Objective: Few treatments for somatization have been proven effective. In the past decade, however, clinical trials of cognitive-behavioral therapy (CBT) have been promising. Our aim was to critically review and synthesize the evidence from these trials. Methods: A search of the Medline database from 1966 through July 1999 was conducted to identify controlled trials designed to evaluate the efficacy of CBT in patients with somatization or symptom syndromes. Results: A total of 31 controlled trials (29 randomized and 2 nonrandomized) were identified. Twenty-five studies targeted a specific syndrome (e.g. chronic fatigue, irritable bowel, pain) while 6 focused on more general somatization or hypochondriasis. Primary outcome assessment included physical symptoms, psychological distress and functional status in 28, 26 and 19 studies, respectively. Physical symptoms appeared the most responsive: CBT-treated patients improved more than control subjects in 71% of the studies and showed possibly greater improvement (i.e., a trend) in another 11% of the studies. A definite or possible advantage of CBT for reducing psychological distress was demonstrated in only 38 and 8% of studies, and for improving functional status in 47 and 26%. Group therapy and interventions as brief as 5 sessions proved efficacious. Benefits were sustained for up to 12 months. Conclusion: CBT can be an effective treatment for patients with somatization or symptom syndromes. Benefits can occur whether or not psychological distress is ameliorated. Since chronic symptoms are exceptionally common and most studies were conducted in referral populations, the optimal sequencing of CBT in treating primary care patients and the identification of those most likely to accept and respond to therapy should be further evaluated.
Kurt Kroenke, MD
Regenstrief Institute for Health Care, RG-6
1050 Wishard Blvd.
Indianapolis, IN 46202 (USA)
Tel. +1 317 630 7584, Fax +1 317 630 6611, E-Mail firstname.lastname@example.org
Number of Print Pages : 11
Number of Figures : 0, Number of Tables : 3, Number of References : 57
Psychotherapy and Psychosomatics
Founded 1953 as ‘Acta Psychotherapeutica et Psychosomatica’ by E.A.D.E. Carp and B. Stokvis, continued by Th. Spoerri (1964–1974) and P.E. Sifneos (1974–1991)
Vol. 69, No. 4, Year 2000 (Cover Date: July-August 2000)
Journal Editor: G.A. Fava, Bologna
ISSN: 0033–3190 (print), 1423–0348 (Online)
For additional information: http://www.karger.com/journals/pps
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