Transdiagnostic cognitive behavioural treatment for persistent physical symptoms that cause functional impairment and psychological distress : pilot randomised controlled trial

Abstract

Persistent physical symptoms (PPS) are somatic symptoms without biological cause. They are common and associated with functional impairment and psychological distress. Despite frequent use of healthcare services, PPS patients report unmet healthcare needs and untimely symptom resolution. Cognitive behavioural treatment (CBT) is an effective intervention for specific PPS types and transdiagnostic interventions demonstrate promising results. This pilot trial aimed to evaluate the feasibility of conducting an efficacy trial of transdiagnostic group CBT for primary care patients with PPS (T-CBT). A two-arm pilot randomised controlled trial with measurements taken pretreatment, mid-treatment and post-treatment was conducted. Primary outcome was functional impairment and secondary outcomes were number of PPS, symptoms of depression, general anxiety, and health anxiety. After intake interviews, 29 participants were randomised into treatment group (n = 8) and waitlist control group (n = 11), with dropout rate of 27.5%. Treatment participation rates were high at 65–100%. The difference between groups was not statistically significant for the primary outcome of functional impairment, p = .053, d = 0.95. However, results indicated a treatment effect in favour of T-CBT regarding number of PPS (p = 0.042, d = 1.05) and health anxiety (p = 0.042, d = 0.95). T-CBT treatment was feasible intervention in this small sample of primary care patients with PPS as demonstrated by high pretreatment functional impairment, high participation, typical dropout and promising treatment effects on functioning and PPS. There is need for effective PPS treatment in routine clinical practice and future studies should evaluate further this formulation-based transdiagnostic CBT for PPS.