Seminar Details


Illness representations and psychological distress in patients with non-cardiac chest pain

Monday 22nd April 2013
1pm - 2pm (12.45 for sandwiches)
Seminar Room 1
PCPH, Upper 3rd Floor, UCL (Royal Free Campus)
Speaker: Rosie Webster

Around 700,000 people attend the Emergency Department (ED) every year with acute chest pain; about half of whom have no serious or cardiac cause for their pain. These non-cardiac chest pain (NCCP) patients often receive no diagnosis, continue to experience pain, suffer high levels of psychological distress and poor quality of life – despite having good physical prognosis. The Common Sense Model of illness representations may provide a good theoretical model for understanding these poor outcomes. The aim of this work was to assess the relationship between illness representations, psychological distress, quality of life, and chest pain in NCCP patients in order to identify appropriate targets for intervention.

An initial questionnaire study demonstrated that the illness representations of increased belief in psychological causes, perception of a more chronic timeline and weaker perceptions of personal control were associated with poorer psychological outcomes. Continued chest pain was related to increased baseline psychological distress and cardiac worries, a stronger baseline perception of identity and a more chronic timeline. These findings therefore highlighted the prominent role that anxiety and stress may play in causing and maintaining NCCP. The role of psychological factors and a lack of understanding in NCCP was demonstrated in a qualitative study of patients who experienced continued pain and distress at follow-up.

Using the findings of these two studies, and previous findings with NCCP patients, a self-help anxiety reduction intervention was developed. This was designed to improve patients’ understanding of NCCP and to provide methods to reduce stress, anxiety and pain. An initial qualitative study has shown the intervention to be acceptable, relevant and understandable to both NCCP patients and the specialist nurses who care for them. Further research is needed to test the efficacy of the intervention in a randomised controlled trial.

This study raises an interesting debate about the role of psychological factors in medically unexplained symptoms such as NCCP, and demonstrates that brief psychological intervention may be appropriate for these patients.

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