Abstract
Evidence-based medicine (EBM) is the integration of best external evidence with clinical expertise and patient values. The full-blown practice of EBM comprises the following 5 steps ; 1. converting the need for information (e.g. diagnosis, prognosis, therapy, and prevention) into an answerable question, 2. tracking down the best evidence with which to answer that question, 3. critically appraising that evidence for its validity, impact, and applicability, 4. integrating the critical appraisal with our clinical expertise and with the patient's unique biology, values and circumstances, and 5. evaluating our effectiveness and efficiency in executing steps 1 to 4 and seeking ways to improve them both for next time. Psychosomatic medicine is comprised of different approaches including internal medicine, psychiatry, behavioral medicine, psychology, and sociology, and it should be recognized and applied in the mainstream of medicine, and many researchers and practitioners are needed to be involved in establishing the EBM of psychosomatic medicine. In the education program at the 52th Annual Conference of the Japanese Society of Psychosomatic Medicine, two previous studies of our own were exemplified to learn how to create and utilize EBM ; one was a meta-analysis of treatment effects of biofeedback in essential hypertension (2003), and the other was a randomized controlled study of cognitive-behavioral therapy (CBT) in hypochondriacal patients (2011). In the latter study, a total of 182 hypochondriacal participants were randomly assigned to a CBT or control group. CBT consisted of six, weekly 90-minute sessions. The control subjects received the usual medical care during the same period. Of greater interest, baseline anxiety was a significant predictor of outcome, measured in terms of reduced hypochondriacal symptoms at follow up, after controlling for the effects of depression and demographic variables. These findings are comparable to those of our previous study with a different sample (2001) which had shown that anxiety, rather than depression, was a significant predictor of the outcome of a 10-week behavioral medicine intervention combining CBT and relaxation training, even though this previous study did not include a control group. The findings are plausible in the context of the association between hypochondriais and anxiety, and more evidence is needed to clarify such relationship.
