Payne Helen, Brooks Susan
School of Education, University of Hertfordshire, Hatfield, United Kingdom.
Front Psychol. 2018 Nov 13;9:2222. doi: 10.3389/fpsyg.2018.02222. eCollection 2018.
Medically unexplained symptoms (MUS) are common and costly in both primary and secondary health care. It is gradually being acknowledged that there needs to be a variety of interventions for patients with MUS to meet the needs of different groups of patients with such chronic long-term symptoms. The proposed intervention described herewith is called The BodyMind Approach (TBMA) and promotes learning for self-management through establishing a dynamic and continuous process of emotional self-regulation. The problem is the mismatch between the patient's mind-set and profile and current interventions. This theoretical article, based on practice-based evidence, takes forward the idea that different approaches (other than cognitive behavioural therapy) are required for people with MUS. The mind-set and characteristics of patients with MUS are reflected upon to shape the rationale and design of this novel approach. Improving services for this population in primary care is crucial to prevent the iterative spiraling downward of frequent general practitioner (GP) visits, hospital appointments, and accident and emergency attendance (A&E), all of which are common for these patients. The approach derives from embodied psychotherapy (authentic movement in dance movement psychotherapy) and adult models of learning for self-management. It has been developed from research and practice-based evidence. In this article the problem of MUS in primary care is introduced and the importance of the reluctance of patients to accept a psychological/mental health referral in the first instance is drawn out. A description of the theoretical underpinnings and philosophy of the proposed alternative to current interventions is then presented related to the design, delivery, facilitation, and educational content of the program. The unique intervention is also described to give the reader a flavor.
医学上无法解释的症状(MUS)在初级和二级医疗保健中都很常见且成本高昂。人们逐渐认识到,需要针对患有MUS的患者采取多种干预措施,以满足不同群体此类慢性长期症状患者的需求。本文所述的拟议干预措施称为身心疗法(TBMA),通过建立动态且持续的情绪自我调节过程来促进自我管理学习。问题在于患者的思维模式和特征与当前干预措施不匹配。这篇基于实践证据的理论文章提出,患有MUS的人需要不同的方法(认知行为疗法之外的方法)。对患有MUS的患者的思维模式和特征进行了反思,以形成这种新方法的基本原理和设计。改善初级保健中针对这一人群的服务对于防止频繁看全科医生(GP)、预约住院以及急诊就诊(A&E)的恶性循环至关重要,而这些情况在这些患者中都很常见。该方法源自体现性心理治疗(舞蹈动作心理治疗中的本真动作)和成人自我管理学习模式。它是基于研究和实践证据发展而来的。本文介绍了初级保健中MUS的问题,并指出了患者最初不愿接受心理/心理健康转诊的重要性。然后介绍了与该项目的设计、实施、促进和教育内容相关的拟议替代当前干预措施的理论基础和理念。还描述了这种独特的干预措施,让读者有所了解。