Abstract
AimThe aim of the study is to investigate if cognitive behavioral therapy given in a group setting affects anxiety and depression, stress, pain, coping strategies during daily life, and health‐related quality of life (HRQoL), among frequent attenders (FAs) in primary care.MethodsCognitive behavioral therapy was offered to 331 FAs between 18 and 65 years of age, of whom 89 accepted and 54 completed all steps in the protocol; patients were assigned to 1 of 3 groups: 0, 6, and 12‐month waiting time. The therapy consisted of 12 sessions administered in group format. Outcome measures were Beck's Anxiety Inventory (BAI), Beck's Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS), Everyday Life Stress (ELS), Coping Strategy Questionnaire, Multidimensional Pain Inventory‐Swedish version, and Short Form‐36.ResultsMean age among patients who completed cognitive behavioral therapy was 49.9 years, with a female majority (79.6%). Anxiety and depression scores were reduced after treatment (BAI 16.7 vs 13.6; BDI 16.3 vs 15.7; HADS‐Anxiety 8.41 vs 6.05; HADS‐Depression 7.09 vs 5.69). Because waiting time itself did not affect symptoms, differences reflect treatment effects. Stress ratings were not affected by treatment. Use of nonadaptive coping strategies like praying and hoping and catastrophizing decreased. Frequent attenders experienced a higher sense of life control. Frequent attenders reported significantly lower HRQoL than general Swedish population norms in all 8 Short Form‐36 domains including mental and physical component summary scores (MCS and PCS), and all domains were unaffected by treatment.ConclusionCognitive behavioral therapy exerts some beneficial effects in FAs. Content of treatment addressed musculoskeletal pain, stress, anxiety, and depression. This broad approach resulted in reduced anxiety, depression, and impact of pain because of enhanced life control.
Highlights
The health complaints targeted for cognitive behavioral therapy (CBT) in the present study were musculoskeletal pain and psychosocial distress, which was defined as subjective reports of stress, anxiety, and depression; these were the most common reasons among frequent attenders (FAs) for visits to general practitioners (GPs)
We found no improvement of health‐related quality of life (HRQoL) in the present study, 1 previous multicomponent intervention including assessment, medication, education, monitoring, and evaluation showed HRQoL improvement in FAs suffering from depression.[7]
Cognitive behavioral therapy given in a group setting results in decreased feelings of anxiety and depression in the short term among FAs, and effects remain durable over a time period of 1 year
Summary
Patients in primary care who suffered from physically unexplained symptoms for more than 2 years were characterized by cognitive deficits, including low attention and slow psychomotor speed, poor verbal skills, and diminished executive function, and they used more nonfunctional passive and avoidant coping strategies than healthy controls.[9] Coping strategies for pain, anxiety, and stress have been shown to influence HRQoL, perceived impact of pain, and different kinds of psychosocial distress.[10,11,12,13] Frequent attenders with their various health problems may benefit from CBT using a multimodal approach of applicable methods from relevant areas. All statistical analyses were performed using SPSS version 22 (IBM, Armonk, NY)
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