Cognitive behavioural therapy useful for people who frequently go to the doctors, study finds

People with long term health conditions who have a history of going to the GP frequently over two or more years could benefit from cognitive behavioural therapy according to new research at The University of Nottingham.

Primary care experts at Nottingham's Institute of Mental Health and the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands set out to explore whether cognitive behavioural therapy (CBT) is an acceptable and effective method of helping people with long term health conditions who frequently and persistently see their GP because of high levels of anxiety about their health.

The unique investigation, published in the British Journal of General Practice, found that a course of CBT in a sample cohort of suitable patients more than halved the number of visits they made to the GP or practice nurse over six months and reduced it further in the next six months.

Professor of Psychiatry and Community Mental Health, Richard Morriss, said: "Demand for primary care and GP consultation rates has increased by more than 20 per cent in the past 20 years so we believe action is needed to offer appropriate care to try to slow or reverse this unsustainable pressure on services. A minority of patients are consistently in the top 10 per cent of frequent GP consulters and often visit their doctor seeking reassurance about their long term health conditions.

"CBT has already been proven to work in people who frequently attend medical out-patient consultations so we wanted to test the feasibility and acceptability of cognitive behaviour therapy to help some primary care patients and look at the evidence for its clinical and cost effectiveness."

Out of a target sample of 462 frequent attenders from five GP practice in the East Midlands, 87 agreed to be assessed for suitability to take part in the study. 32 patients undertook CBT over a three month period with most attending at least six sessions. 86 per cent of them were happy with the treatment and valued sharing their physical and mental health concerns with a CBT practitioner and developing coping strategies. Just over half of the participants achieved clinically significant improvements in their mental health, using the Short Form 36 Mental Health Scale questionnaire, and their visits to the GP or practice nurse reduced from an average of eight in three months, to three visits in three months at one year after the CBT intervention.

One patient taking part in the study discovered that the nausea and occasional vomiting she experienced was made worse by anxiety. A course of CBT highlighted the way that her desperate attempts to prevent feelings of nausea actually increased her anxiety and made the symptoms worse. This had frequently led to the patient seeking anti-sickness medication from her GP. With CBT, the anti-emetic prescriptions were gradually reduced along with the frequency of GP visits.

A 39 year old female participant said: "I am in no way cured but what I am able to do is deal with my mental health issues in a very positive way. I feel very confident in seeing and acknowledging the issue, breaking it down into very small pieces and deal with it accordingly… I don't beat myself up any more about the past… I can honestly say that my mental state of mind is a million miles away from the wreck I was before I started my therapy."

The report concludes that CBT seems to be feasible and acceptable to this subset of long-term frequent attenders in primary care. With improved patient recruitment strategies, the research team says this approach could contribute to decreasing GP workload and is worth investigating and evaluating on a larger scale.

The study was funded by NIHR CLAHRC East Midlands, a partnership of regional health services, universities and industry which turns research into cost-saving and high-quality care through cutting-edge innovation.