Clinician training involving a comprehensive approach that combines pharmacologic therapy with biopsychosocial, cognitive behavioral, and case-management skills training or that emphasizes specific reattribution training (see next paragraph) has been found to be effective in managing patients who have CMI. Studies that provided comprehensive training for clinicians tended to show substantial benefit in physical functioning and mental health in patients even after 6–24 months of follow-up. For example, training clinicians to use a multifaceted intervention combining appropriate medications based on symptoms, cognitive behavioral therapy (CBT), and a specific patient-centered method proved beneficial in several studies (Smith and Dwamena, 2007; Smith et al., 2003, 2006, 2009). Similarly, Margalit and El-Ad (2008) demonstrated decreased hospital days and emergency room visits at both the 1-year and 2-year points after CBT, medication, and other therapies were administered by clinicians with expertise in treating patients who have CMI. Improvement in physical functioning and mental health was observed in patients who have CMI 12 months after the use of effective case management plans developed by an expert group of clinicians (Pols and Battersby, 2008). Finally, a collaborative-care model with CBT and side-by-side psychiatric consultation with the primary care clinician showed improvement in the severity of symptoms and in social functioning and decreased health care use after 6 months (Van Der Feltz-Cornelis et al., 2006). In that study, the primary care clinicians were trained in case management and CBT.
Reattribution training involves skills in empathizing with patients regarding their physical complaints and helping them to connect their physical symptoms with their emotions and psychosocial circumstances. Studies based on reattribution training have had mixed results. There were mild decreases in physical symptoms and pain (Aiarzaguena et al., 2007; Larisch et al., 2004) and some improvement in patient satisfaction with physician–patient communication (Morriss et al., 2007). However, two studies that examined the impact of “the extended reattribution and management” model in which clinicians received training in biopsychosocial history taking and management strategies in addition to reattribution training showed no long-term benefits (Rosendal et al., 2007; Toft et al., 2010), although one of them (Toft et al., 2010) showed mild benefits of improved physical functioning at 3 months.
The effectiveness of another form of clinician training, consultation with a mental health professional with or without consultation letters, also has been studied. Consultation letters educate the referring clinician about the chronic nature of the symptoms and suggest treatment strategies for the care team to use that are based on frequency of follow-up visits and psychosocial models rather than high-cost testing and procedures. Consultations with mental health experts did not appear to be effective