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PLoS By Category | Recent PLoS Articles
Anesthesiology and Pain Management - Mental Health - Neuroscience - Public Health and Epidemiology

Effective Group Training for Patients with Unexplained Physical Symptoms: A Randomized Controlled Trial with a Non-Randomized One-Year Follow-Up
Published: Tuesday, August 07, 2012
Author: Lyonne N. L. Zonneveld et al.

by Lyonne N. L. Zonneveld, Yanda R. van Rood, Reinier Timman, Cornelis G. Kooiman, Adriaan van't Spijker, Jan J. V. Busschbach


Although cognitive-behavioral therapy for Unexplained Physical Symptoms (UPS) is effective in secondary care, studies done in primary care produced implementation problems and conflicting results. We evaluated the effectiveness of a cognitive-behavioral group training tailored to primary care patients and provided by a secondary community mental-health service reaching out into primary care.

Methodology/Principal Findings

The effectiveness of this training was explored in a randomized controlled trial. In this trial, 162 patients with UPS classified as undifferentiated somatoform disorder or as chronic pain disorder were randomized either to the training or a waiting list. Both lasted 13 weeks. The preservation of the training's effect was analyzed in non-randomized follow-ups, for which the waiting group started the training after the waiting period. All patients attended the training were followed-up after three months and again after one year. The primary outcomes were the physical and the mental summary scales of the SF-36. Secondary outcomes were the other SF-36-scales and the SCL-90-R. The courses of the training's effects in the randomized controlled trial and the follow-ups were analyzed with linear mixed modeling. In the randomized controlled trial, the training had a significantly positive effect on the quality of life in the physical domain (Cohen's d?=?0.38;p?=?.002), but this overall effect was not found in the mental domain. Regarding the secondary outcomes, the training resulted in reporting an improved physical (Cohen's d?=?0.43;p?=?0.01), emotional (Cohen's d?=?0.44;p?=?.0.01), and social (Cohen's d?=?0.36;p?=?0.01) functioning, less pain and better functioning despite pain (Cohen's d?=?0.51;p?=?<0.001), less physical symptoms (Cohen's d?=?-.23;p?=?0.05) and less sleep difficulties (Cohen's d?=?-0.25;p?=?0.04) than time in the waiting group. During the non-randomized follow-ups, there were no relapses.


The cognitive-behavioral group training tailored for UPS in primary care and provided by an outreaching secondary mental-health service appears to be effective and to broaden the accessibility of treatment for UPS.

Trial Registration NTR1609