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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: Drs Barsky and Ahern¹ reported that compared with usual care, a cognitive behavior therapy (CBT) intervention in primary care, enhanced by a letter to the primary care physician that outlined the treatment strategy, improved hypochondriacal beliefs, attitudes, and anxieties, but did not significantly affect hypochondriacal somatic symptoms. I am concerned that the results do not necessarily support the use of this labor-intensive treatment.

First, as the authors pointed out, they could not separate the independent effect of the CBT intervention from that of the consultation letter that was sent to the primary care physician. This letter outlines 5 strategies that have been reported to be effective in previous work.^2-4 Thus, the appropriate comparison intervention would not be usual care, but rather the consultation letter without the CBT intervention.

Second, the results may reflect a social desirability bias. If a patient spends 6 individual counseling sessions with a . . . [Full Text of this Article]

Paula M. Trief, PhD
triefp@upstate.edu
Departments of Psychiatry and Medicine
SUNY Upstate Medical University
Syracuse, NY

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