Medically Unexplained Symptoms – Can Counselling Really Help?

By: Alex Erde

25% of all visits to the GP in the UK are now said to be over medically unexplained symptoms (MUS).

What are Medically Unexplained Symptoms?

If you go to a doctor over an ongoing physical complaint and they cannot find an obvious physiological cause, or detect the presence of a disease? You will be described as having ‘medically unexplained symptoms’ (MUS).

What are common MUS?

The most common medically unexplained symptoms include pain in your joints or muscles or back, persistent headaches, fatigue, insomnia, dizziness, stomach complaints, chest pains and heart palpitations.

Syndromes related to MUS include irritable bowel syndrome (IBS), fibromyalgia, and chronic fatigue syndrome.

A diagnosis of medically unexplained symptoms doesn’t mean your symptoms are fake or ‘all in your head’. If they are having an affect on your ability to function well, that is a very real thing.

Why is counselling suggested for MUS?

There is a high incidence of anxiety disorders and depression reported in those who suffer from medically unexplained symptoms. Treating the psychological problem has often been found alleviate the physical problems.

Counselling and psychotherapy also help with stress. And whether the stress is caused by the medically unexplained symptoms themselves, or came before any symptoms manifested, dealing with stress takes unneeded strain off the body allowing it to heal more easily.

Medically unexplained symptoms and trauma

Counselling can help you process previous trauma. And studies have now linked some forms of medically unexplained symptoms to childhood trauma.

For example, one study found that 44% of female attendees to a clinic for those with gastrointestinal complaints like IBS had suffered sexual abuse as a child.

Medically unexplained symptoms and trauma have also been linked by neuroscience. A neurologist by the name of Dr. Robert Scaer has done research into what he terms ‘the whiplash effect’. He believes that your brain ‘remembers’ past trauma, so a small trauma in the present will cause your brain to trigger neurophysiological changes including brain function, blood pressure, and also muscles and digestion. This would explain why, when two people are rear ended at the same speed, one will develop ongoing emotional, cognitive, and physical issues and the other won’t.

But it’s not ‘all in my head’

In some ways, all sickness derives from the head. Like Dr. Scaer’s theory above demonstrates, the brain is the ‘control centre’ of many of our physiological responses.

And with more and more physical conditions lately, not just with MUS, our minds and moods are being found to be in direct relation. For example, anger has now been linked to heart attacks and diabetes, and depression is linked to insomnia and a lowered immune system.

Don’t forget that even if your illness is eventually found to be physiological, being ill over several months or years makes it difficult for anyone to keep up their positive moods and self-esteem, let alone maintain a social life or manage finances. At the very least therapy can help you handle all the stresses being ill brings.

No matter whether your symptoms are ultimately found to be 100% physiological, or not at all, working with a counsellor or psychotherapist will not make things worse and is quite likely to make things better in some way.

How can psychotherapy help  if I have MUS?

1. Counselling can lower your stress and anxiety levels.

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Counselling can help you understand the reasons for your ongoing stress, whether it’s caused by trying to understand your symptoms or preceded your symptoms and is caused by early life trauma. It can also help you find new ways of thinking and acting that can cause you less stress in the future.

2. It can give you a confidential space to let off steam.

When you have been unwell for a long time there can come a point where you can feel there is nobody to talk to. Perhaps you feel its not fair to keep burdening your family or friends, or you don’t feel comfortable with how they’ve treated your illness. Or you’ve tried for a long time to be positive about it all but feel guilty that deep down you are feeling angry or despondent. A counselling room is a space where you can be honest, even if it’s just sharing how helpless you feel after another specialist found nothing.

3. Therapy helps you communicate better.

The best of us have a hard time communicating logically when we are feeling frustrated or low. If you have been feeling unwell for a long time, your frustration or low moods can leave you unable to express yourself, which can just lead to more upset. Counselling is a space to unload and work through your frustrations so that you can have a clearer mind the next time you have to speak to a loved one or even doctor. And it can also teach you new tools and tactics for communicating effectively.

4. Counselling gives you back a sense of being in charge of life again.

Being ill for a long time and not finding any answers can leave you feeling helpless and can also cause you to lose interest in moving forward with your hopes and dreams. Therapy can not only help you feel in charge of your life again by showing you how to get on top your thoughts, moods, and actions, it can help you find ways to work towards your goals despite not feeling well.

5. It can help you find joy in life again.

Being sick makes life more difficult. It can affect relationships, your career, and your finances. Counselling offers you a new perspective and helps you move forward despite your illness, helping you to remember how to feel good again.

What sort of counselling helps?

Cognitive Behavioural Therapy (CBT) has been shown to help sufferers of medically unexplained symptoms. CBT is focussed on helping you recognise the link between your thoughts, feelings, physical sensations, and actions. It can help you learn to recognise when your physical symptoms are causing you to go on a ‘negative spiral’ and then learn how to monitor your thoughts so that you can choose to feel differently.

Mindfulness based cognitive therapy (MBCT) has likewise been shown in a study to produce positive results for those with MUS. Mindfulness on its own is also helpful. While research is still ongoing, evidence shows that mindfulness is useful in reducing and managing chronic pain.

It’s important not to write off all therapy if these types do not work for you. There are many kinds of therapies and therapists, and it’s a matter of finding the one that works for you.

How to approach counselling if you have MUS

If you suffer from MUS and have been recommended to try a therapist, keep these things in mind:

• be open-minded. At the very least, therapy can help you deal with the stress from your illness.
• trust your therapist wants the best for you. Despite bad experiences with other doctors you might have recently had, a therapist is there to be on your side, not against you.
• know that you are in charge. Finding the right therapist can be a bit like dating. Give them a fair chance as it can take time to find your pace, but if it really isn’t working you are not indebted to stay but can try someone else.
• make the commitment. Like all things, therapy works best if you show up fully, not half-heartedly.
• and actually show up. If you feel tired or unwell, try to go anyway. Your therapist will work with you whatever state you are in.
• do your homework. Some therapies like CBT involve work between sessions you do at home. Don’t let perfectionism stop you from doing it.
• don’t see attending therapy as proof you don’t have a physiological problem and become resentful. See therapy as something that can help whether or not your symptoms eventually are found explainable.

Still have a question about unexplained medical symptoms? Or want to share your personal experience? Start the conversation below.

pictures by Seattle municipal archives, Eddi Van W, Department of Foreign Affairs, BK