Managing persistent bodily symptoms which have no medical explanation Professor Helen Payne, University of Hertfordshire Susan Brooks, Pathways2Wellbeing info@pathways2wellbeing.com

What is MUS? e.g. chronic pain, chronic fatigue, IBS, fibromyalgia etc MUS -Previously known as psychosomatic conditions/MUPS Persistent, physical symptoms which do not appear to have an organic cause or respond to treatment Clinical & social predicament, includes broad spectrum of presentations, difficulty accounting for symptoms based on known pathology (Edwards et al 2010)

Lack of Effective Interventions Psychological therapies- disadvantages Pain clinics- not all have pain/fail to integrate mind and body Medication- can have pain/symptom relief Alternative therapies- e.g. yoga, relaxation

MUS Characteristics 1 Fewer years in formal education (Creed, Barsky 2004) Parental neglect/illness in childhood (for women) (Craig, Cox, Klein 2002) Far more consultations, healthcare costs (£18 billion per year), & hospitalisations High levels of health anxiety/anxiety; depression (Malhi 2013) Aggravated by stress Unnecessary procedures/surgery

MUS Characteristics 2 More sick leave/ likely to be unemployed Comparable to MES in impairment of function/poorer quality of life than MES Poorer general health & worse mental health Poor affect regulation / needy of emotional support Past/current family dysfunction and/or a history of trauma, neglect or abuse Attachment issues (Adshead & Guthrie 2015)

Problems of MUS to patient and NHS Emotional costs Financial costs Lack of self-management Isolation NHS: GPs frustration Health care costs (primary/secondary) GP lack of capacity Wastage

The BodyMind Approach™ Based on research conducted at UH; practice-based evidence since Derived from AM & Mindfulness, group work & integrative psychotherapy Physical symptom acts as gateway to the mind ‘Playing with the symptom so it does not play on you’ Promotes wellbeing and resilience leading towards Recovery

Structure of courses Up to 12 patients per group, 12 x 2 hour workshops Inclusion /exclusion criteria Triage/assessment/monitoring Variety of symptoms Two phases- over 12 months Facilitated groups

Experiential Practice Self care - hand massage Breathing practice 2s discuss with partner how your body reacted when shocked

Assessment Tools Standardised measurements: Pre, post and at 6 month follow up MYMOP (symptom/activity/wellbeing) PHQ9 (depression) GAD (anxiety) GAF (functioning) In-house questionnaire (demographics)

Real-world Lessons Learned Champion Self / Other health professionals referral No time and venue on adverts Patients failing to return PEF Responding to locality requests for courses We need to recruit more facilitators Trialling of individual sessions Promote cross referrals between IAPT and p2w

Outcomes comparing pre to 6 month follow up Wellbeing:

Symptom Severity:

Difficult Activity:

Global Functioning:

Overall MYMOP2:

Anxiety:

Other data 87.5% of participants completed sessions. The 6 month follow up has been completed

Percentage Change in Questions Pre Group Compared with Six Month Follow-up Question Asked Percentage Improved Percentage Worsened Percentage No Change Support   100% GP Visits 57% 43% Hospital Visits 14% 29% Medication 15% 70% Number of Symptoms Employment Status

Information Introductory courses (BACP CPD accredited): 14-15 Oct 2016 Training for facilitators (BACP accredited): 25-26 Nov 2016 Email: Hannah.Murdoch@pathways2wellbeing.com Anticipated courses for patients: May-June 2016; Sept-Nov 2016

Questions Over to you

Contact details @p2w_ltd info@pathwayswellbeing.com www.pathways2wellbeing.com @p2w_ltd