ARTICLE 2: the cognitive behavioural model of medically unexplained symptoms (MUS)

Question 1

CBT model for MUS

Answer 1

Proposes a model that is autopoietic = an autonomous and self-maintaining unity. The components interact and generate the same network of processes which produce them.
An autopoietic interaction of cognitive, behavioural and physiological factors cause physical symptoms in the absence of (psycho)pathology (MUS/MUPS).

Question 2

Components of the model

Answer 2

1. Predisposing factors –> predispose
2. Perpetuating factors –> maintain
3. Precipitating factors –> trigger

Question 3

(1) Predisposing factors

Answer 3

PREDISPOSING FACTORS:

• Parental illness and vicariously learning illness behaviours
• Neuroticism and somatopsychic stress

Question 4

(2) Perpetuating factors

Answer 4

MAINTINING FACTORS:

• Sensitisation
• HPA axis sensitisation
• Attention processes
• Symptom perceptions
• Responses to illness

Question 5

(3) Precipitating factors

Answer 5

TRIGGERING FACTORS:

• Life events: events that trigger the start of a self-perpetuating cycle (via chronic stress).

Question 6

Sensitisation (perpetuating factor)

Answer 6

Heightened response to stimuli because of a prior experience to them. Could lead to normally benign sensations to be experienced as pain, leading to further vigilance and sensitisation.

Question 7

Attention (perpetuating factor) on symptoms

Answer 7

Bodily symptoms are generated by multiple determinants (stress, sensitisations etc.) –> a filter selects symptoms for conscious attention –> multiple determinants attribute to faulty filtering (lack of distraction, alexithymia) –> increased symptom perception –> interference with normal functioning –> stops ongoing activity –> reorientation to threat/symptoms –> negative reinforcement (person acts to reduce aversive arousal).

Question 8

Symptoms perception model of MUPS

Answer 8

Negative affectivity, selective attention and somatic attributions are key factors for determining the experience of common physical symptoms. Catastrophic beliefs about symptoms contribute to behavioural avoidance and thus anxiety and symptom maintenance through operant conditioning.

Question 9

Conditioning and MUPS

Answer 9

• Classical conditioning: symptoms stress cues become associated with symptoms.
• Operant conditioning: further sensitisation processes (avoidance etc.)

Question 10

Distress intolerance

Answer 10

A key theme in treatment for MUPS –> developing the ability to tolerate symptoms, while not letting symptoms guide behaviour.