Cochrane for Clinicians

Putting Evidence into Practice

Psychological Interventions for Medically Unexplained Physical Symptoms


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Am Fam Physician. 2015 Dec 1;92(11):975-976.

Clinical Question

Do psychological therapies reduce the severity of medically unexplained physical symptoms?

Evidence-Based Answer

Psychological therapy, specifically cognitive behavior therapy (CBT), has been shown to reduce the severity of medically unexplained physical symptoms in patients with somatoform disorders. The effect is small to moderate in magnitude, but in these studies CBT was as acceptable as usual care to patients. (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Up to one-third of patients who present to their physician with physical symptoms will receive no medical explanation for those symptoms.1 Persistent medically unexplained physical symptoms are part of the diagnostic criteria for many somatoform disorders. They place a heavy burden on the patient and can strain the patient-physician relationship.2 An earlier systematic review concluded that new generation antidepressants are slightly better than placebo for short-term treatment of these symptoms.3

The authors of this Cochrane review sought to determine whether there were any effective nonpharmacologic treatments for medically unexplained physical symptoms. This meta-analysis included 21 studies with 2,658 participants. All studies were randomized and examined some form of psychological therapy, with most examining CBT. All participants

Author disclosure: No relevant financial affiliations.

The practice recommendations in this activity are available at

The views expressed in this article represent those of the authors and do not represent the views of the U.S. Army, the U.S. Navy, the Department of Defense, or the U.S. government.


van Dessel N, den Boeft M, van der Wouden JC, et al. Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults. Cochrane Database Syst Rev. 2014;(11):CD011142.


1. Kirmayer LJ, Groleau D, Looper KJ, Dao MD. Explaining medically unexplained symptoms. Can J Psychiatry. 2004;49(10):663–672.

2. Jackson JL, George S, Hinchey S. Medically unexplained physical symptoms. J Gen Intern Med. 2009;24(4):540–542.

3. Kleinstäuber M, Witthöft M, Steffanowski A, van Marwijk H, Hiller W, Lambert MJ. Pharmacological interventions for somatoform disorders in adults. Cochrane Database Syst Rev. 2014;(11):CD010628.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at


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