secondary sample of patients of control GPs was also interviewed to ascertain if barriers identified were specific to reattribution or common to consultations about MUS in general. APPROACH: Thematic analysis of in-depth interviews.RESULTS: Potential barriers include the complexity of patients' problems and patients' judgements about how to manage their presentation of this complexity. Many did not trust doctors with discussion of emotional aspects of their problems and chose not to present them. The same barriers were seen amongst patients whose GPs were not trained, suggesting the barriers are not particular to reattribution.CONCLUSIONS: Improving GP explanation of unexplained symptoms is insufficient to reduce patients' concerns. GPs need to (1) help patients to make sense of the complex nature of their presenting problems, (2) communicate that attention to psychosocial factors will not preclude vigilance to physical disease and (3) ensure a quality of doctor-patient relationship in which patients can perceive psychosocial enquiry as appropriate.

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“…Only one study showed a positive outcome 184 and four reported no effect of training on patient outcomes. 99,145,162,173 Trials of collaborative care models reported benefits, 150,188 as did trials of different types of psychological therapy [cognitive-behavioural therapy (CBT, reflecting interviews)]. 114,118,129,169 Search for systematic reviews Primary database search…”

Section: Medically Unexplained Symptomsmentioning

confidence: 99%

Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study

Dowrick

Chew‐Graham

Lovell

et al. 2013

Programme Grants for Applied Research

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BackgroundEvidence-based interventions exist for common mental health problems. However, many people are unable to access effective care because it is not available to them or because interactions with caregivers do not address their needs. Current policy initiatives focus on supply-side factors, with less consideration of demand.Aim and objectivesOur aim was to increase equity of access to high-quality primary mental health care for underserved groups. Our objectives were to clarify the mental health needs of people from underserved groups; identify relevant evidence-based services and barriers to, and facilitators of, access to such services; develop and evaluate interventions that are acceptable to underserved groups; establish effective dissemination strategies; and begin to integrate effective and acceptable interventions into primary care.Methods and resultsExamination of evidence from seven sources brought forward a better understanding of dimensions of access, including how people from underserved groups formulate (mental) health problems and the factors limiting access to existing psychosocial interventions. This informed a multifaceted model with three elements to improve access: community engagement, primary care quality and tailored psychosocial interventions. Using a quasi-experimental design with a no-intervention comparator for each element, we tested the model in four disadvantaged localities, focusing on older people and minority ethnic populations. Community engagement involved information gathering, community champions and focus groups, and a community working group. There was strong engagement with third-sector organisations and variable engagement with health practitioners and commissioners. Outputs included innovative ways to improve health literacy. With regard to primary care, we offered an interactive training package to 8 of 16 practices, including knowledge transfer, systems review and active linking, and seven agreed to participate. Ethnographic observation identified complexity in the role of receptionists in negotiating access. Engagement was facilitated by prior knowledge, the presence of a practice champion and a sense of coproduction of the training. We developed a culturally sensitive well-being intervention with individual, group and signposting elements and tested its feasibility and acceptability for ethnic minority and older people in an exploratory randomised trial. We recruited 57 patients (57% of target) with high levels of unmet need, mainly through general practitioners (GPs). Although recruitment was problematic, qualitative data suggested that patients found the content and delivery of the intervention acceptable. Quantitative analysis suggested that patients in groups receiving the well-being intervention improved compared with the group receiving usual care. The combined effects of the model included enhanced awareness of the psychosocial intervention among community organisations and increased referral by GPs. Primary care practitioners valued community information gathering and access to the Improving Access to Mental Health in Primary Care (AMP) psychosocial intervention. We consequently initiated educational, policy and service developments, including a dedicated website.ConclusionsFurther research is needed to test the generalisability of our model. Mental health expertise exists in communities but needs to be nurtured. Primary care is one point of access to high-quality mental health care. Psychosocial interventions can be adapted to meet the needs of underserved groups. A multilevel intervention to increase access to high-quality mental health care in primary care can be greater than the sum of its parts.Study registrationCurrent Controlled Trials ISRCTN68572159.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Psychosocial interventions for somatizing patients by the general practitioner

Cited by 94 publications

References 36 publications

Somatoform disorders and causal attributions in patients with suspected allergies: Do somatic causal attributions matter?

Somatoform disorders and causal attributions in patients with suspected allergies: Do somatic causal attributions matter?

What Do Patients Choose to Tell Their Doctors? Qualitative Analysis of Potential Barriers to Reattributing Medically Unexplained Symptoms

Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study

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