A Randomized Trial of Treatments for High-Utilizing Somatizing Patients
ABSTRACT BACKGROUND Somatization and hypochondriacal health anxiety are common sources of distress, impairment, and costly medical utilization in primary care practice. A range of interventions is needed to improve the care of these patients. OBJECTIVE To determine the effectiveness of two cognitive...
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| Veröffentlicht in: | Journal of general internal medicine : JGIM 2013-11, Vol.28 (11), p.1396-1404 |
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| creator | Barsky, Arthur J. Ahern, David K. Bauer, Mark R. Nolido, Nyryan Orav, E. John |
| description | ABSTRACT
BACKGROUND
Somatization and hypochondriacal health anxiety are common sources of distress, impairment, and costly medical utilization in primary care practice. A range of interventions is needed to improve the care of these patients.
OBJECTIVE
To determine the effectiveness of two cognitive behavioral interventions for high-utilizing, somatizing patients, using the resources found in a routine care setting.
DESIGN
Patients were randomly assigned to a two-step cognitive behavioral treatment program accompanied by a training seminar for their primary care physicians, or to relaxation training. Providers routinely working in these patients’ primary care practices delivered the cognitive behavior therapy and relaxation training. A follow-up assessment was completed immediately prior to treatment and 6 and 12 months later.
SUBJECTS
Eighty-nine medical outpatients with elevated levels of somatization, hypochondriacal health anxiety, and medical care utilization.
MEASUREMENTS
Somatization and hypochondriasis, overall psychiatric distress, and role impairment were assessed with well-validated, self-report questionnaires. Outpatient visits and medical care costs before and after the intervention were obtained from the encounter claims database.
RESULTS
At 6 month and 12 month follow-up, both intervention groups showed significant improvements in somatization (
p
< 0.01), hypochondriacal symptoms (
p
|
| doi_str_mv | 10.1007/s11606-013-2392-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3797340</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1443412944</sourcerecordid><originalsourceid>FETCH-LOGICAL-c566t-46087d36c6f20b966baeecfedb1b400e73b8786f1845fec1afdb5949915a1b1d3</originalsourceid><addsrcrecordid>eNp1kV1LHTEQhoNY6ulpf4A3slAKvUmbSbLJ5kYQabUgtLR6HbLZ5BjZ3WiyR6i_vln2VG3BqxmYZz7eeRE6BPIJCJGfM4AgAhNgmDJFsdhDK6hpjYEruY9WpGk4biTjB-hNzjekgJQ2r9EBZVxxCmyFzk6qn2bs4hAeXFddpmD6KvqSODMNbpxy5WOqzsPmGl9NoQ8PYdxUv-JgpiX9UZIZe4teedNn924X1-jq65fL03N88f3s2-nJBba1EBPmgjSyY8IKT0mrhGiNc9a7roWWE-IkaxvZCA8Nr72zYHzX1oorBbWBFjq2RsfL3NttO7jOlt3J9Po2hcGk3zqaoP-tjOFab-K9ZlKVR5Ay4ONuQIp3W5cnPYRsXd-b0cVt1sA540BVCWv0_j_0Jm7TWOTNFAXFGZkpWCibYs7J-cdjgOjZJr3YpMv39WyTFqXn6LmKx46_vhTgww4w2ZreJzPakJ84qYisYVZDFy6X0rhx6dmJL27_AxwFqno</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1442194304</pqid></control><display><type>article</type><title>A Randomized Trial of Treatments for High-Utilizing Somatizing Patients</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><creator>Barsky, Arthur J. ; Ahern, David K. ; Bauer, Mark R. ; Nolido, Nyryan ; Orav, E. John</creator><creatorcontrib>Barsky, Arthur J. ; Ahern, David K. ; Bauer, Mark R. ; Nolido, Nyryan ; Orav, E. John</creatorcontrib><description>ABSTRACT
BACKGROUND
Somatization and hypochondriacal health anxiety are common sources of distress, impairment, and costly medical utilization in primary care practice. A range of interventions is needed to improve the care of these patients.
OBJECTIVE
To determine the effectiveness of two cognitive behavioral interventions for high-utilizing, somatizing patients, using the resources found in a routine care setting.
DESIGN
Patients were randomly assigned to a two-step cognitive behavioral treatment program accompanied by a training seminar for their primary care physicians, or to relaxation training. Providers routinely working in these patients’ primary care practices delivered the cognitive behavior therapy and relaxation training. A follow-up assessment was completed immediately prior to treatment and 6 and 12 months later.
SUBJECTS
Eighty-nine medical outpatients with elevated levels of somatization, hypochondriacal health anxiety, and medical care utilization.
MEASUREMENTS
Somatization and hypochondriasis, overall psychiatric distress, and role impairment were assessed with well-validated, self-report questionnaires. Outpatient visits and medical care costs before and after the intervention were obtained from the encounter claims database.
RESULTS
At 6 month and 12 month follow-up, both intervention groups showed significant improvements in somatization (
p
< 0.01), hypochondriacal symptoms (
p
< 0.01), overall psychiatric distress (
p
< 0.01), and role impairment (
p
< 0.01). Outcomes did not differ significantly between the two groups. When both groups were combined, ambulatory visits declined from 10.3 to 8.8 (
p
= 0.036), and mean ambulatory costs decreased from $3,574 to $2,991 (
p
= 0.028) in the year preceding versus the year following the interventions. Psychiatric visits and costs were unchanged.
CONCLUSIONS
Two similar cognitive behavioral interventions, delivered with the resources available in routine primary care, improved somatization, hypochondriacal symptoms, overall psychiatric distress, and role function. They also reduced the ambulatory visits and costs of these high utilizing outpatients.</description><identifier>ISSN: 0884-8734</identifier><identifier>EISSN: 1525-1497</identifier><identifier>DOI: 10.1007/s11606-013-2392-6</identifier><identifier>PMID: 23494213</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>Adult ; Behavior therapy. Cognitive therapy ; Biological and medical sciences ; Cognitive therapy ; Cognitive Therapy - methods ; Delivery of Health Care - utilization ; Female ; Follow-Up Studies ; General aspects ; Health care expenditures ; Health services utilization ; Humans ; Hypochondria ; Hypochondriasis - diagnosis ; Hypochondriasis - psychology ; Hypochondriasis - therapy ; Internal Medicine ; Male ; Medical sciences ; Medicine ; Medicine & Public Health ; Middle Aged ; Miscellaneous ; Original Research ; Psychology. Psychoanalysis. Psychiatry ; Psychopathology. Psychiatry ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Self Report ; Somatoform Disorders - diagnosis ; Somatoform Disorders - psychology ; Somatoform Disorders - therapy ; Treatment Outcome ; Treatments</subject><ispartof>Journal of general internal medicine : JGIM, 2013-11, Vol.28 (11), p.1396-1404</ispartof><rights>Society of General Internal Medicine 2013</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c566t-46087d36c6f20b966baeecfedb1b400e73b8786f1845fec1afdb5949915a1b1d3</citedby><cites>FETCH-LOGICAL-c566t-46087d36c6f20b966baeecfedb1b400e73b8786f1845fec1afdb5949915a1b1d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3797340/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3797340/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,724,777,781,882,27905,27906,41469,42538,51300,53772,53774</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27907510$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23494213$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Barsky, Arthur J.</creatorcontrib><creatorcontrib>Ahern, David K.</creatorcontrib><creatorcontrib>Bauer, Mark R.</creatorcontrib><creatorcontrib>Nolido, Nyryan</creatorcontrib><creatorcontrib>Orav, E. John</creatorcontrib><title>A Randomized Trial of Treatments for High-Utilizing Somatizing Patients</title><title>Journal of general internal medicine : JGIM</title><addtitle>J GEN INTERN MED</addtitle><addtitle>J Gen Intern Med</addtitle><description>ABSTRACT
BACKGROUND
Somatization and hypochondriacal health anxiety are common sources of distress, impairment, and costly medical utilization in primary care practice. A range of interventions is needed to improve the care of these patients.
OBJECTIVE
To determine the effectiveness of two cognitive behavioral interventions for high-utilizing, somatizing patients, using the resources found in a routine care setting.
DESIGN
Patients were randomly assigned to a two-step cognitive behavioral treatment program accompanied by a training seminar for their primary care physicians, or to relaxation training. Providers routinely working in these patients’ primary care practices delivered the cognitive behavior therapy and relaxation training. A follow-up assessment was completed immediately prior to treatment and 6 and 12 months later.
SUBJECTS
Eighty-nine medical outpatients with elevated levels of somatization, hypochondriacal health anxiety, and medical care utilization.
MEASUREMENTS
Somatization and hypochondriasis, overall psychiatric distress, and role impairment were assessed with well-validated, self-report questionnaires. Outpatient visits and medical care costs before and after the intervention were obtained from the encounter claims database.
RESULTS
At 6 month and 12 month follow-up, both intervention groups showed significant improvements in somatization (
p
< 0.01), hypochondriacal symptoms (
p
< 0.01), overall psychiatric distress (
p
< 0.01), and role impairment (
p
< 0.01). Outcomes did not differ significantly between the two groups. When both groups were combined, ambulatory visits declined from 10.3 to 8.8 (
p
= 0.036), and mean ambulatory costs decreased from $3,574 to $2,991 (
p
= 0.028) in the year preceding versus the year following the interventions. Psychiatric visits and costs were unchanged.
CONCLUSIONS
Two similar cognitive behavioral interventions, delivered with the resources available in routine primary care, improved somatization, hypochondriacal symptoms, overall psychiatric distress, and role function. They also reduced the ambulatory visits and costs of these high utilizing outpatients.</description><subject>Adult</subject><subject>Behavior therapy. Cognitive therapy</subject><subject>Biological and medical sciences</subject><subject>Cognitive therapy</subject><subject>Cognitive Therapy - methods</subject><subject>Delivery of Health Care - utilization</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>General aspects</subject><subject>Health care expenditures</subject><subject>Health services utilization</subject><subject>Humans</subject><subject>Hypochondria</subject><subject>Hypochondriasis - diagnosis</subject><subject>Hypochondriasis - psychology</subject><subject>Hypochondriasis - therapy</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Miscellaneous</subject><subject>Original Research</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. Psychiatry</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Self Report</subject><subject>Somatoform Disorders - diagnosis</subject><subject>Somatoform Disorders - psychology</subject><subject>Somatoform Disorders - therapy</subject><subject>Treatment Outcome</subject><subject>Treatments</subject><issn>0884-8734</issn><issn>1525-1497</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp1kV1LHTEQhoNY6ulpf4A3slAKvUmbSbLJ5kYQabUgtLR6HbLZ5BjZ3WiyR6i_vln2VG3BqxmYZz7eeRE6BPIJCJGfM4AgAhNgmDJFsdhDK6hpjYEruY9WpGk4biTjB-hNzjekgJQ2r9EBZVxxCmyFzk6qn2bs4hAeXFddpmD6KvqSODMNbpxy5WOqzsPmGl9NoQ8PYdxUv-JgpiX9UZIZe4teedNn924X1-jq65fL03N88f3s2-nJBba1EBPmgjSyY8IKT0mrhGiNc9a7roWWE-IkaxvZCA8Nr72zYHzX1oorBbWBFjq2RsfL3NttO7jOlt3J9Po2hcGk3zqaoP-tjOFab-K9ZlKVR5Ay4ONuQIp3W5cnPYRsXd-b0cVt1sA540BVCWv0_j_0Jm7TWOTNFAXFGZkpWCibYs7J-cdjgOjZJr3YpMv39WyTFqXn6LmKx46_vhTgww4w2ZreJzPakJ84qYisYVZDFy6X0rhx6dmJL27_AxwFqno</recordid><startdate>20131101</startdate><enddate>20131101</enddate><creator>Barsky, Arthur J.</creator><creator>Ahern, David K.</creator><creator>Bauer, Mark R.</creator><creator>Nolido, Nyryan</creator><creator>Orav, E. John</creator><general>Springer US</general><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20131101</creationdate><title>A Randomized Trial of Treatments for High-Utilizing Somatizing Patients</title><author>Barsky, Arthur J. ; Ahern, David K. ; Bauer, Mark R. ; Nolido, Nyryan ; Orav, E. John</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c566t-46087d36c6f20b966baeecfedb1b400e73b8786f1845fec1afdb5949915a1b1d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Behavior therapy. Cognitive therapy</topic><topic>Biological and medical sciences</topic><topic>Cognitive therapy</topic><topic>Cognitive Therapy - methods</topic><topic>Delivery of Health Care - utilization</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>General aspects</topic><topic>Health care expenditures</topic><topic>Health services utilization</topic><topic>Humans</topic><topic>Hypochondria</topic><topic>Hypochondriasis - diagnosis</topic><topic>Hypochondriasis - psychology</topic><topic>Hypochondriasis - therapy</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Miscellaneous</topic><topic>Original Research</topic><topic>Psychology. Psychoanalysis. Psychiatry</topic><topic>Psychopathology. Psychiatry</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Self Report</topic><topic>Somatoform Disorders - diagnosis</topic><topic>Somatoform Disorders - psychology</topic><topic>Somatoform Disorders - therapy</topic><topic>Treatment Outcome</topic><topic>Treatments</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Barsky, Arthur J.</creatorcontrib><creatorcontrib>Ahern, David K.</creatorcontrib><creatorcontrib>Bauer, Mark R.</creatorcontrib><creatorcontrib>Nolido, Nyryan</creatorcontrib><creatorcontrib>Orav, E. John</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of general internal medicine : JGIM</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Barsky, Arthur J.</au><au>Ahern, David K.</au><au>Bauer, Mark R.</au><au>Nolido, Nyryan</au><au>Orav, E. John</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Randomized Trial of Treatments for High-Utilizing Somatizing Patients</atitle><jtitle>Journal of general internal medicine : JGIM</jtitle><stitle>J GEN INTERN MED</stitle><addtitle>J Gen Intern Med</addtitle><date>2013-11-01</date><risdate>2013</risdate><volume>28</volume><issue>11</issue><spage>1396</spage><epage>1404</epage><pages>1396-1404</pages><issn>0884-8734</issn><eissn>1525-1497</eissn><abstract>ABSTRACT
BACKGROUND
Somatization and hypochondriacal health anxiety are common sources of distress, impairment, and costly medical utilization in primary care practice. A range of interventions is needed to improve the care of these patients.
OBJECTIVE
To determine the effectiveness of two cognitive behavioral interventions for high-utilizing, somatizing patients, using the resources found in a routine care setting.
DESIGN
Patients were randomly assigned to a two-step cognitive behavioral treatment program accompanied by a training seminar for their primary care physicians, or to relaxation training. Providers routinely working in these patients’ primary care practices delivered the cognitive behavior therapy and relaxation training. A follow-up assessment was completed immediately prior to treatment and 6 and 12 months later.
SUBJECTS
Eighty-nine medical outpatients with elevated levels of somatization, hypochondriacal health anxiety, and medical care utilization.
MEASUREMENTS
Somatization and hypochondriasis, overall psychiatric distress, and role impairment were assessed with well-validated, self-report questionnaires. Outpatient visits and medical care costs before and after the intervention were obtained from the encounter claims database.
RESULTS
At 6 month and 12 month follow-up, both intervention groups showed significant improvements in somatization (
p
< 0.01), hypochondriacal symptoms (
p
< 0.01), overall psychiatric distress (
p
< 0.01), and role impairment (
p
< 0.01). Outcomes did not differ significantly between the two groups. When both groups were combined, ambulatory visits declined from 10.3 to 8.8 (
p
= 0.036), and mean ambulatory costs decreased from $3,574 to $2,991 (
p
= 0.028) in the year preceding versus the year following the interventions. Psychiatric visits and costs were unchanged.
CONCLUSIONS
Two similar cognitive behavioral interventions, delivered with the resources available in routine primary care, improved somatization, hypochondriacal symptoms, overall psychiatric distress, and role function. They also reduced the ambulatory visits and costs of these high utilizing outpatients.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>23494213</pmid><doi>10.1007/s11606-013-2392-6</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0884-8734 |
| ispartof | Journal of general internal medicine : JGIM, 2013-11, Vol.28 (11), p.1396-1404 |
| issn | 0884-8734 1525-1497 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3797340 |
| source | MEDLINE; Springer Nature - Complete Springer Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Adult Behavior therapy. Cognitive therapy Biological and medical sciences Cognitive therapy Cognitive Therapy - methods Delivery of Health Care - utilization Female Follow-Up Studies General aspects Health care expenditures Health services utilization Humans Hypochondria Hypochondriasis - diagnosis Hypochondriasis - psychology Hypochondriasis - therapy Internal Medicine Male Medical sciences Medicine Medicine & Public Health Middle Aged Miscellaneous Original Research Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Public health. Hygiene Public health. Hygiene-occupational medicine Self Report Somatoform Disorders - diagnosis Somatoform Disorders - psychology Somatoform Disorders - therapy Treatment Outcome Treatments |
| title | A Randomized Trial of Treatments for High-Utilizing Somatizing Patients |
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