July 27, 2011 -- Cognitive behavior therapy (CBT) that incorporates a self-help workbook may help people with pain, weakness, dizziness, and other symptoms -- with no underlying physical disease -- to feel and function better, a study shows.
The study is published in Neurology.
CBT is a time-limited course of talk therapy that aims to improve symptoms by changing the way people think about and cope with their symptoms. It can be helpful on its own. But access to CBT can be an issue in certain communities.
The new method incorporates a self-help workbook to overcome these barriers by giving people the tools to practice on their own. Study participants are taught how to use this workbook during four, 30-minute counseling sessions over a three-month period by a nurse or therapist.
The workbook explains symptoms as changes in the nervous system that are influenced by behavioral and psychological factors. It provides self-management tips on reducing "unhelpful thinking" about coping with symptoms, as well as homework assignments.
After three months, the 62 participants who received the self-help workbook with counseling were about twice as likely to report improvements in their overall health as those who did not. All participants received usual medical care which may include antidepressants and pain drugs.
Thirteen percent more people in the CBT group said their health was "better" or "much better" compared to those who received usual care. These improvements waned after six months, but those receiving the CBT continued to show greater improvement in their symptoms, physical functioning, and were more satisfied with their treatment. Most of the participants in the study also had psychiatric diagnoses such as panic disorder, anxiety disorder, and depression.
"Functional or unexplained symptoms make up approximately a third of patients attending neurology clinics," says study researcher Michael Sharpe, MD, a psychiatrist at the University of Edinburgh, U.K. "These are symptoms which occur either without any disease or which seems markedly disproportionate to any disease that is present."
"We know that in the majority of cases these symptoms do not disappear after an assessment with a neurologist who tells them that they are not due to disease," he says.
"It is important to remember that patients have come to see a physician with concern about a physical symptom [and] they want to know if the symptom is due to a serious disease," Sharpe says. "Many patients interpret being told it is psychological as being dismissive."
Lesley Arnold, MD, a psychiatrist at the University of Cincinnati, says that CBT has a role in many painful diseases and conditions such as the pain disorder fibromyalgia. The "innovative and interesting approach" detailed in the new study new adds some supervision, which is very important, she says.
Engaging nurses in CBT can help maximize already limited resources and allow more people to benefit from this type of therapy, she says. "Nurses help doctors integrate CBT into their practice and provide patients with a great tool."
Paul J. Mattis, PhD, the director of neuropsychology at North Shore University Hospital and an assistant investigator at the Feinstein Institute for Medical Research in Manhasset, N.Y., says that U.S. doctors see people with these unexplained symptoms "all of the time."
Some symptoms have no physical cause, while others have a physical cause but may still be exacerbated by stress. In either case, CBT is useful, he says.
"It would be wonderful if every medical clinic could have a therapist in it, but the new approach can be extremely useful as a first step and could be used within the medical practice for when there is a stress-related symptom," Mattis says.