Cognitive-behavior therapy for medically unexplained symptoms: A critical review of the treatment literature

Research has indicated that substantial numbers of physical or medical symptoms presented by patients remain unexplained medically. For example, studies have indicated that less than 25% of physical complaints presented to physicians have known or demonstrable organic or biological causes. Cognitive-bebavior therapy (CBT) provides for a potentially effective means of impacting on this significant public health problem, both medically and psychologically. This paper reviews the extant literature regarding CBT for medically unexplained symptoms, as well as three related disorders-chronic fatigue syndrome, fibromyalgia, and noncardiac chest pain. Whereas this review provides support for the efficacy of CBT for such problems (e.g., effect sizes for CBT compared to control conditions centered around .40), it also identified a variety of methodological limitations regarding the studies themselves. Based on this analysis, recommendations for future research endeavors are provided and the implications of this area for prevention and treatment are offered.