Outcomes by Treatment Type
Table 3 shows the proportion of positive trials by major
treatment category. A positive study was defined as one in
which the treatment group fared better than the control group
on at least one of the three patient-centered outcomes. The one
treatment for which there seems to be convincing evidence is
CBT, which proved beneficial for at least one outcome in 11
of 13 trials. Of the five trials examining antidepressants, four
were positive (two trials of St. John’s wort and one of opi-
pramol for SD-spectrum disorders and one trial of fluoxetine
for BDD), whereas one was equivocal for the primary out-
come but positive for at least one secondary patient-centered
outcome (venlafaxine for SD-spectrum disorders). It should be
noted that all antidepressant trials specified a primary outcome
whereas many nonpharmacological studies did not specify a
primary outcome but simply reported multiple outcomes.
Of the other treatments, only two were evaluated in 1or
2 studies. Three of the four trials examining the effectiveness
of providing a simple psychiatric consultation letter to PCPs
were positive; the benefits were in terms of improved func-
tional status (3 of 4 positive for this outcome) rather than
reduced psychological distress (0 of 4 positive). Somatic
symptom outcomes were not assessed in any of these four
studies, although there were cost savings in all three studies
that examined this outcome. Only one of the three trials
examining the effectiveness of providing specialized training
to PCPs in managing the somatizing patient proved positive.