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CBT for Health Anxiety

Summary and Comment |
October 31, 2013

CBT for Health Anxiety

  1. Peter Roy-Byrne, MD

Significant improvements occurred, even with novice therapists providing cognitive-behavioral therapy, although remission levels were disappointingly low for this severe condition.

  1. Peter Roy-Byrne, MD

Health anxiety is common and leads to persistent suffering and costly medical evaluations. In this pragmatic, randomized, controlled treatment trial, researchers identified 444 patients visiting specialty clinics in six U.K. hospitals who had high health anxiety and who met diagnostic criteria for hypochondriasis.

The patients were randomized to modified cognitive-behavioral therapy (CBT; 5−10 sessions) or standard care. Novice therapists were trained to deliver the CBT program, which was developed by some study authors. CBT patients had significantly lower levels of health anxiety than usual-care patients at 12 months, the primary outcome, and corresponding improvements in self-rated depression and anxiety symptoms. Health anxiety also improved at 3, 6, and 24 months. At 1 year, twice more CBT patients than usual-care patients had normal levels of health anxiety (14% vs. 7%). Social function, quality of life, and costs did not differ between the two groups.

Comment

This noteworthy study shows beneficial effects with novice, less costly therapists. The medical illnesses of this older population (mean age, 49) may have limited researchers' abilities to see cost reductions. The low remission level of 14% and high number needed to treat for one to improve (NNT, 14) compare less favorably with pharmacotherapy or psychotherapy for anxiety and depression, but are consistent with hypochondriasis, a more severe and difficult-to-treat illness. Broader adoption of this treatment would likely both improve patient suffering and reduce costs in younger, less medically ill patients, but other medical and psychiatric comorbidities in these patients might need to be addressed to optimize outcomes.

  • Disclosures for Peter Roy-Byrne, MD at time of publication Equity Valant Medical Solutions Grant / research support NIH-NIDA; NIH-NIMH Editorial boards Depression and Anxiety; UpToDate Leadership positions in professional societies Anxiety Disorders Association of America (Ex-Officio Board Member); Washington State Psychiatric Society (Treasurer)

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