Cognitive behavioral therapy 'effective' for health anxiety

New research suggests that cognitive behavioral therapy is more effective at reducing health anxiety in medical patients, compared with standard care. This is according to a study published in The Lancet.

Researchers from the UK, led by Professor Peter Tyrer from Imperial College London, say an additional benefit of cognitive behavioral therapy (CBT) is that it can be delivered to patients by non-specialist staff with minimal training at minimal cost.

According to the UK's National Health Service (NHS), health anxiety, or hypochondria, is defined as obsessive worrying about health, "usually to the point where it causes great distress and affects your ability to function properly."

Health anxiety, the NHS explains, can cause some people to experience unexplained physical symptoms, such as headaches or chest pains, leading to a person assuming they are suffering from a serious disorder, regardless of a clinician's reassurance that they are healthy.

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Researchers say that 10-20% of patients experience health anxiety, but CBT therapy has been shown to help.

According to the researchers, 10-20% of hospital patients suffer from health anxiety, and this poses a substantial burden on health services since a patient's fear of having a serious disorder leads to medical consultation.

The study authors note that previous studies have demonstrated that CBT - a therapy that aims to change a person's behavior and thought patterns - is successful as a treatment for other anxiety disorders. Therefore, the researchers set out to determine whether this therapy would be effective in treating health anxiety.

Non-CBT professionals used to provide therapy

For their study, the researchers analyzed 444 patients from the CBT for Health Anxiety in Medical Patients (CHAMP) trial, aged between 16- and 75-years-old who were being treated for abnormal health anxiety.

Of these, 219 patients were randomly assigned to receive 5-10 sessions of modified cognitive behavioral treatment for health anxiety, while 225 were assigned to receive standard care.

CBT treatment was given at outpatient clinics and provided by non-CBT experts who had only been trained in two workshops, and who were supervised by more experienced CBT therapists at 2-4 week intervals.

Following the treatment, the researchers compared differences between the two groups for health anxiety, generalized anxiety, depression, social function, quality of life and the health costs over a 2-year period.

CBT 'doubles' health anxiety improvements

When the patients were followed-up 1 year after the beginning of their treatment, results showed that 13.9% of patients who received CBT treatment demonstrated normal levels of health anxiety, compared with 7.3% of patients who received standard care.

Furthermore, patients treated with CBT also showed improved generalized anxiety and depression, compared with those who received standard treatment.

The researchers note that all of these improvements were sustained 2 years after treatment and demonstrated no significant differences in cost.

Prof. Tyrer says:

"Until now, we had no evidence that health anxiety in medical settings could be successfully treated.

Our results indicate that CBT for health anxiety is relatively cheap, can be delivered by general nurses with minimal training, and could be easily rolled out in hospital settings."

CBT in health services is 'problematic'

However, in a comment article linked to the study, Chris Williams of the University of Glasgow and Allan House of the University of Leeds, say that although these findings are "intriguing," translation of these findings into health services could be "problematic."

"A challenge arises when we move from considering stand-alone therapies to thinking about service configuration, in that health anxiety is only one of the problems noted in medical outpatients," they say.

"Depression, hazardous alcohol use, poor treatment adherence, and other forms of medically unexplained presentation all press for recognition and intervention."

They note that developing "multiple parallel services makes no sense," particularly since common emotional disorders substantially overlap. They add:

"Treatment should be available in general hospital settings, in multi-disciplinary liaison psychiatry or clinical health psychology clinics that can deal with the full range of problems that present."

 

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