What is already known on this topic?

Many patients who experience significant health anxiety and somatisation, and who also over-utilise medical services, are unresponsive to standard medical care.1 Cognitive behavioural therapy (CBT) has been shown to provide modest reductions in symptomatology and healthcare utilisation in these patients.1 Relaxation training (RT) also has been shown to benefit this population, but has been less widely studied.1

What does this paper add?

• Given that somatising patients often fail to pursue mental health referrals, stepped-care approaches to treatment within primary care have been suggested. Stepped-care approaches provide a very brief intervention to all patients and a more intensive treatment to the subset of patients who are unresponsive to the initial brief intervention. Barsky and colleagues’ study extended the scope of previous research on treatment of somatising patients1 by examining the effectiveness of a stepped-care cognitive-behavioral approach administered by primary care clinicians in a primary care treatment setting.

• This is the first direct comparison, conducted in primary care, of the clinical effectiveness of cognitive behavioural therapy and relaxation training for easing hypochondriacal beliefs and somatisation symptoms.

Limitations

• Although the study examined a group of patients …