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Psychological therapists' judgments of pain and treatment decisions: The impact of 'medically unexplained symptoms'

Jones, B; Williams, ACDC; (2020) Psychological therapists' judgments of pain and treatment decisions: The impact of 'medically unexplained symptoms'. Journal of Psychosomatic Research , 131 , Article 109937. 10.1016/j.jpsychores.2020.109937. Green open access

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Abstract

BACKGROUND: Clinical judgments of pain are influenced by patient and observer factors, and affect their treatment decisions. This study investigated the factors of a lack of a medical explanation for pain, 'medically unexplained' comorbid conditions, and ethnicity, on CBT therapists' judgments of pain and treatment. METHOD: An online experimental study was conducted in which participants viewed computer-generated faces expressing pain with a brief written patient history, then estimated the severity and likely exaggeration of pain, and likelihood of pain being caused by a mental or physical health problem. Participants ranked a number of treatment options for priority. RESULTS: 107 CBT therapists were recruited as participants. Estimates of pain were lower, and of likely exaggeration higher, for patients with pain presented without a medical explanation or with a comorbid 'medically unexplained' condition. They were also more likely to be recommended CBT for depression over referral to a specialist service or psychological treatment for pain. Contrary to expectations, ethnicity produced no effect on pain judgments, only on treatment decisions. Participants' training also affected their treatment decisions. CONCLUSIONS: Lack of medical explanation for pain and other long-term conditions biases assessment and treatment decisions by CBT therapists. As CBT therapists are increasingly referred people with 'medically unexplained' symptoms in primary care, these biases need to be addressed for better treatment.

Type: Article
Title: Psychological therapists' judgments of pain and treatment decisions: The impact of 'medically unexplained symptoms'
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.jpsychores.2020.109937
Publisher version: https://doi.org/10.1016/j.jpsychores.2020.109937
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences > Clinical, Edu and Hlth Psychology
URI: https://discovery.ucl.ac.uk/id/eprint/10092900
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