Open AccessCognitive Behavior Therapy for Medically Unexplained Symptoms: A Systematic Review and Meta-analysis of Published Controlled Trials
Author(s) -
Vikas Me,
Tess Maria Rajan,
Pooja Patnaik Kuppili,
Siddharth Sarkar
Publication year - 2017
Publication title -
indian journal of psychological medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.417
H-Index - 24
eISSN - 0975-1564
pISSN - 0253-7176
DOI - 10.4103/ijpsym.ijpsym_17_17
Subject(s) - meta analysis , publication bias , confidence interval , sample size determination , medicine , random effects model , randomized controlled trial , medline , relative risk , strictly standardized mean difference , clinical trial , cognition , forest plot , critical appraisal , clinical psychology , psychiatry , alternative medicine , statistics , political science , mathematics , pathology , law
Medically unexplained symptoms (MUS) commonly present across the board in medical specialties and are often challenging to treat. Our objective was to assess the efficacy for cognitive-behavior therapy (CBT) in MUS. Electronic search of databases was carried out for published controlled trials in English language peer-reviewed journals from inception till August 2016. Effect sizes for the trials were computed using standardized mean difference, and I 2 test was used to assess sample heterogeneity. Pooled mean effect sizes were derived using a random-effects model. Critical appraisal of studies was done using the Cochrane risk of bias assessment tool. A total of 11 trials involving 1235 subjects were included in the study. Ten trials used standard CBT techniques while one studied the efficacy of mindfulness-based CBT technique. The control arms were treatment as usual in five trials, augmented care in four and waitlisted controls in two trials. The pooled mean effect size for CBT was 0.388 (range 0.055-0.806, 95% confidence intervals 0.316-0.461). The I 2 value was 0 using a random effects model indicating low heterogeneity among studies. Risk of bias was noted in many included studies. Egger plot intercept indicated potential publication bias. CBT was superior to the waiting list, treatment as usual or enhanced usual care with moderate effect sizes in the treatment of MUS. These findings are impacted by the limited number of studies in this area and questionable methodological rigor of included studies.