Background: Alongside experiencing physical symptoms with no identifiable organic cause, patients with MUS commonly experience comorbid anxiety and depression. They also have high health utilisation costs, which has implications for the health service. Interventions which target these symptoms in a cost effective way need to be developed and evaluated. Objective: To develop and evaluate a self-help mindfulness-based stress reduction (MBSR) intervention for patients with medically unexplained symptoms (MUS). Methods: A systematic review of the literature was carried out to evaluate the effectiveness of MBSR for reducing psychological distress in people with MUS. Study 1 developed and evaluated a self-help MBSR intervention in a clinical setting. Fifteen participants were recruited from eight practice, however only five completed post-intervention measures. A combination of t-tests and descriptive statistics were used to compare changes in levels of psychological distress, quality of life, symptoms and mindfulness at post-intervention. Pearson‘s correlations were used to identify relationships between improvements in mindfulness and improvements in outcomes. Study 2, exploring the reasons for the difficulties recruiting participants to Study 1, was then carried out through questionnaires to GPs. Results: Though more evidence is needed, the systematic review found MBSR to have moderate effects on psychological distress, which are largely maintained or improved at follow-up. Study 1 found symptom frequency and levels of acceptance to have improved at post-intervention. Study 2 found that the main reasons for GPs not recruiting participants was that they were busy and found it difficult to prioritise given other demands. Conclusions: Evidence to date suggests that MBSR is an effective intervention for patients with MUS. Future studies may benefit from recruiting participants from relevant organisations or using alternative methods such as database searches. No firm conclusions can be made about the self-help MBSR intervention‘s efficacy due to the study‘s limitations, however changes seen in the completer group suggest that further research would be warranted.

Medically Unexplained Symptoms (MUS) are bodily symptoms for which no organic cause has been identified, and which result in significant levels of psychological distress and functional impairment. MUS are thought to be highly prevalent in primary care settings, and have considerable costs to society. Despite evidence of overlapping psychological and physical presentations, MUS are not well understood or treated in culture that predominantly views the body through the lenses of dualism and mechanistic reductionism. An alternative 'interactive' view of the body as playing a more dynamic role is elaborated through George Kelly's (1955) Personal Construct Psychology. The author draws upon Lin & Payne's (2014) 'frozen construing' theory, and empirical literature on relationships between identity and MUS, to suggest that for people with MUS, the symptomatic body is distressing because the person is struggling to integrate its meaning with their identity. It is hypothesized that embodied processes, that may actually protect the self (and others who share a construct system with that person) from events which threaten to dramatically alter how the self is construed, are difficult to understand because of their preverbal nature. Hence symptoms, and the body itself, are dissociated from the person's more elaborated verbal self-constructions. Several hypotheses relating to this suggestion were tested using a modified form of the repertory grid technique that was designed to explore construct systems of both mind and body, for self and others. Twenty participants with MUS, recruited from the community, completed the repertory grid interviews and measures of depression, anxiety and symptom severity, which were correlated with relevant repertory grid indices to test hypotheses. Findings indicated that symptom constructs, contrary to expectations, were well integrated into participants' construct systems. The alleviation of psychological distress was significantly associated with increased perceived distance between the self in general and the self when symptoms are worst (a relationship which appeared to be independent of severity of symptoms), providing evidence of a process of dissociation that protected the current self from assimilating the undesirable characteristics that were associated with the symptom. The way in which the self when symptoms are worst is construed appeared to influence levels of distress, with more predictive power than several other indices. The study also found evidence for some participants of hypothesized relationships between desired aspects of the current self and symptoms, that would imply that symptom disappearance would actually threaten a desirable aspect of how the self is construed. Content analysis of these constructs revealed (as predicted) that such desirable aspects of self tended to relate to being responsible and sensitive to the needs of others, and were elaborated through bodily constructs in a way that suggested that they were not well integrated with the primary ways that these participants made sense of their identity. For these particular participants, discrepancies between the ideals that they had for themselves, and how they would like to be seen by others, were associated with increased depression. Several participants were identified whose constructions of self and others were dominated by constructs relating to both mental and physical strength and weakness. These participants appeared to be struggling to find coherent meaning for themselves as the result of symptoms, which were regarded as invalidating a pre-symptom construal of themselves as being 'strong'. There seemed to be a continuum of being a 'body for others' on the one hand, a previously 'strong person' on the other, and a person who is 'strong for others' in the middle. Implications for clinical practice are discussed. Although the findings of the current study are limited by a small sample size, it appears that exploring the meaning of the body in the construction of self helps to elaborate the meaning of the body and symptoms in a verbal, expressible form. This process is likely to be helpful to those who struggle to find meanings for their symptoms both in their own construct systems and in a society that objectifies the body.

Bakgrund En stor del av de patienter som frekvent söker vård lider av psykosomatiska sjukdomar (MUPS) och somatiseringssyndrom (MUS). Båda dessa tillstånd grundar sig i psykiska påfrestningar men yttrar sig i form av fysiska symptom. Stress är en psykisk påfrestning som är mycket utbredd i vårt samhälle idag. När människan utsätts för stress startar en rad olika fysiska processer i kroppen, som en del av vår överlevnadsinstinkt. Trots det är det många som stressar sig sjuka. Då kroppen inte får chans till återhämtning ökar risken för ohälsa med risk för psykosomatiska sjukdomar och somatiseringssyndrom som följd. Syfte Studiens syfte var att belysa upplevelser hos patienter med psykosomatiska sjukdomar och somatiseringssyndrom i den somatiska vården. Metod En litteraturöversikt valdes som metod, där 16 artiklar inkluderades. Artiklarna var av kvantitativ eller kvalitativ metod och analyserades enligt metoden integrerad analys. Resultat Patienter med MUPS/MUS lider av ohälsa och remitteras runt till olika vårdenheter utan att få den hjälp de behöver. Detta innebär ytterligare påfrestning på hälsan hos dessa patienter. Starka känslor såsom utanförskap, oro, skam och rädsla för sin egna ohälsan genomsyrar dessa patienters upplevelser. Kunskapen för dessa sjukdomstillstånd är bristfällig och det saknas tydliga riktlinjer och behandlingsmetoder inom vården. Slutsats Stigmatisering kring psykisk ohälsa skapar skam och utanförskap, vilket patienter med MUPS/MUS i stor utsträckning upplever. Bristande kunskap har visat på ineffektiv behandling vilket dessutom medför enorma kostnad för samhället. Sambandet mellan kropp och själ får inte förbises. Sjukvårdspersonal bör därför utbildas i att se den psykologiska faktorn bakom de fysiologiska symptomen. / Background A large proportion of patients who frequently seek health care suffer from psychophysiologic disorders (MUPS) and somatoform disorders (MUS). Both of these conditions derive from mental illness yet they manifest as physical symptoms. Stress is a psychological phenomenon which is widely spread in our society today. When a person is exposed to stress, a variety of physical reactions commence within our body, due to our survival instinct. In spite of this, a lot of people become physically and mentally ill from stress. When our body is deprived of recovery, there is a higher probability for lack of health and therefore the risk of developing psychophysiologic disorder and somatoform syndromes increases. Aim The purpose of the study was to illuminate patients with psychophysiologic disorders and somatoform disorders and their experiences within the somatic healthcare. Method A literature review has been conducted with an including total of 16 articles. The chosen articles consisted of quantitative or qualitative methods, analyzed according to the integrated analysis method. Results Patients with MUPS/MUS suffer from lack of health and are often referred to various care units without getting the help they need. This leads to further distress with a decreased health experience. Strong emotions such as exclusion, anxiety, shame and fear of lacking health permeate these patients' experiences. The knowledge regarding these conditions are insufficient and no distinct guidelines nor clear treatments exist within the healthcare system. Conclusions The stigmatization regarding mental illness leads to feelings of shame and exclusion for these patients. The lack of knowledge leads to ineffective treatment, which also entails an increased economic burden for the society. The relationship between the body and the soul must not be overlooked. Healthcare professionals need to be educated in the ability to recognize the underlying psychological factors behind the physiological symptoms.