Medically Unexplained Physical Symptoms: Why Counseling Psychologists Should Care About Them, 2020, McAndrew et al

Andy · Feb 6, 2020

Medically unexplained symptoms and/or syndromes (MUS) affect the health of 20% to 30% of patients seen in primary care. Optimally, treatment for these patients requires an interdisciplinary team consisting of both primary care and mental health providers. We propose that counseling psychologists may develop expertise to improve the care of patients with MUS who are already in their practice, expand the number of patients they help, and enhance the integration of counseling psychology into the broader medical community. Additionally, counseling psychologists’ expertise in culture, attunement to therapeutic processes, and focus on prioritizing patients’ perspectives and quality of life can fill the gap in research on MUS. By focusing on MUS, counseling psychologists can provide unique contributions to health service delivery.
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Paywall, https://journals.sagepub.com/doi/10.1177/0011000019888874
Sci hub, https://sci-hub.se/10.1177/0011000019888874

Trish · Feb 6, 2020

At a quick glance through it looked pretty bad, quoting the likes of Deary, Chalder, Sharpe...

Then I was surprised to see this part:

Effective change mechanisms in CBT treatments for MUS are unknown. One particularly controversial aspect of CBT treatment is the type of activity required of patients. CBT manuals generally recommend a gradual increase in behavior under the assumption that slowly increasing activity will improve a patient’s energy level (Allen, Escobar, Lehrer, Gara, & Woolfolk, 2002).

Evidence for this recommendation, however, is not well-established. For example, in a recent clinical trial for patients with one MUS condition, chronic fatigue syndrome, researchers compared a treatment with gradual increases in activity to a treatment with activity pacing (White et al., 2011). Activity pacing is based on the understanding that patients with MUS have a limited amount of daily energy; therefore, increasing activity will sap this energy (commonly referred to as an envelope or spoon theory).

The investigators found that gradual increases in activity were significantly more efficacious than activity pacing (White et al., 2011). However, patient advocate groups (as well as other researchers (Wilshire, 2017; Wilshire et al., 2018), raised concerns about the analyses, given that the investigators changed the definition of the investigated outcome.

Due to this challenge, the database was made public for reanalysis by other investigators and patients (Wilshire, 2017; Wilshire et al., 2018). The reanalysis questioned the strength of the efficacy of gradually increasing activity for these patients.
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Note: I have only skimmed the paper, so the following may be wrong:

The general tenor of the paper seems to be a career opportunity by US counsellors to move more into the field of Health Psychology, and get themselves integrated into medical teams to treat MUS with CBT. There seems to be some acknowledgement that using CBT to persuade patients that their 'MUS' symptoms have no physical basis is not a good idea, but they still go on about catastrophising and the biopsychosocial model and getting patients with MUS to gradually increase activity, so it seems to be a mix of directive and supportive CBT with some GET they are suggesting.

I conclude the article is less about good evidence and more about expanding career opportunities.

ScottTriGuy · Feb 6, 2020

Trish said: ↑

The general tenor of the paper seems to be a career opportunity by US counsellors to move more into the field of Health Psychology, and get themselves integrated into medical teams to treat MUS with CBT. There seems to be some acknowledgement that using CBT to persuade patients that their 'MUS' symptoms have no physical basis is not a good idea, but they still go on about catastrophising and the biopsychosocial model and getting patients with MUS to gradually increase activity, so it seems to be a mix of directive and supportive CBT with some GET they are suggesting.

I conclude the article is less about good evidence and more about expanding career opportunities.
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Ditto.

And they'll be oblivious to the patient's trauma caused by being repeatedly gaslighted. That's where they'd may actually be helpful instead of further embedding harm.

rvallee · Feb 6, 2020

Alternative idea: take all the money that could be wasted on this and spend it on competent research focused on solving those symptoms, with people who actually want to solve them, and how they fit in a coherent clinical framework that can actually produce meaningful treatments and impact on quality of life.

At the very most generous best, even if such counseling actually were maximally efficacious (which it isn't), it would only have a tiny impact on patients, no more than 5% and that's extremely generous. This is working at the margins, the equivalent of doing feng-shui on the cells we have been wrongfully imprisoned in. Get us out, instead. Literally nothing else matters.

Andy · Jan 3, 2024

Now open access, https://journals.sagepub.com/doi/10.1177/0011000019888874

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Medically Unexplained Physical Symptoms: Why Counseling Psychologists Should Care About Them, 2020, McAndrew et al

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