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BMC Psychol. 2020 Feb 5;8(1):13. doi: 10.1186/s40359-020-0380-2.

Treating medically unexplained symptoms via improving access to psychological therapy (IAPT): major limitations identified.

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Centre for Primary Care, Division of Health Sciences and Population Health, University of Manchester, Manchester, UK.
, Liverpool, UK.



Improving Access to Psychological Therapies is a UK Government funded initiative to widen access to psychological treatment for a range of common mental health complaints, such as depression and anxiety. More recently, the service has begun to treat patients with medically unexplained symptoms. This paper reports on a review of treatment protocols and early treatment data for medically unexplained symptoms, specifically the illness myalgic encephalomyelitis/chronic fatigue syndrome.


A series of seven core problems and failings are identified, including an unproven treatment rationale, a weak and contested evidence-base, biases in treatment promotion, exaggeration of recovery claims, under-reporting of drop-out rates, and a significant risk of misdiagnosis and inappropriate treatment.


There is a pressing need for independent oversight of this service, specifically evaluation of service performance and methods used to collect and report treatment outcomes. This service offers uniform psycho-behavioural therapy that may not meet the needs of many patients with medically unexplained health complaints. Psychotherapy should not become a default when patients' physical symptoms remain unexplained, and patients should be fully informed of the rationale behind psychotherapy, before agreeing to take part. Patients who reject psychotherapy or do not meet selection criteria should be offered appropriate medical and psychological support.


Chronic fatigue syndrome; Improving access to psychological therapies; Medically unexplained symptoms; Myalgic encephalomyelitis; Recovery measurement; Treatment

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