Access Type

Open Access Dissertation

Date of Award

January 2016

Degree Type


Degree Name




First Advisor

Mark Lumley


Trauma, stress, and inhibited emotions contribute to pain and physical symptoms. People may disclose stressors and express emotions when encouraged, which may improve their symptoms. We developed an intensive interview aimed at: 1) raising patient awareness about the links between their stress and health; 2) engaging patients in emotional experiencing and expression processes. We tested its effects on patient attributions of their symptoms, in addition to physical and psychological outcomes in primary care patients with Medically Unexplained Symptoms (MUS).

In this study, 75 patients (87% women; 79% White; mean age = 39 years) with MUS (e.g., localized chronic pain, fibromyalgia, irritable bowel syndrome, headaches) were recruited from a family medicine clinic. Participants completed self-report measures of their physical and psychological functioning, in addition to their symptom attributions and motivations to change at baseline and after 6 weeks. Then, participants were randomized (2:1 ratio) to one of two conditions: stress and emotion interview (n = 49) or waitlist control (n = 26) conditions. The interview was a single, 90-minute session in the clinic examination room, in which interviewers obtained patients’ medical and life stress histories. Stress experiences were linked to pain and other health changes over the patients’ lives, and then patients were engaged in an experiential exercise to express emotions (e.g., anger, sadness) related to their stressors. Intent-to-treat analyses indicated that the interview condition led to significantly greater reductions in pain severity, pain interference, global psychological symptoms, and specifically reduced depression and interpersonal sensitivity at follow-up, compared to controls. Sleep problems also improved and contemplation to change decreased with the intervention. Contrary to hypotheses, neither global physical symptoms nor symptom attributions changed differentially between conditions over time.

Clinical observations and patient reports indicated that the majority of patients had substantial unresolved victimization, conflict, and/or secrets, which typically had not been disclosed in this setting. Even though patients struggled to express their emotions, they were typically thankful and appreciative of this interview opportunity. Given that no professionals, including psychologists, routinely focus on these emotional issues, these findings provide preliminary evidence for the importance of integrating an emotional component in the assessment and intervention with MUS in primary care.

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