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

• Published in: Journal of psychosomatic research 2020-04, Vol.131, p.109937-109937, Article 109937
• Main Authors: Jones, Brittni, Williams, Amanda C de C
• Format: Article
• Language: English
• Subjects: Bias; Chronic illnesses; Clinical decision making; Cognitive behavioral therapy; Comorbidity; Decision making; Ethnicity; Exaggeration; Health problems; Health status; Idiopathic; Mental health; Minority & ethnic groups; Pain; Patients; Primary care; Psychological intervention; Symptoms; Therapists; Unexplained
• ISSN: 0022-3999; 1879-1360
• DOI: 10.1016/j.jpsychores.2020.109937

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. 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. 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. 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. •Chronic pain and medically unexplained symptoms are increasingly treated with cognitive behavioural therapy (CBT).•This research investigates CBT therapists' judgments of pain and treatment decisions for these patients.•Previous studies show bias in professional judgments of chronic pain that can negatively impact on treatment decisions.