Psychiatry Xagena

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Clinical effectiveness of cognitive behaviour therapy for health anxiety in medical patients

Health anxiety has been treated by therapists expert in cognitive behaviour therapy with some specific benefit in some patients referred to psychological services. Those in hospital care have been less often investigated. Following a pilot trial suggesting efficacy researchers have carried out a randomised study in hospital medical clinics.

A multicentre, randomised trial on health anxious patients attending cardiac, endocrine, gastroenterological, neurological, and respiratory medicine clinics in secondary care was undertook.
Researchers have included those aged 16-75 years, who satisfied the criteria for excessive health anxiety, and were resident in the area covered by the hospital, were not under investigation for new pathology or too medically unwell to take part.

It was used a computer-generated random scheme to allocate eligible medical patients to an active treatment group of five-to-ten sessions of adapted cognitive behaviour therapy ( CBT-HA group ) delivered by hospital-based therapists or to standard care in the clinics.

The primary outcome was change in health anxiety symptoms measured by the Health Anxiety Inventory at 1 year.

Analysis was by intention to treat.

Of 28 991 patients screened, 444 were randomly assigned to receive either adapted cognitive behaviour therapy ( CBT-HA group, 219 participants ) or standard care ( standard care group, 225 ), with 205 participants in the CBT-HA group and 212 in the standard care group included in the analyses of the primary endpoints.

At 1 year, improvement in health anxiety in the patients in the CBT-HA group was 2.98 points greater than in those in the standard care group ( 95% CI 1.64-4.33, p less than 0.0001 ), and twice as many patients receiving cognitive behaviour therapy achieved normal levels of health anxiety compared with those in the control group ( 13.9% vs 7.3%; odds ratio, OR=2.15, 95% CI 1.09-4.23, p=0.0273 ).

Similar differences were observed at 6 months and 2 years, and there were concomitant reductions in generalised anxiety and, to a lesser extent, depression.

Of nine deaths, six were in the control group; all were due to pre-existing illness.

Social functioning or health-related quality of life did not differ significantly between groups.

This form of adapted cognitive behaviour therapy for health anxiety led to sustained symptomatic benefit over 2 years, with no significant effect on total costs. It deserves wider application in medical care. ( Xagena )

Tyrer P et al, The Lancet 2014; 383: 219-225