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J. Clin. Med. 2017, 6(12), 109; doi:10.3390/jcm6120109

Implementing a Psychotherapy Service for Medically Unexplained Symptoms in a Primary Care Setting

1
Centre for Emotions & Health, Departments of Psychiatry & Family Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
2
Centre for Emotions & Health, Department of Psychiatry, Dalhousie University, Halifax, NS B3H 2E2, Canada
*
Author to whom correspondence should be addressed.
Received: 10 October 2017 / Revised: 13 November 2017 / Accepted: 16 November 2017 / Published: 29 November 2017
(This article belongs to the Special Issue Psychosocial Interaction between Physicians and Patients)
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Abstract

Medically unexplained symptoms (MUS) are known to be costly, complex to manage and inadequately addressed in primary care settings. In many cases, there are unresolved psychological and emotional processes underlying these symptoms, leaving traditional medical approaches insufficient. This paper details the implementation of an evidence-based, emotion-focused psychotherapy service for MUS across two family medicine clinics. The theory and evidence-base for using Intensive Short-Term Dynamic Psychotherapy (ISTDP) with MUS is presented along with the key service components of assessment, treatment, education and research. Preliminary outcome indicators showed diverse benefits. Patients reported significantly decreased somatic symptoms in the Patient Health Questionnaire-15 (d = 0.4). A statistically significant (23%) decrease in family physicians’ visits was found in the 6 months after attending the MUS service compared to the 6 months prior. Both patients and primary care clinicians reported a high degree of satisfaction with the service. Whilst further research is needed, these findings suggest that a direct psychology service maintained within the family practice clinic may assist patient and clinician function while reducing healthcare utilization. Challenges and further service developments are discussed, including the potential benefits of re-branding the service to become a ‘Primary Care Psychological Consultation and Treatment Service’. View Full-Text
Keywords: medically unexplained symptoms; short-term dynamic psychotherapy; family medicine; primary care; emotions; unconscious; somatization; psychotherapy; persistent physical symptoms; ISTDP medically unexplained symptoms; short-term dynamic psychotherapy; family medicine; primary care; emotions; unconscious; somatization; psychotherapy; persistent physical symptoms; ISTDP
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Cooper, A.; Abbass, A.; Town, J. Implementing a Psychotherapy Service for Medically Unexplained Symptoms in a Primary Care Setting. J. Clin. Med. 2017, 6, 109.

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