[Mindfulness for medical, surgical and psychiatric residents]. / Mindfulness voor artsen in opleiding tot medisch specialist.

BACKGROUND: Mindfulness based stress reduction (mbsr) has been demonstrated to result in a reduction of stress and improvement of well-being in both healthy volunteers and the general population.
AIM: To examine the effect of mbsr on burnout symptoms, well-being and professional development in medical, surgical and psychiatric residents. METHODS A randomised controlled trial of 148 medical, surgical and psychiatric residents of the Radboud umc, half of whom immediately participated in mbsr and half after a three-month waiting period. Self-report questionnaires were administered online before and after the intervention and waiting list period. Effect of mbsr on professional development was explored with a qualitative interview with a purposive sample of 19 residents six months after completion. RESULTS No differences were found between the mindfulness and waitlist group regarding emotional exhaustion in the study population as a whole. However, those with high level of burnout symptoms benefitted significantly more from the course than the others. In addition, participants in the mindfulness group demonstrated a higher competence, less worry and more mindfulness skills, self-compassion and empathy. In terms of professional development, residents reported improvements in self-awareness, insight, acceptance, resilience and relating to others.
CONCLUSION: mbsr could result in a reduction of symptoms for medical and surgical residents with a high level of burnout symptoms. For the medical and surgical residents as a whole, mindfulness may enhance their professional development in several areas.

[Approaching psychological problems like a general practitioner]. / Psychische problemen benaderen als een huisarts.

An important cause of the high prescription levels of psychotropic medication for psychological symptoms is that these symptoms are assessed according to the same model as applied for physical symptoms, the disease model. This has led to a one-sided medical approach to psychological symptoms. A person-centred approach offers an alternative; the positive aspects of the disease-centred approach are retained and attention for the patient and his/her context become the central focal point for the general practitioner. Important elements of the person-centred approach are empathy, a good doctor-patient relationship, a shared approach to problem definition and understanding of the patient's problem, development of a therapeutic alliance, and a focus on the patient's hopes and expectations. If additional primary care-based treatment by mental health practice nurses is indicated, this model could be suitable since it is based on patients' strengths and focuses on personal growth rather than reduction of symptoms.

[Mindfulness-based cognitive therapy for patients with somatoform disorders]. / Mindfulness-based cognitieve therapie voor patiënten met somatoforme stoornissen.

UNLABELLED: BACKGROUND The daily lives of patients with somatoform disorders are often severely impaired by the symptoms of their illness. Cognitive behavioural therapy has proved to be an effective treatment for somatoform disorders. However, patients with these disorders are often reluctant to consult a psychologist for their physical symptoms. Mindfulness-based cognitive therapy (mbct) might be a useful form of treatment because it gives explicit attention to physical experiences and because it has a strong focus on acceptance of symptoms. AIM: To measure the effectiveness and cost-effectiveness of mbct for patients with somatoform disorders and to provide insight into how the therapy can gradually bring about behavioural change. METHOD: In this randomised controlled trial (rct), half of the participants (n=61) received mbct and the other half (n=56) received usual care. Participants belonged to the 10% of patients who visited primary care practitioners the most frequently; they had unexplained medical symptoms for at least six months. The primary outcomes were health status and mental and physical functioning. Measurements were taken at baseline, after 3 months and one year after baseline. In addition, records were kept of the costs involved so that we could obtain insight into health care use. Twelve patients were interviewed extensively at three points in time. RESULTS: Although the health status and the physical functioning were almost the same in the two conditions, the mental functioning improved in the patients who had attended mbct with an effect size of 0.3. At three months past baseline vitality and social functioning were significantly higher in the mindfulness condition than in the control condition. There was no significant difference between the total healthcare costs in the two conditions. The use of hospital care was lower in the mbct condition. At the same time, however, greater use was made of mental health care in the mbct condition. The interview study enabled us to establish a process of change. As a result of this process, patients focused less on short-term symptom reduction and more on the acceptance of their symptoms and on self-care. CONCLUSION: With the improvement that occurred in patients' mental functioning, we conclude that mbct is a meaningful therapy for patients with somatoform disorders. The fact that patients increased their use of mental health care after mbct could indicate that patients with somatoform disorders become more willing to receive mental health care.

Explanatory models of medically unexplained symptoms: a qualitative analysis of the literature.

Background Medically unexplained symptoms (MUS) are common in primary health care. Both patients and doctors are burdened with the symptoms that negatively affect patients' quality of life. General practitioners (GPs) often face difficulties when giving patients legitimate and convincing explanations for their symptoms. This explanation is important for reassuring patients and for maintaining a good doctor-patient communication and relationship.Objective To provide an overview of explanatory models for MUS.Study design We performed a systematic search of reviews in PsycINFO and PubMed about explanatory models of MUS. We performed a qualitative analysis of the data according to the principles of constant comparative analysis to identify specific explanatory models.Results We distinguished nine specific explanatory models of MUS in the literature: somatosensory amplification, sensitisation, sensitivity, immune system sensitisation, endocrine dysregulation, signal filter model, illness behaviour model, autonomous nervous system dysfunction and abnormal proprioception. The nine different explanatory models focus on different domains, including somatic causes, perception, illness behaviour and predisposition. We also found one meta-model, which incorporates these four domains: the cognitive behavioural therapy model.Conclusion Although GPs often face difficulties when providing explanations to patients with MUS, there are multiple explanatory models in the scientific literature that may be of use in daily medical practice.