title: Effective group training for patients with unexplained physical symptoms: a randomized controlled trial with a non-randomized one-year follow-up.
abstract: BACKGROUND
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  TrialRegister.nl NTR1609 <rctview.asp&quest;TC&hairsp;&equals;&hairsp;1609>
authors.affiliation: Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. L.Zonneveld@amc.uva.nl
authors.forename: Lyonne N L
authors.initials: LN
authors.lastname: Zonneveld
authors.forename: Yanda R
authors.initials: YR
authors.lastname: van Rood
authors.forename: Reinier
authors.initials: R
authors.lastname: Timman
authors.forename: Cornelis G
authors.initials: CG
authors.lastname: Kooiman
authors.forename: Adriaan
authors.initials: A
authors.lastname: Van't Spijker
authors.forename: Jan J V
authors.initials: JJ
authors.lastname: Busschbach
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011615:Psychotherapy, Group; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome