Efficacy of Adjunctive Single Session Counseling for Medically Unexplained Symptoms: A Randomized Controlled Trial

Context: Medically unexplained symptoms (MUS) are often poorly responsive to standard treatments.

Aim: The aim of the study is to assess short-term efficacy of adjunctive single session cognitive behavior therapy (CBT)-based counseling for patients with MUS.

Setting and design: Randomized controlled trial at a psychosomatic clinic of a tertiary care hospital.

Materials and methods: Patients with MUS were randomized to receive either the single session counseling (intervention group) (n = 41) or control group which received treatment as usual (n = 35). The counseling intervention focused on three areas - cognitive reattribution, shifting focus, and guided muscular relaxation and lasted around 30 min. The two groups were assessed at baseline and after 1 month for change in outcome measures.

Statistical analysis used: Repeated measures analysis of variance. P value was adjusted for multiple comparisons using Bonferroni correction and set at <0.01 for significance.

Results: Both groups did not differ on change in the primary outcome measure: Patient Health Questionnaire - 15 scores (P = 0.055). However, at follow-up, the intervention group showed statistically greater reduction in the number of workdays lost (P = 0.005). Trend level changes were noted for depressive symptom reduction only in the intervention group (P = 0.022).

Conclusions: One session CBT-based therapy demonstrates potentially important benefits over standard care among Indian patients with MUS. Further testing in larger samples with longer follow-up periods is therefore recommended.