On the psychological end, chronic illnesses of any stripe,
including those that are unexplained, can lead to declines in
functioning, changes in body image, and consequent avoidance
of activities and people, O’Brien adds.
“When you’re constantly sick, you’re not going to feel like
going out with your friends on a Friday night,” he says. “And
after some time you tend to lose friends.” These factors lead to
reactive depression and anxiety, which in turn creates a negative
feedback loop that can exacerbate symptoms, he says.
In addition, these patients can inadvertently get overly
entangled in the medical system, in part because physicians
don’t know how to refer them to the right mental health
professionals, Sharpe says.
“Once you start going down the medical route, it can
be hard to get out,” he says. Patients may receive scads of
unnecessary and even dangerous medical tests and surgeries,
for example, and at the same time fail to receive helpful
psychological interventions. The situation is costly for them and
for the system, he says.
What does help?
A number of tactics can help such clients, says Galper, who
notes that psychologists who specialize in health psychology or
behavioral medicine are more likely than others to be trained in
addressing such conditions.
To start, it’s vital that clients receive a thorough medical
workup if they haven’t done so already, says psychiatrist
Joel Dimsdale, MD, professor emeritus at the University of
California, San Diego, who was a member of the DSM- 5
somatic symptoms work group.
Research also shows that a variant of cognitive behavioral
therapy — one tailored to addressing a patient’s medical
symptoms — can be extremely helpful with many of these
conditions, Sharpe adds.
A main strategy is acknowledging the reality of the physical
symptoms but explaining to clients that stress reactions make
symptoms worse. The next step is helping clients discover
for themselves that if they can change those reactions, it
can improve their health. In a randomized controlled study
reported in Pain Research and Treatment in 2012, for instance,
Rutgers University psychology professor Robert Woolfolk, PhD,
and colleagues showed that fibromyalgia patients who received
a form of cognitive behavioral therapy along with usual care
reported less pain and overall better functioning post-treatment
and at a nine-month follow-up than those who received only
usual care. Likewise, a 2010 study in Psychological Medicine by
health psychologist Rona Moss-Morris, PhD, of the University
of Southampton and colleagues found that more than three-quarters of patients with irritable bowel syndrome who received
a self-help form of CBT plus usual care reported symptom
relief immediately after treatment and at three- and six-month
follow-up, compared to about 21 percent of controls who
received usual care.
Another crucial tack is to validate the patient’s experience,
says psychologist Leonard Jason, PhD, of DePaul University,
who studies chronic fatigue syndrome.
“The most important thing you can do is to develop that
bond,” he says. “If someone believes a person will listen to
them and respect them, that immediately makes them feel like
they can take some important steps toward feeling good about
He also advises working on concrete health goals where
patients can see progress. “All patients with chronic fatigue
syndrome have sleep problems, for example,” he says. “So, I
suggest that they learn some sleep hygiene, or work with a
medical doctor and try some sleep medications.”
It’s also important for mental health professionals to stay
within their scope of expertise — to focus on the emotional
and cognitive aspects of a client’s condition rather than its
medical aspects, Dimsdale adds. This can include helping
clients tame excessive thoughts, feelings and behaviors related
to their symptoms, and encouraging them to keep track of what
aggravates or ameliorates their symptoms and make changes
accordingly. “There is considerable room for what in essence
amounts to rehabilitation,” he says.
Others are studying the impact of mindfulness meditation
on patients with medically unexplained conditions. A 2011
prospective, randomized controlled study reported in the
American Journal of Gastroenterology by Susan A. Gaylord, PhD,
of the University of North Carolina at Chapel Hill and colleagues,
for instance, found that female patients with irritable bowel
syndrome randomly assigned to eight weeks of mindfulness
training had greater reductions in physical symptoms
immediately after the training and at a three-month follow-up than those assigned to a support group. They also reported
higher quality of life and lower distress and anxiety at three
months than support-group members.
Finally, some studies show that antidepressants can help
ameliorate a gamut of unexplained symptoms, whether or not
the person is depressed, says Sharpe. That could be because
depression increases the propensity to ruminate and to view
stimuli as aversive, because the neural pathways for negative
psychological and physical symptoms such as pain and
depression are closely related, or both, he notes.
In a very basic way, simply letting people who live with a
medical mystery know you’re in their corner can be therapeutic,
“For most people, facing it alone is one of their biggest
fears,” she says. “So I always try to give the message, what can
a psychologist do? I can help you face it, so you don’t have to
go through this alone. I can help you stay very focused on your
quality of life in the here and now, rather than pinning your
hopes on a diagnosis that may or may not ever come.” n