|Sullivan, N., Phillips, L.A., Pigeon, W.R., Quigley, K.S., Graff, F., Litke, D.R., Helmer, D.A., Rath, J.F., & McAndrew, L.M. (2019). Coping with medically unexplained physical symptoms: The role of illness beliefs and behaviors. International Journal of Behavioral Medicine. doi: 10.1007/s12529-019-09817-z|
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Medically unexplained syndromes (MUS) can be highly disabling. Research on coping with MUS has shown that beliefs about MUS and how individuals respond to their symptoms may contribute to disability. However little is known about which specific thoughts and behaviors are related to better functioning. As part of a large study, Dr. Lisa McAndrew and her team asked Veterans with MUS about how they think about their symptoms, how they respond to their MUS, and their level of functioning. The researchers found that Veterans who saw their MUS as controllable and understandable were functioning better compared to those who saw their MUS as threatening (e.g., having severe consequences). The researchers also found that these beliefs were related to certain behaviors. For example, those who saw their MUS as threatening were more likely to limit the activities they engage in, which was related to more disability. On the reverse side, seeing MUS as controllable and understandable was related to less limiting behavior and less push-crash behavior (i.e., a cycle of avoiding activity followed by extreme bouts of activity that leave an individual burned out). Less limiting and less push-crash behavior was related to better functioning. The findings of this study suggest some specific ways that might be helpful for Veterans to cope with the symptoms of MUS, and improve functioning.
|McAndrew, L.M., Helmer, D.A., Lu, S-E., Chandler, H.K., Slotkin, S., Quigley, K.S. (2018). Longitudinal relationship between onset of physical symptoms and functional impairment. Journal of Behavioral Medicine. dx.doi.org/10.1007/s10865-018-9937-4|
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To understand the relationship between pain and disability as they develop, Dr. McAndrew and her team followed 790 military personnel returning from deployments in Iraq and Afghanistan. Military personnel were assessed before, immediately after, 3-months after and 1-year after their deployment. The researchers found that for those who experienced an increase in pain symptoms during deployment also reported increases in their disability at later time points. Interestingly, the reverse was not found; disability reported during deployment did not lead to later increases in pain. In other words, disability did not cause acute pain to become chronic, as has been commonly assumed. The results of this study suggest the need for new models of how acute pain becomes chronic.
|McAndrew, L.M., Friedlander, M., Phillips, L.A., Santos, S., & Helmer, D.A. (2018). Concordance of Illness Perceptions: The key to improving the care of medically unexplained symptoms. Journal of Psychosomatic Research. dx.doi.org/10.1016/j.jpsychores.2018.05.015|
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Dr. McAndrew and her team reviewed the literature on patient-provider relationships in the context of medically unexplained symptoms. Their review suggests that the key to improving patient-provider relationships is for the patient and provider to negotiate a shared understanding of the patient’s symptoms. Having such a shared understanding of illness perceptions, consequentially, becomes the foundation for developing an effective treatment plan.
|Phillips, L. A., McAndrew, L., Laman-Maharg, B., & Bloeser, K. (2017). Evaluating challenges for improving medically unexplained symptoms in US military veterans via provider communication. Patient Education and Counseling.|
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Effective patient-provider-communication is a key aspect of care. Veterans experiencing Medically unexplained Symptoms (MUS) reported on their communications with primary care providers about their illness. While both interpersonal skills and MUS discussion (i.e., illness and treatment factors) were significantly related to care satisfaction, only MUS discussion was related to treatment adherence. Results communicate the importance of patient-provider interactions in Veteran MUS treatment.