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 opipramol 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 functional 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.