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MUS, PPS services and IAPT integration into NHS primary care - what's happening across the UK?

Cheshire

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Pathways2Wellbeing has transferred knowledge from proof of concept, market research and health economy studies into Hertfordshire NHS, and is actively pursuing other clinical commissioning groups in the UK.
Wow, the art of transforming a vague and unprovable hypothesis into a marketing concept...

The aim is to facilitate alternative connections between physical symptoms and patient perception of their symptoms based on creative practices, which develop mindfulness, body awareness, activity, self-regulation and stress reduction, reflection and meaning making.
This is so obviously exagerated and oversold, both bombastic and sufficiantly vague to mean anything to anybody. I'm speechless...

Thanks @Dx Revision Watch for putting all that together in a dedicated thread.

Helen Payne seems particurlarly "creative" in the way she presents things, and as all the rest of the clique, does not hesitate to hide things and lies.
I started to listen to the video you linked to in @Countrygirl thread and to her big study presentation, and everything is so obviously biased in her demonstration.
That's desperating that such a bad work is promoted in such a way, with terrible consequences for patients.

For example, the criteria for entering the study (p.14) makes a MH diagnosis mandatory:
Referral guidance to GPs was based on the criteria implemented in the pilot study. The criteria were given to the GPs during awareness-raising presentations and in the referral form for example, confirming that MUS was present/diagnosed for at least six months; that the patient was a frequent attendee (i.e. more than five visits for that symptom in the past 12 months); that there was co-morbidities of depression and/or anxiety and that the patient was a fluent English speaker.
But whenever she speaks, she generalises her results to anyone with "MUS", with or without MH problems. That is so wrong and dishonest and unscientific...
 

Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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(Some of these links will have appeared on other PR threads.)

Pathways2Wellbeing

http://www.pathways2wellbeing.com/

Pathways2Wellbeing is a spin-off company from the University of Hertfordshire.

Prof Helen Payne ( Profile ) seeks to "embed" pathways2wellbeing into primary care and drag ME, CFS, IBS, FM kicking and screaming to her ‘The BodyMind Approach’ (TBMA®) therapy sessions.

She's targeting the Netherlands, too:

Here's a flyer for prospective facilitators to deliver the ‘The BodyMind Approach’ (TBMA®) - "derived from authentic movement, dance movement, psychotherapy, experiential learning methods, mindfulness practices and group analysis":

PDF Flyer: http://t.co/Ky4whyCIYh

A taster from the Netherlands flyer:



She's hawking it in Slovenia, too:

http://www.napovednik.com/dogodek390285_ples_kot_terapija_pogovor_s_prof_dr_helen_payne


There's a training overview here for group facilitators:

http://www.pathways2wellbeing.com/v6 overview.pdf


She also does this stuff at intensive retreats:

http://admp.org.uk/2016/06/

"UKCP accredited psychotherapist; MBACP; ADMP UK Snr. Reg. movement psychotherapist. Helen is one of the leading international experts in the field of Body/Movement Psychotherapy.

"...Authentic Movement (AM) will be the method used during this intensive. Pioneered by Mary Starks Whitehouse in California, AM enables a direct connection to the depths of our unconscious, accessing the rich resources of our intuitive wisdom expressed through the embodied word, image, sensation and relationship as well as through natural, rejuvenating movement. Founded on Jung’s concept of the active imagination and the collective unconscious, authentic movement also derives from dance movement therapy, play therapy, groupwork and spiritual practice where symbolic meaning is seen in physical expression. As practised with Helen it has a safe, self-directed, non-judgemental and empathic framework. Participants learn to dwell more easily in their bodies, and to engage creatively with a direct experience of the self beyond words and concepts. It can assist in developing body awareness, body-mind-spirit connections and kinetic meditation where mindfulness is crucial to practice. The roles of witness and mover are explored in dyadic, triadic and group formations with the four phase process. The retreat will provide ritual, witnessing and movement experiences, silence, verbal and symbolic reflective processes, as well as small teaching seminars. Due to the environment we will explore participatory consciousness which can emerge through engaging in authentic movement in relationship with all aspects of the sentient world. Be inspired in a setting with wildlife up close, beautiful landscapes, places to explore, good food and friendly faces. Studio sessions will be interspersed with reflection time in silence, opportunities to experience nature and artwork periods. Seminars will address questions arising from your explorations in studio time as well as those relevant to your professional practice..."


For those who haven't already seen it, here is Prof Helen Payne hawking her BodyMind Approach’ (TBMA®) stuff at a presentation. The video is 8 minutes long:



2:35mins: "This is why the GPs like it..."

''...so they just keep going back to the GP, every day - every single day, these patients go back..."

Every single day? Really?

At one point, she stumbles over the term "Bodily stress syndrome". I have pointed out to her that ICD-11 has not yet approved the Goldberg group's proposals for the Primary Care version of ICD-11 and that there are two work groups making recommendations for the revision of the somatoform disorders.


Prof Payne has another presentation, here:



Hard-to-control Unexplainable Medical Symptoms: Wellbeing for Body and Mind’ - Professor Helen Payne

This one is 54 mins long and I have not yet listened to it. But I'm told that at 8.44 in from the start, a slide lists "Chronic Fatigue" and "ME".

There's a PowerPoint presentation here:

http://www.eoescn.nhs.uk/index.php/download_file/force/2008/261/

Complementing IAPT for people with medically unexplained symptoms (MUS) unable to access services
Professor Helen Payne, University of Hertfordshire Susan Brooks,
Pathways2wellbeing east of England IAPT conference 1 July 2015
copyright pathways2wellbeing IAPT and MUS


A short YouTube advert, here:


Pathways2Wellbeing Manor Pharmacy
7 Aug 2015


A paper published here (only the Abstract available):

http://www.sciencedirect.com/science/article/pii/S0197455615300435

The Arts in Psychotherapy
Volume 47, February 2016, Pages 55–65

Clinical outcomes from The BodyMind Approach™ in the treatment of patients with medically unexplained symptoms in primary health care in England: Practice-based evidence

Helen Payne, MPhil, PhD, UKCP Reg. Psychotherapist, ADMP UK, AVRa
Susan D.M. Brooks, BSc, MA, MA, MBAb


A manuscript which can be downloaded in full, here:

http://researchprofiles.herts.ac.uk...eaks_its_Mind_2015_The_Arts_in_Psychother.pdf

Accepted Manuscript

Title: The Body speaks its Mind: The BodyMind Approach® for Patients with Medically Unexplained Symptoms in Primary Care in England

Author: Helen Payne
PII: S0197-4556(14)00136-1
DOI: http://dx.doi.org/doi:10.1016/j.aip.2014.12.011
Reference: AIP 1302



 
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Countrygirl

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[QUOTE="Dx Revision Watch, post: 801639, member: 338
Clay modelling to examine the symptoms purpose, anyone?

I'll be posting more on Prof Helen Payne's Hertfordshire University spin-off, tomorrow.[/QUOTE]

It just beggars belief!

I am trying to screw up courage to see my GP......................but I am still worried that I will blow on all four cylinders if I am greeted by this nonsense.
 

Countrygirl

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https://clinicaltrials.gov/ct2/show/NCT02444520


Medically unexplained symptoms (MUS) can be defined as physical symptoms that at present have no clear physical pathological cause.

Principal Investigator: Trudie Chader, PhD King's College London
Which in translation means when referring to ME : We haven't bothered to read the science for the last 30 years, we have no respect for the experience and knowledge of our patients and we find it convenient to label them with personality flaws as that let's us off the hook and keeps us on our gravy train.

If they don't possess the intellect to grapple with a complex illness why don't they just get themselves a proper job like stacking shelves in Tesco where at least they won't be inflicting harm on people?

There.............I feel better for that.
:p

(Clay modelling indeed.:lol:)

(I have a hunch that I am still not ready to keep my cool in a GP's appointment:aghhh: )
 

Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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With the proliferation of MUS and PPS services in some parts of the country, I wonder how long it will be before some of the dedicated CFS/ME services are decommissioned in favour of MUS/PPS services or MUS/PPS embedded within primary care?


Notes from EACLPP Workgroup meeting in Budapest July 2011


PDF: https://dxrevisionwatch.files.wordp...ically_unexplained_symptoms_budapest_2011.pdf

Report from Working group meeting on MUS/somatisation/bodily distress, Budapest July 1st 2011

Extracts:

 
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Countrygirl

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Participants learn to dwell more easily in their bodies, and to engage creatively with a direct experience of the self beyond words and concepts. It can assist in developing body awareness, body-mind-spirit connections and kinetic meditation where mindfulness is crucial to practice. The roles of witness and mover are explored in dyadic, triadic and group formations with the four phase process.
:jaw-drop:

She cannot be serious??!!

Do doctors really accept this rubbish?

Hard to believe.

Have they lost their collective mind?
 

Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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For any readers who haven't started at the beginning of the thread:

Please add to this thread, now, or in the future:
  • if there are MUS or PPS services or GP managed MUS services or IAPT services implemented or piloting in your own NHS Trust area;
  • if you come across other examples of MUS or PPS services or GP managed MUS or IAPT services in other areas of the country;
  • if you have been told by your GP that your ME, CFS, FM or IBS is now being managed as a MUS or PPS or under mental health disorders;
  • if you have been referred to a MUS or PPS service;
  • if your GP has recently expressed a change of views on the management of ME, CFS or has been pressuring you to accept a referral for CBT or for other psychological therapies.
  • if your GP has recently reviewed your prescription med regime and is proposing to reduce or withdraw any medications that were specifically prescribed for managing your ME, CFS symptoms.
 
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Cheshire

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What strucks me about the whole MUS concept is that it is essentially an English (and a bit Dutch too) thing. Nearly nothing in France, very few in the USA...

Not to say that psychosomatic theories do not exist in other countries, but do someone have an idea why this specific form of psychosomatic view is so widespread in the UK?
 

A.B.

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Clay modelling to examine the symptoms purpose, anyone?
https://en.wikipedia.org/wiki/Divination

Divination (from Latin divinare "to foresee, to be inspired by a god",[2] related to divinus, divine) is the attempt to gain insight into a question or situation by way of an occultic, standardized process or ritual.[3] Used in various forms throughout history, diviners ascertain their interpretations of how a querent should proceed by reading signs, events, or omens, or through alleged contact with a supernatural agency.

Nowadays the supernatural entity is the psyche. Invisible and mysterious, only a select few can hope to understand it. Certainly not the patients themselves.
 

Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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Disproportionate as judged by what means?

No room for error there, huh? Completely safe.
"...A person will meet the criteria for SSD by reporting just one bodily symptom that is distressing and/or disruptive to daily life and having just one of the following three reactions to it that persist for at least six months:
1) 'disproportionate' thoughts about the seriousness of their symptom(s); or 2) a high level of anxiety about their health; or, 3) devoting excessive time and energy to symptoms or health concerns.

"Unless DSM-5 changes these incredibly over inclusive criteria, it will greatly increase the rates of diagnosis of mental disorders in the medically ill – whether they have established diseases (like diabetes, coronary disease or cancer) or have unexplained medical conditions that so far have presented with somatic symptoms of unclear etiology.

"The diagnosis of mental disorder will be based solely on the clinician's subjective and fallible judgment that the patient's life has become 'subsumed' with health concerns and preoccupations, or that the response to distressing somatic symptoms is 'excessive' or 'disproportionate,' or that the coping strategies to deal with the symptom are 'maladaptive'.

"These are inherently unreliable and untrustworthy judgments that will open the floodgates to the overdiagnosis of mental disorder and promote the missed diagnosis of medical disorder.

"The DSM-5 Work Group is taking a flying leap into the unknown. There are no published research data on the likely prevalence rates, clinical characteristics or treatment of 'Somatic Symptom Disorder,' or its validity and safety as a construct. Decisions to code or not to code will hang on the arbitrary and subjective perceptions of DSM end-users who often spend very little time with the patient and lack training in psychiatry etc"


Extract from Allen J Frances M.D. with Suzy Chapman
DSM5 in Distress
Mislabeling Medical Illness As Mental Disorder
The eleventh DSM 5 mistake needs an eleventh hour correction.
Posted Dec 08, 2012
 
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Countrygirl

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  • if you have been told by your GP that your ME, CFS, FM or IBS is now being managed as a MUS or PPS or under mental health disorders;
  • if you have been referred to a MUS or PPS service;
  • if your GP has recently expressed a change of views on the management of ME, CFS or has been pressuring you to accept a referral for CBT or for other psychological therapies.
  • if your GP has recently reviewed your prescription med regime and is proposing to reduce or withdraw any medications that were specifically prescribed for managing your ME, CFS symptoms.
Yes, yes, yes and yes.

Devon has been invaded by the psychobabblers.
 

Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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:jaw-drop:

She cannot be serious??!!

Do doctors really accept this rubbish?

Hard to believe.

Have they lost their collective mind?
That extract came from the Intensive Retreats - which are not the Pathways2Wellbeing sessions for MUS - but I wonder how many GPs buying into Pathways2Wellbeing will have scrutinized the group facilitators' literature.

Perhaps they get no further than:

"Potential savings
The potential savings per GP per year from using Pathways2Wellbeing groups for all medically unexplained symptoms patients is 383 hours in consultation time and includes savings of:

  • £70,757 for consultations;
  • £22,537 for prescriptions;
  • therefore the total savings for medically unexplained symptoms patients per GP per year is £93,294; and
  • GPs have an increased capacity – approximately 383 hours per year per GP – and hospital referral letters, tests, scans and appointment costs are saved amounting to approximately £133,000 for every 30 patients.
 
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MEMum

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This suggestion alone warrants a response--in the form of a mockumentary. I'm thinking a youtube skit with a clay modelling class setting. (Title, Fun with Clay, maybe? Or Clay Play...or Okay With Clay...)


I'm really looking forward to seeing this. Maybe we could take said pig, or lighter version to a #MILLIONSMISSING shoe event in May....
 

Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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In the Members Only thread, Countrygirl highlighted these extracts from

http://researchprofiles.herts.ac.uk...eaks_its_Mind_2015_The_Arts_in_Psychother.pdf

Title: The Body speaks its Mind: The BodyMind Approach® for Patients with Medically Unexplained Symptoms in Primary Care in England

The patient directs her/his attention to embodied, inner experiences of self, actively reflecting and commenting on bodily sensations as they are raised into awareness. Gradually participants become more connected to their embodied, direct experience of self and may then be able to act as their own witness and as a witness for others
Normally this patient population are resistant to attending therapy/psychological interventions often due to their explanatory model and the stigma attached to these treatments.
TBMA is not a technique but a process. It honours the legitimacy of the participant’s physical symptoms and helps to identify the psychological and social factors needed for healing. The bodymind notion is consistent with, and supported by, neurobiological models which draw on central nervous system mechanisms to explain medically unexplained symptoms.
TBMA also validates the symptom as opposed to other approaches which invalidate and/or negate the symptom e.g. terms such as psychological therapies/psychosomatic conditions which result in patients not feeling believed.
By starting where the patient is, the sensory, physical, bodily symptom is acknowledged and worked with as an ally, promoting a positive re-association with the body which has often become the ‘enemy’.
Where in the body is the displeasure and where is the more pleasurable experiences located in the body? Sitting in chairs, facing the wall, away from the circle with eyes closed (and/or with a non-moving partner as witness with eyes open) directed exercises are presented to a tight time frame.
People with MUS are often resistant to psychological therapies so it makes sense for them to attend a group where their physical symptoms are honoured.
Finally, we were invited by the local post graduate medical centre to train GPs, and trainee GPs in their final year, in the nature of MUS and the referral system to the Clinic at regular up-dating events/CPD which has helped raise awareness of the problem.
Very few self-referrals have been made by patients to date. Patients opting to self-refer on line or via the telephone (with their permission the GP would be contacted to confirm a suitable referral) would require a different belief about their symptoms i.e. that their symptoms were more than solely bodily based. However, their explanatory model is that there is an organic cause which has just not yet been detected. A different message such as ‘learn to live well with your bodily symptoms’ and ‘learn to improve your wellbeing’ is being disseminated to patients to encourage self-referrals.
The frustration felt by the GP in being unable to help this heart-sink patient has disappeared, improving their quality of life and job satisfaction.
So that's all right, then....
 

Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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This suggestion alone warrants a response--in the form of a mockumentary. I'm thinking a youtube skit with a clay modelling class setting. (Title, Fun with Clay, maybe? Or Clay Play...or Okay With Clay...)

An interviewer goes around the room asking each participant to explain their clay creation, and how it has helped "cure" them of their illness belief. They all look sick, and disinterested, because, you know...they are...

Not sure of all the details yet, but at the end, the camera pans to reveal a giant clay pig, being molded by the only enthusiastic participant--the class teacher/facilitator. The pig's purpose, of course, is to hold all of the money amassed from his/her psychobabble.

Would have to be loaded with sarcasm/wit, naturally.
Love it. It has to be "Okay With Clay".