Yet,it is also possible that pre-treatment variables associated with differential referral to out-patient and in patient care responsible for these findings.Moreover, we found no difference in the effectiveness of group v. individual therapy; this is in contrast to results form a previous meta analysis that included also patients with less severe somatoform disorder,underscoring the need for a separate meta-analysis focusing on patients with severe disorder only.Generally,elderly patients benefited less from psychotherapy,which indicates that some elements of the treatment may need to be adapted to the patient's age.