Cognitive behavioural therapy for medically unexplained physical symptoms: a randomised controlled trial

BMJ 1995; 311 doi: (Published 18 November 1995) Cite this as: BMJ 1995;311:1328
  1. Anne E M Speckens, psychiatrist in traininga,
  2. Albert M van Hemert, epidemiologista,
  3. Philip Spinhoven, clinical psychologista,
  4. Keith E Hawton, consultant psychiatristb,
  5. Jan H Bolk, consultant physicianc,
  6. Harry G M Rooijmans, professor of general psychiatrya
  1. a Department of Psychiatry, B1-P, University Hospital Leiden, Postbox 9600 2300 RC Leiden, Netherlands
  2. b University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX
  3. c Department of General Internal Medicine, University Hospital Leisen, Netherlands
  1. aCorrespondence to: Dr Speckens
  • Accepted 20 August 1995


Objective: To examine the additional effect of cognitive behavioural therapy for patients with medically unexplained physical symptoms in comparison with optimised medical care.

Design: Randomised controlled trial with follow up assessments six and 12 months after the baseline evaluation.

Setting: General medical outpatient clinic in a university hospital.

Subjects: An intervention group of 39 patients and a control group of 40 patients.

Interventions: The intervention group received between six and 16 sessions of cognitive behavioural therapy. Therapeutic techniques used included identification and modification of dysfunctional automatic thoughts and behavioural experiments aimed at breaking the vicious cycles of the symptoms and their consequences. The control group received optimised medical care.

Main outcome measures: The degree of change, frequency and intensity of the presenting symptoms, psychological distress, functional impairment, hypochondriacal beliefs and attitudes, and (at 12 months of follow up) number of visits to the general practitioner.

Results: At six months of follow up the intervention group reported a higher recovery rate (odds ratio 0.40; 95% confidence interval 0.16 to 1.00), a lower mean intensity of the physical symptoms (difference −1.2; −2.0 to −0.3), and less impairment of sleep (odds ratio 0.38; 0.15 to 0.94) than the controls. After adjustment for coincidental baseline differences the intervention and control groups also differed with regard to frequency of the symptoms (0.32; 0.13 to 0.77), limitations in social (0.35; 0.14 to 0.85) and leisure (0.36; 0.14 to 0.93) activities, and illness behaviour (difference −2.5; −4.6 to −0.5). At 12 months of follow up the differences between the groups were largely maintained.

Conclusion: Cognitive behavioural therapy seems to be a feasible and effective treatment in general medical patients with unexplained physical symptoms.


  • Funding The Dutch Ministry of Education and Sciences and the Ministry of Welfare, Public Health, and Culture.

  • Conflict of interest None.

  • Accepted 20 August 1995
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