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Psychosocial Treatments for Multiple Unexplained Physical Symptoms: A Review of the Literature

Allen, Lesley A. PhD; Escobar, Javier I. MD; Lehrer, Paul M. PhD; Gara, Michael A. PhD; Woolfolk, Robert L. PhD

Review Articles: Review

Objective: Patients presenting with multiple medically unexplained physical symptoms, termed polysymptomatic somatizers, often incur excessive healthcare charges and fail to respond to standard medical treatment. The present article reviews the literature assessing the efficacy of psychosocial treatments for polysymptomatic somatizers.

Methods: Relevant articles were identified by scanning Medline and PsychLit. Thirty-four randomized, controlled studies were located. Whenever possible results from each study were transformed into effect sizes. An analysis of the efficacy of the psychotherapeutic approaches is provided.

Results: Various psychosocial interventions have been investigated with polysymptomatic somatizers. Although the majority of studies suggest psychosocial treatments benefit this population, the literature is tarnished by methodological shortcomings. Effect sizes are modest at best. Long-term improvement has been demonstrated in fewer than one-quarter of the trials.

Conclusions: Although seemingly beneficial, psychosocial treatments have not yet been shown to have a lasting and clinically meaningful influence on the physical complaints of polysymptomatic somatizers.

From the Department of Psychiatry (L.A.A., J.I.E., P.M.L., M.A.G.), Robert Wood Johnson Medical School–University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey; and Department of Psychology (R.L.W.), Rutgers University, New Brunswick, New Jersey.

Address reprint requests to: Lesley A. Allen, PhD, Department of Psychiatry, RWJMS–UMDNJ, 671 Hoes Lane, Piscataway, NJ 08854. Email: allenla@umdnj.edu

Received for publication March 1, 2001; revision received November 26, 2001.

Copyright © 2002 by American Psychosomatic Society
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