Therapy for psychosomatic symptomsWhen the body carries the stress.

The NHS describes medically unexplained symptoms as persistent physical symptoms, such as pain or dizziness, that doctors cannot link to a medical condition, and stresses that they are real and can affect daily life (NHS). Common examples include muscle or joint pain, back pain, headaches, tiredness, feeling faint, chest pain, palpitations and stomach problems (NHS). Some people experience less common symptoms such as numbness, weakness or seizures.

The word "psychosomatic" is sometimes heard as an accusation. In fact, it describes something everyone experiences: a racing heart before a speech, a stomach that tightens with worry, shoulders that rise towards the ears during a hard week. When stress is intense or long-lasting, these ordinary reactions can become persistent and distressing in their own right. Symptoms may also be partly physical and partly influenced by stress, and the line between the two is not always clear.

Psychosomatic symptoms are often maintained by a cycle that is easy to fall into and hard to see from the inside. A physical sensation appears, perhaps during a stressful period. You notice it, worry about what it means and start to monitor it closely. Attention and worry raise tension and arousal in the body, which makes the sensation stronger or more frequent. You may begin to avoid activity, rest more, search online or seek repeated reassurance, all understandable, but each of which can keep the focus on the symptom and reduce the things that help you feel well.

Low mood and anxiety can amplify the cycle. The NHS notes that some people with unexplained symptoms also have depression or anxiety, which can make physical symptoms worse, and that treating these can often relieve physical symptoms (NHS).

Two reviews give a balanced picture. A Cochrane review of 21 studies with 2,658 participants found that psychological therapies, mostly forms of cognitive behavioural therapy, reduced symptom severity compared with usual care or waiting lists, with a small to medium effect on average; CBT was the only approach studied thoroughly enough to support tentative conclusions, and the overall quality of evidence was low to moderate (van Dessel et al., 2014). A separate meta-analysis of people with severe somatoform disorder in specialist care found psychotherapy more effective than usual treatment for physical symptoms and day-to-day functioning, with effects maintained at follow-up (Koelen et al., 2014).

In plain language: therapy helps many people, but not everyone, and improvements are often gradual rather than dramatic. We think it is important to say that clearly.

See a doctor first, and urgently if you have chest pain, sudden weakness or numbness, fainting, severe breathlessness or any symptom that is new or rapidly worsening. Consider therapy, alongside medical care, if:

• tests have not found a cause and symptoms continue to limit your life;
• worry about your health takes up a lot of your time;
• you are avoiding activities, work or social life because of symptoms;
• symptoms tend to flare with stress, conflict or emotional strain;
• you are also feeling low, anxious or exhausted.

If you feel hopeless or have thoughts of harming yourself, please seek urgent help. Online therapy is not an emergency service.