Specific psychotherapeutic treatment methods Reattribution model

The reattribution model is a simple model of consultation that improves the general practitioner's detection and management of patients presenting with medically unexplained symptoms. The method can effectively be taught to general practitioners and will improve the outcome of their patients. (4142»

The first stage of the three-stage model (T.ib.!§ 4) is called 'feeling understood', as the important point is that the patient feels that the doctor understands the problem and is taking him or her seriously. The second stage is called 'broadening the agenda', here the basic aim is to involve discussion of both physical and emotional topics during the consultation. The final stage is called 'making the link', with the aim of providing the patients with an explanation that is understandable to them of how stress, life events, and conflicts may produce physical symptoms.

Table 4 The reattribution model

Cognitive-behavioural therapy

Cognitive-behavioural therapy appears to be a feasible and quite effective treatment for patients with medically unexplained physical symptoms. (3 d3) Patients with somatoform disorders tend to attribute bodily sensations to physical diseases, rather than to emotions or trivial causes. (32) In cognitive-behavioural therapy such dysfunctional automatic thoughts are identified and modified. Through behavioural therapy, attempts are made to change the illness behaviour that arises from an inaccurate belief in physical disease—thus breaking the vicious circles of the symptoms and their consequences.

Brief psychotherapy

In a controlled randomized clinical trial, a modified version of interpersonal psychotherapy was found to have been effective in treating a group of patients complaining of medically unexplained gastrointestinal symptoms.(±!> The main aim of the therapist in interpersonal psychotherapy is to develop a meaningful and emotionally significant alliance with the patients, from which explorations of psychological issues and change might follow. The model emphasizes the importance of developing a true 'feeling language', in which innermost fears and emotions can be shared. The therapy focuses on the patients' suffering and their physical symptoms more than on interpretation.

Group therapy

A time-limited directed group therapy of somatization disorder has been shown to be effective in several uncontrolled studies. (36,) The main aim of the therapy is to help the patients improve their social and coping skills through group discussions of different topics and through exercises. A randomized, controlled clinical trial showed that a short-term group intervention, in conjunction with state-of-the-art care, improves health status and reduces overall costs for the medical care of patients with somatization disorder. (36>

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