BACKGROUND:Patients diagnosed as having somatization disorder (SD) who present with a lifetime history of multiple, medically unexplained physical symptoms represent a significant challenge to health care providers. To date, no psychotherapeutic or pharmacologic intervention has been found to produce clinically meaningful improvement in symptoms or functioning of patients with SD. We examined the efficacy of cognitive-behavioral therapy (CBT) for SD. METHODS:Eighty-four participants meeting criteria for SD were randomly assigned to 1 of 2 conditions: (1) standard medical care augmented by a psychiatric consultation intervention or (2) a 10-session, manualized, individually administered CBT regimen added to the psychiatric consultation intervention. Assessments were conducted at baseline and 3, 9, and 15 months after baseline. The primary outcome measure was the severity scale of the Clinical Global Impression Scale for Somatization Disorder (CGI-SD). Secondary outcome measures were responder status as determined by clinical ratings, self-reported measures of physical functioning and somatic symptoms, and health care utilization assessed via medical records. RESULTS: Fifteen months after baseline, somatization symptoms were significantly less severe in the group treated with CBT (0.84 points on the CGI-SD 7-point scale) (P<.001). Patients treated with CBT also were significantly more likely to be rated as either very much improved or much improved than patients treated with only augmented standard medical care (40% [n = 17] vs 5% [n = 2]). Cognitive-behavioral therapy was associated with greater improvements in self-reported functioning and somatic symptoms and a greater decrease in health care costs. CONCLUSION: For patients diagnosed as having SD, CBT may produce clinical benefits beyond those that result from the current state-of-the-art treatment.
RCT Entities:
BACKGROUND:Patients diagnosed as having somatization disorder (SD) who present with a lifetime history of multiple, medically unexplained physical symptoms represent a significant challenge to health care providers. To date, no psychotherapeutic or pharmacologic intervention has been found to produce clinically meaningful improvement in symptoms or functioning of patients with SD. We examined the efficacy of cognitive-behavioral therapy (CBT) for SD. METHODS: Eighty-four participants meeting criteria for SD were randomly assigned to 1 of 2 conditions: (1) standard medical care augmented by a psychiatric consultation intervention or (2) a 10-session, manualized, individually administered CBT regimen added to the psychiatric consultation intervention. Assessments were conducted at baseline and 3, 9, and 15 months after baseline. The primary outcome measure was the severity scale of the Clinical Global Impression Scale for Somatization Disorder (CGI-SD). Secondary outcome measures were responder status as determined by clinical ratings, self-reported measures of physical functioning and somatic symptoms, and health care utilization assessed via medical records. RESULTS: Fifteen months after baseline, somatization symptoms were significantly less severe in the group treated with CBT (0.84 points on the CGI-SD 7-point scale) (P<.001). Patients treated with CBT also were significantly more likely to be rated as either very much improved or much improved than patients treated with only augmented standard medical care (40% [n = 17] vs 5% [n = 2]). Cognitive-behavioral therapy was associated with greater improvements in self-reported functioning and somatic symptoms and a greater decrease in health care costs. CONCLUSION: For patients diagnosed as having SD, CBT may produce clinical benefits beyond those that result from the current state-of-the-art treatment.
Authors: Katharine A Phillips; Dan J Stein; Scott L Rauch; Eric Hollander; Brian A Fallon; Arthur Barsky; Naomi Fineberg; David Mataix-Cols; Ygor Arzeno Ferrão; Sanjaya Saxena; Sabine Wilhelm; Megan M Kelly; Lee Anna Clark; Anthony Pinto; O Joseph Bienvenu; Joanne Farrow; James Leckman Journal: Depress Anxiety Date: 2010-06 Impact factor: 6.505
Authors: Jeannette M Gelauff; Yasmine E M Dreissen; Marina A J Tijssen; Jon Stone Journal: Curr Treat Options Neurol Date: 2014-04 Impact factor: 3.598
Authors: Norman H Rasmussen; David C Agerter; Robert C Colligan; Macaran A Baird; Charles E Yunghans; Stephen S Cha Journal: Ment Health Fam Med Date: 2008-09
Authors: Maria Katsamanis; Paul M Lehrer; Javier I Escobar; Michael A Gara; Anupama Kotay; Regina Liu Journal: Psychosomatics Date: 2011 May-Jun Impact factor: 2.386
Authors: Samuel Malins; Joe Kai; Christopher Atha; Anthony Avery; Boliang Guo; Marilyn James; Shireen Patel; Christopher Sampson; Michelle Stubley; Richard Morriss Journal: Br J Gen Pract Date: 2016-07-18 Impact factor: 5.386