Cognitive-behavioral therapy for somatization and symptom syndromes: A critical review of controlled clinical trials

Objective: Few treatments for somatization have been proven effective. In t he past decade, however, clinical trials of cognitive-behavioral therapy (C BT) have been promising. Our aim was to critically review and synthesize th e evidence from these trials. Methods: A search of the Medline database fro m 1966 through July 1999 was conducted to identify controlled trials design ed to evaluate the efficacy of CBT in patients with somatization or symptom syndromes. Results: A total of 31 controlled trials (29 randomized and 2 n onrandomized) were identified. Twenty-five studies targeted a specific synd rome (e.g. chronic fatigue, irritable bowel, pain) while 6 focused on more general somatization or hypochondriasis. Primary outcome assessment include d physical symptoms, psychological distress and functional status in 28, 26 and 19 studies, respectively. Physical symptoms appeared the most responsi ve: 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 ps ychological 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 wi th somatization or symptom syndromes. Benefits can occur whether or not psy chological distress is ameliorated. Since chronic symptoms are exceptionall y common and most studies were conducted in referral populations, the optim al sequencing of CBT in treating primary care patients and the identificati on of those most likely to accept and respond to therapy should be further evaluated. Copyright (C) 2000 S. Karger AG. Basel.