***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Objective : To examine the additional effect of cognitive behavioural therapy for patients with medically unexplained physical symptoms in comparison with optimised medical care . Design : R and omised controlled trial with follow up assessment s six and 12 months after the baseline evaluation . Setting : General medical outpatient clinic in a university hospital . Subjects : An intervention group of 39 patients and a control group of 40 patients . Interventions : The intervention group received between six and 16 sessions of cognitive behavioural therapy . Therapeutic techniques used included identification and modification of dysfunctional automatic thoughts and behavioural experiments aim ed at breaking the vicious cycles of the symptoms and their consequences . The control group received optimised medical care . Main outcome measures : The degree of change , frequency and intensity of the presenting symptoms , psychological distress , functional impairment , hypochondriacal beliefs and attitudes , and ( at 12 months of follow up ) number of visits to the general practitioner . Results : At six months of follow up the intervention group reported a higher recovery rate ( odds ratio 0.40 ; 95 % confidence interval 0.16 to 1.00 ) , a lower mean intensity of the physical symptoms ( difference −1.2 ; −2.0 to −0.3 ) , and less impairment of sleep ( odds ratio 0.38 ; 0.15 to 0.94 ) than the controls . After adjustment for coincidental baseline differences the intervention and control groups also differed with regard to frequency of the symptoms ( 0.32 ; 0.13 to 0.77 ) , limitations in social ( 0.35 ; 0.14 to 0.85 ) and leisure ( 0.36 ; 0.14 to 0.93 ) activities , and illness behaviour ( difference −2.5 ; −4.6 to −0.5 ) . At 12 months of follow up the differences between the groups were largely maintained . Conclusion : Cognitive behavioural therapy seems to be a feasible and effective treatment in general medical patients with unexplained physical symptoms Abstract Objective : To evaluate the acceptability and efficacy of adding cognitive behaviour therapy to the medical care of patients presenting with the chronic fatigue syndrome . Design : R and omised controlled trial with final assessment at 12 months . Setting : An infectious diseases outpatient clinic . Subjects : 60 consecutively referred patients meeting consensus criteria for the chronic fatigue syndrome . Interventions : Medical care comprised assessment , advice , and follow up in general practice . Patients who received cognitive behaviour therapy were offered 16 individual weekly sessions in addition to their medical care . Main outcome measures : The proportions of patients ( a ) who achieved normal daily functioning ( Karnofsky score 80 or more ) and ( b ) who achieved a clinical ly significant improvement in functioning ( change in Karnofsky score 10 points or more ) by 12 months after r and omisation . Results : Only two eligible patients refused to participate . All r and omised patients completed treatment . An intention to treat analysis showed that 73 % ( 22/30 ) of recipients of cognitive behaviour therapy achieved a satisfactory outcome as compared with 27 % ( 8/30 ) of patients who were given only medical care ( difference 47 percentage points ; 95 % confidence interval 24 to 69 ) . Similar differences were observed in subsidiary outcome measures . The improvement in disability among patients given cognitive behaviour therapy continued after completion of therapy . Illness beliefs and coping behaviour previously associated with a poor outcome changed more with cognitive behaviour therapy than with medical care alone . Conclusion : Adding cognitive behaviour therapy to the medical care of patients with the chronic fatigue syndrome is acceptable to patients and leads to a sustained reduction in functional impairment . Key messages Key messages There is no generally accepted form of treatment New findings show that patients referred to hospital for the chronic fatigue syndrome have a better outcome if they are given a course of cognitive behaviour therapy than if they receive only basic medical care Clinical improvement with cognitive behaviour therapy may be slow but often continues after treatment has ended Cognitive behaviour therapy should be considered as an option for patients presenting with the chronic fatigue We performed a prospect i ve study to describe the broad spectrum of causes of chest pain in patients presenting to the emergency department and to compare the diagnoses in  referred patients , self-referred patients and patients rushed in by ambulance .  The final diagnosis in a consecutive case series of 578 chest pain patients was established after discharge from the hospital . The underlying disorders were grouped into cardiac , respiratory , gastro-oesophageal disorders , musculoskeletal pathology , somatization disorders , other diseases and unknown . For comparison of the frequencies of the disease categories the Chi-squared test was used . Out of 578 patients , 161 ( 27.9 % ) were self-referred , 369 ( 63.8 % ) were referred by the general practitioner  and 48 ( 8.3 % ) were rushed in by ambulance . Cardiac diseases represented 51.7 % of the cases , myocardial infa rct ion and unstable angina 19 % and 12.8 % respectively . Cardiac diseases were statistically significantly less common in self-referred patients ( p < 0.0005 ) . Pulmonary diseases encompassed 14.2 % of the population , followed by somatization disorders ( 9.2 % ) , musculoskeletal pathology ( 7.1 % ) and other causes ( 4.3 % ) . In 11.1 % of the cases no definite final diagnosis could be established . Somatization disorders were significantly more frequent in self-referred and ambulance patients . Cardiac and pulmonary problems are the most frequent underlying disorders in acute chest pain patients in the emergency department . Somatization disorders and musculoskeletal pathology represented respectively 19.1 % and 14.8 % of the non-cardiac causes . The referral pattern influenced significantly the distribution of the disease categories with more cardiac and less psychiatric disorders in referred patients Three methods of breathing retraining ( guided breathing retraining , guided breathing retraining with physiologic monitoring of thoracic and abdominal movement plus peripheral temperature , and guided breathing retraining with physiologic monitoring of thoracic and abdominal movement , peripheral temperature and end-tidal carbon dioxide ) were compared with a no-treatment control group to determine the effectiveness of breathing retraining on modifying respiratory physiology and reducing functional cardiac symptoms in subjects with signs associated with hyperventilation syndrome . Of 41 subjects studied , 16 were diagnosed with mitral valve prolapse . Results demonstrated that all 3 methods of breathing retraining were equally effective in modifying respiratory physiology and reducing the frequency of functional cardiac symptoms . Results determined that respiratory rate and subject 's perception that training had generalized were the best predictors of treatment success . Furthermore , it was found that subjects with mitral valve prolapse  responded as well to treatment as did those without prolapse Personality and life events were measured in 69 consecutive patients ( 36 men and 33 women ) below age 40 attending the emergency care unit because of chest pain without obvious organic cause ( 91 % participation rate ) . The results were compared with 32 r and omly sample d healthy subjects matched with regard to age and sex ( 86 % participation rate ) . The patient group had significantly higher scores for " neuroticism ' , ' Type A behaviour ' and ' vital exhaustion ' . Further more the patients had experienced significantly more life events , in particular uncontrollable ones , during the last year . We conclude that ' Type A behaviour ' , ' neuroticism ' , ' vital exhaustion ' and critical recent life events are linked with emergency consultation for chest pain of non-cardiac origin . Possible explanations of the link between the psychological reaction and the chest pain are enhanced tension in the thoracic muscles producing chest pain and oesophageal disorders . This study stresses the importance of careful medical and psychosocial examination of each case of unexplained chest pain at the emergency care unit 
    Output:
    
This review suggests a modest to moderate benefit for psychological interventions , particularly those using a cognitive-behavioural framework , which was largely restricted to the first three months after the intervention .
Hypnotherapy is also a possible alternative .
The evidence for brief interventions was less clear .