CBT for Long-Term Conditions and Medically Unexplained Symptoms　describes how cognitive behavioural therapy (CBT) can be used to treat anxiety and depression with a co-morbid long-term physical health condition (LTC) or medically unexplained symptoms (MUS). The book teaches cognitive behavioural therapists and other clinicians to help patients deal with the psychological aspects of physical symptoms, whatever their cause. It is divided into three parts, beginning with core skills for working with people with LTC and MUS. This includes assessment, formulation and goal setting. Part II focuses on CBT for LTC and includes chapters on low intensity interventions, working with depression and anxiety using protocols, and a consideration of an identity and strengths-based approach to working with LTC. The final part provides details of a formulation driven approach to working with MUS, broken down into individual chapters on working with behaviours, cognitions and emotions. With numerous case examples, the book provides accessible and practical guidance for mental health professionals, particularly CBT practitioners, working with anyone with long-term conditions or MUS.

Research has shown that socio-demographic profile and psychopathology symptoms are related to levels of happiness in old age. The aims of this cross-sectional study were: 1) to investigate the effect of recent stressful life events and socio-demographic factors on psychopathological symptoms in elderly residents in mountain regions of Crete, Greece and 2) to explore the mechanism which underlies the relationship between socio-demographic factors and psychopathological symptoms, with levels of happiness in old age. To this end, we used the nine psychopathology dimensions of symptoms as defined in the Symptom Checklist-90-R (SCL-90), while the Holmes and Rahe stress inventory was administered to quantify the stressful life events. A sample of 205 elderly men and women (age=77.1+/-6.7 years) living in 10 remote rural and isolated villages participated in this study. Data was collected through questionnaires completed upon individual meetings with each participant, with the interviewer's assistance. Each questionnaire included the two aforesaid scales alongside questions on individual socio-demographic characteristics. Analysis of variance was applied to detect socio-demographic factors that have a significant effect on specific psychopathological symptoms. Then, path analysis was applied to quantify the direct and indirect effect of the selected socio-demographic factors on happiness levels. Stressful life events were found to have no statistically significant effect on the presence of specific symptoms (somatization, psychoticism, anxiety) in elderly adults. Furthermore, certain socio-demographic factors (marital status, smoking, family income and social activity) were found to influence happiness, which varied according to the level of psycho-emotional tension. The results suggest that somatization, psychoticism, and phobic anxiety symptoms are psychic reactions independent of recent stressful life events. Our study,despite its regional character, may contribute in the development of appropriate clinical assessment tools and interventions, helping primary care practitioners to approach elderly people living in remote villages in a more appropriate and holistic manner, improving thereby the effectiveness of their interventions.

There are several treatment options for conversion disorder, but none have emerged as a treatment of choice. This case report describes one woman's experiences of conversion disorder and the multidisciplinary and multi-agency care plan developed to meet her needs. It offers reflections from the perspective of staff and the patient herself about which aspects of the treatment were most effective. The study aims to give insight into the benefits and the gaps of the programme. This is a descriptive case study arising from collaboration between client and professionals throughout the period of the care plan. It concludes that the multidisciplinary and multi-agency approach has much to offer in the treatment of conversion disorder.

Reply to the commentary Reattribution for medically unexplained symptoms by Hiske J. van Ravesteijn, Peter L. B. J. Lucassen, and Tim C. olde Hartman, (see record 2008-05194-021) on the current authors' original article Randomised controlled trial of training practices in reattribution for medically unexplained symptoms (2007). First, we conducted a 6-hour training intervention in reattribution because, on the basis of a series of studies of training in primary care, this is the length of training that most general practitioners (GPs) are prepared to attend in the UK and also in many other healthcare systems in the world. Second, the paper describing the reattribution model, which was written by one of our team and subsequent descriptions of reattribution written by members of our team, have always promoted a model in which doctors provide the 'making the link' explanation although they should do this through negotiation with the patient. Third, we agree that an instrumental task-oriented consultation such as reattribution might be perceived as less empathic by patients with medically unexplained symptoms than treatment as usual. However, in our trial the data from the patient satisfaction questionnaire suggests that compared with treatment as usual, after reattribution training twice as many patients were very satisfied with how well the GP understood the nature of their problems and their worries. Finally, we agree that certain subgroups of patients with medically unexplained symptoms may benefit from reattribution. However, our trial was not powered to examine this issue. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Background: The top 3% of frequent attendance in primary care is associated with 15% of all appointments in primary care, a fivefold increase in hospital expenditure, and more mental disorder and functional somatic symptoms compared to normal attendance. Although often temporary if these rates of attendance last more than two years, they may become persistent (persistent frequent or regular attendance). However, there is no long-term study of the economic impact or clinical characteristics of regular attendance in primary care. Cognitive behaviour formulation and treatment (CBT) for regular attendance as a motivated behaviour may offer an understanding of the development, maintenance and treatment of regular attendance in the context of their health problems, cognitive processes and social context. Methods/design: A case control design will compare the clinical characteristics, patterns of health care use and economic costs over the last 10 years of 100 regular attenders (>= 30 appointments with general practitioner [ GP] over 2 years) with 100 normal attenders (6-22 appointments with GP over 2 years), from purposefully selected primary care practices with differing organisation of care and patient demographics. Qualitative interviews with regular attending patients and practice staff will explore patient barriers, drivers and experiences of consultation, and organisation of care by practices with its challenges. Cognitive behaviour formulation analysed thematically will explore the development, maintenance and therapeutic opportunities for management in regular attenders. The feasibility, acceptability and utility of CBT for regular attendance will be examined. Discussion: The health care costs, clinical needs, patient motivation for consultation and organisation of care for persistent frequent or regular attendance in primary care will be explored to develop training and policies for service providers. CBT for regular attendance will be piloted with a view to developing this approach as part of a multifaceted intervention.