Efficacy of Treatment for Somatoform Disorders: A Review of Randomized Controlled Trials
Psychosomatic MedicinePublished 1 November 2007
Kurt Kroenke
Citations444
SJR quartileQ2
SJR score1.00
SNIP0.84
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TL;DR
CBT is the best established treatment for a variety of somatoform disorders, with some benefit also demonstrated for a consultation letter to the primary care physician.
Abstract
CBT is the best established treatment for a variety of somatoform disorders, with some benefit also demonstrated for a consultation letter to the primary care physician. Preliminary but not yet conclusive evidence exists for antidepressants.
Keywords
PsychologyMedicineArts and Humanities
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