1
|
Burton-Fisher W, Gordon K. Holding the hope? Therapist and client perspectives on long COVID recovery: A Q-methodology. Br J Health Psychol 2024; 29:746-770. [PMID: 38735864 DOI: 10.1111/bjhp.12724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 04/12/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE Long COVID is a global health concern which has debilitating effects on the individual experiencing it. In the United Kingdom, psychological therapies are being offered to people with long COVID, although the evidence for these therapies is yet to be demonstrated. This research aimed to understand how therapists and clients define and understand recovery from long COVID, and use hope theory to interpret the results. METHODS An online Q-methodology was employed, where participants sorted a range of statements pertaining to long COVID recovery based on their level of agreement with them. These arranged statements (Q-sorts) were collated and factor analysed to explore and compare underlying perspectives. RESULTS Sixteen participants were recruited for the study, including eleven clients, four IAPT therapists and one therapist working in the broader long COVID pathway. A four-factor model is reported, including (1) Psychological Pathways to Recovery, (2) Social Context and Agency, (3) Physiological Goals of Recovery and (4) Personal Meaning Making. All IAPT therapists loaded onto the psychological pathways factor, whereas the remaining participants shared more diverse perspectives. CONCLUSIONS The belief that long COVID recovery was possible, taken as an indicator of hopefulness, was rated highest for Factor 1, Psychological Pathways to Recovery, and Factor 3, Physiological Recovery Goals. This suggested that having a clear definition of recovery, or clear guidance on how to intervene, promoted hopefulness and, theoretically, well-being. However, clients reported experiences of being invalidated and disbelieved by health professionals, with psychological explanations sometimes being experienced as dismissive and invalidating. Clinical implications and future research directions are discussed.
Collapse
Affiliation(s)
| | - Kim Gordon
- Professional Doctorate in Clinical Psychology, Staffordshire University, Staffordshire, United Kingdom
| |
Collapse
|
2
|
Sun W, Fang S, Wang Y, Zheng Y, Zhou X, Yi Y, Xiong X, Wang J. Prevalence and associated factors of health anxiety in patients with temporomandibular disorders. Oral Dis 2024. [PMID: 38852160 DOI: 10.1111/odi.15037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/23/2024] [Accepted: 05/24/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVES To investigate the prevalence and associated factors of health anxiety (HA) in patients with Temporomandibular Disorders (TMDs) using the 8-item Whiteley Index (WI-8) scale. MATERIALS AND METHODS Three hundred and twenty-nine TMDs patients completed the Visual Analog Scale (VAS), WI-8, Jaw Functional Limitation Scale-8 (JFLS-8), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) scales. Clinical examinations were conducted following the Diagnostic Criteria for TMDs Axis I. RESULTS The prevalence of HA among TMDs patients was 18.54%. Patients with HA had higher scores of VAS-current (p = 0.026), VAS-maximum (p = 0.024), VAS-average (p = 0.030), JFLS-8 (p < 0.001), GAD-7 (p < 0.001) and PHQ-9 (p < 0.001), lower maximum mouth opening (p = 0.016), lower proportion of structure-related TMDs (p = 0.028), and higher proportion of pain-related TMDs (p < 0.001) compared to those without HA. The correlation coefficient was 0.61 (p < 0.001) between WI-8 and GAD-7 and 0.64 (p < 0.001) between WI-8 and PHQ-9. CONCLUSION Approximately one-fifth of patients with TMDs experienced HA. HA was associated with pain perception, functional limitations, depressive, and anxiety symptoms in individuals with TMDs. HA may contribute to heightened subjective pain experiences rather than structural changes in the TMJ.
Collapse
Affiliation(s)
- Wentian Sun
- National Clinical Research Center for Oral Diseases, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Shanbao Fang
- Department of Orthodontics, College & Hospital of Stomatology, Guangxi Medical University, Nanning, Guangxi, China
| | - Yu Wang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yunhao Zheng
- National Clinical Research Center for Oral Diseases, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Xueman Zhou
- National Clinical Research Center for Oral Diseases, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yating Yi
- National Clinical Research Center for Oral Diseases, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Xin Xiong
- National Clinical Research Center for Oral Diseases, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Temporomandibular Joint, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jun Wang
- National Clinical Research Center for Oral Diseases, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
3
|
Ingeman K, Frostholm L, Wellnitz KB, Wright K, Frydendal DH, Onghena P, Rask CU. Internet-Delivered Therapy for Parents With Health Anxiety by Proxy: Protocol for a Single-Case Experimental Design Study. JMIR Res Protoc 2023; 12:e46927. [PMID: 37999936 DOI: 10.2196/46927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Health anxiety (HA) by proxy is described as parents' obsessive worries that their child is severely ill although this is not medically confirmed. Research on HA by proxy suggests that it is highly distressing for the parent and that the child may be at risk of developing maladaptive symptom coping strategies. No targeted treatment for this group exists. We developed PROXY, an 8-week psychological internet-delivered treatment for parents with HA by proxy. The treatment components of PROXY are informed by cognitive behavioral therapy as well as acceptance and commitment therapy, and it was developed in collaboration with parents experiencing HA by proxy and clinical experts. OBJECTIVE This paper describes the protocol for a study investigating the potential effects of PROXY on parents' worries about their children's health using a single-case experimental design (SCED). METHODS Five parents clinically evaluated as experiencing HA by proxy will be included. A replicated randomized SCED study will be conducted in which each participant will be randomized to receive treatment after a baseline period of between 7 and 26 days (phase A). The treatment phase duration is 8 weeks for all participants (phase B), followed by a follow-up phase lasting between 14 and 33 days (phase C), ensuring that all participants remain in the study for 96 days. Participants will report daily anxiety level by SMS text message throughout the study. They will also answer self-report questionnaires, including questions on HA by proxy and own HA, 4 times during the study. Data will be submitted to structured visual analysis to inspect anxiety level, the variability of anxiety, trends, the overlap of data points among phases, when effects occur, and the consistency of data patterns across participants. Furthermore, randomization tests will be conducted for each participant to test the null hypothesis that PROXY will have no effect on participants' anxiety. RESULTS The recruitment of parents began in June 2022. As of March 2, 2023, a total of 4 parents have been included in the study. Data collection was expected to cease in April 2023. CONCLUSIONS To the best of our knowledge, this protocol describes the only study of treatment for HA by proxy. As the prevalence of this condition is still unknown, a SCED was chosen because this method allows the inclusion of very few participants while still providing information on effects and treatment courses. Conducting the study with a replicated randomized phase design enables methodologically sound testing despite the inclusion of very few participants. The results will inform researchers on individual treatment courses and effects, which may direct future research in terms of the possible mechanisms of change, ideas for how to refine the treatment content, and how the treatment may be offered to patients in the future. TRIAL REGISTRATION ClinicalTrials.gov NCT04830605; https://clinicaltrials.gov/study/NCT04830605. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46927.
Collapse
Affiliation(s)
- Katrine Ingeman
- Research Unit, Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Lisbeth Frostholm
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Kaare Bro Wellnitz
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Kristi Wright
- Department of Psychology, Faculty of Arts, University of Regina, Regina, SK, Canada
| | - Ditte Hoffmann Frydendal
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Patrick Onghena
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Charlotte Ulrikka Rask
- Research Unit, Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
4
|
Rauwenhoff JCC, Bol Y, Peeters F, van den Hout AJHC, Geusgens CAV, van Heugten CM. Acceptance and commitment therapy for individuals with depressive and anxiety symptoms following acquired brain injury: A non-concurrent multiple baseline design across four cases. Neuropsychol Rehabil 2023; 33:1018-1048. [PMID: 35332849 PMCID: PMC10292126 DOI: 10.1080/09602011.2022.2053169] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
Patients with acquired brain injury (ABI) often experience symptoms of anxiety and depression. Until now, evidence-based treatment is scarce. This study aimed to investigate the effectiveness of Acceptance and Commitment Therapy (ACT) for patients with ABI. To evaluate the effect of ACT for people with ABI, a non-concurrent multiple baseline design across four cases was used. Participants were randomly assigned to a baseline period, followed by treatment and then follow-up phases. Anxiety and depressive symptoms were repeatedly measured. During six measurement moments over a year, participants filled in questionnaires measuring anxiety, depression, stress, participation, quality of life, and ACT-related processes. Randomization tests and NAP scores were used to calculate the level of change across phases. Clinically significant change was defined with the Reliable Change Index. Three out of four participants showed medium to large decreases in anxiety and depressive symptoms (NAP = 0.85 till 0.99). Furthermore, participants showed improvements regarding stress, cognitive fusion, and quality of life. There were no improvements regarding psychological flexibility, value-driven behaviour, or social participation. This study shows that ACT is possibly an effective treatment option for people experiencing ABI-related anxiety and depression symptoms. Replication with single case or large scale group studies is needed to confirm these findings.
Collapse
Affiliation(s)
- Johanne C. C. Rauwenhoff
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Limburg Brain Injury Centre, Maastricht, Netherlands
| | - Yvonne Bol
- Department of Clinical and Medical Psychology, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, Netherlands
| | - Frenk Peeters
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Anja J. H. C. van den Hout
- Department of Clinical and Medical Psychology, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, Netherlands
| | - Chantal A. V. Geusgens
- Department of Clinical and Medical Psychology, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, Netherlands
| | - Caroline M. van Heugten
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Limburg Brain Injury Centre, Maastricht, Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
5
|
Sorid SD, Yap DL, Bravo AJ, Behar E. The Moderating Role of Intolerance of Uncertainty in the Relationship Between Health Anxiety and Pandemic-Related Stress. COGNITIVE THERAPY AND RESEARCH 2023; 47:340-349. [PMID: 37168694 PMCID: PMC10025784 DOI: 10.1007/s10608-023-10365-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2023] [Indexed: 05/13/2023]
Abstract
Background and Objectives Global pandemics, including COVID-19, have a significant effect on mental health, and this may be especially true for individuals with health anxiety. Although health anxiety is related to both pandemic-related fears and perceptions of health risks, there is a paucity of research on individual difference variables that might exert an influence on these relationships. The present study examined intolerance of uncertainty (IU) as a potential moderator of the relationship between health anxiety and COVID-related stress, and the relationship between health anxiety and perceived risk of contracting COVID. Design and Methods A nationally representative sample of North American adults (N = 204) completed self-report measures of health anxiety, IU, COVID-related stress, and perceived risk of contracting COVID. Results Prospective IU moderated the positive relationship between health anxiety and COVID-related stress, as the relationship was strengthened at average and higher levels of prospective IU. Neither IU subscale moderated the relationship between health anxiety and perceived risk. Conclusion These results suggest that individuals with elevated health anxiety and high prospective IU may be at higher risk of experiencing COVID-related stress, illuminating the interplay of risk factors that place anxious populations at an increased risk of experiencing stress during acute health risks. Supplementary Information The online version contains supplementary material available at 10.1007/s10608-023-10365-w.
Collapse
Affiliation(s)
- Samantha D. Sorid
- William & Mary, Williamsburg, United States
- Department of Psychology, Temple University, Philadelphia, United States
| | - David L. Yap
- Hunter College, City University of New York, New York, United States
- The Graduate Center, City University of New York, New York, United States
| | | | - Evelyn Behar
- Hunter College, City University of New York, New York, United States
- The Graduate Center, City University of New York, New York, United States
| |
Collapse
|
6
|
Frydendal DH, Rask CU, Jensen JS, Wellnitz KB, Frostholm L. Mindful non-reactivity and psychological flexibility mediate the effect of internet-delivered acceptance and commitment therapy for health anxiety. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
|
7
|
Kancherla N, Vanka SC, Pokhrel S, Shahzadi RB, Vijaya Durga Pradeep G. The Development of Illness Anxiety Disorder in a Patient After Partial Thyroidectomy. Cureus 2022; 14:e25416. [PMID: 35769682 PMCID: PMC9233939 DOI: 10.7759/cureus.25416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 11/12/2022] Open
Abstract
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), characterises illness anxiety disorder (IAD) as the preoccupation with having or acquiring a serious illness in the absence of somatic symptoms (or, if present, symptoms that are only mild in severity). DSM-5 includes illness anxiety disorder in the category called somatic symptom and related disorders, characterised by prominent somatic concerns, distress, and impaired functioning. More often than in psychiatric settings, individuals with illness anxiety disorder are encountered in primary care and specialist medical settings. Despite negative laboratory results, the benign course of the alleged disease over time, and adequate reassurances from specialists, their conviction of being ill persists. Illness anxiety preoccupations are heterogeneous, and the degree of insight is variable. Their illness-related preoccupation interferes with their relationships with family, friends, and coworkers. They are frequently addicted to internet searches about their feared illness, inferring the worst from the information (or false information) they uncover. Patients with illness anxiety disorder often have comorbid psychopathology, especially anxiety and depressive disorders. Typically, illness anxiety disorder is chronic. Physical symptoms are absent or mild and frequently represent a misinterpretation of normal bodily sensations. This case report presents the case of a patient diagnosed with IAD by a psychiatrist. The patient had been seen by his primary care physician and therapist for three years without any improvement in his symptoms before he was referred to a psychiatrist. After undergoing a partial thyroidectomy in 2018, this patient has been experiencing increasing symptoms of recurrent anxiety/fear consistent with IAD, despite extensive medical examinations that have consistently revealed normal results.
Collapse
|
8
|
Shi C, Taylor S, Witthöft M, Du X, Zhang T, Lu S, Ren Z. Attentional bias toward health-threat in health anxiety: a systematic review and three-level meta-analysis. Psychol Med 2022; 52:604-613. [PMID: 35341486 DOI: 10.1017/s0033291721005432] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Attentional bias toward health-threat may theoretically contribute to the development and maintenance of health anxiety, but the empirical findings have been controversial. This study aimed to synthesize and explore the heterogeneity in a health-threat related attentional bias of health-anxious individuals, and to determine the theoretical model that better represents the pattern of attentional bias in health anxiety. Four databases (Web of Science, PubMed, PsycINFO, and Scopus) were searched for relevant studies, with 17 articles (N = 1546) included for a qualitative review and 16 articles (18 studies) for a three-level meta-analysis (N = 1490). The meta-analytic results indicated that the health anxiety group, compared to the control group, showed significantly greater attentional bias toward health-threat (g = 0.256). Further analyses revealed that attentional bias type, paradigm, and stimuli type were significant moderators. Additionally, compared to the controls, health-anxious individuals displayed significantly greater attention maintenance (g = 0.327) but nonsignificant attention vigilance to health-threat (g = -0.116). Our results provide evidence for the attention maintenance model in health-anxious individuals. The implications for further research and treatment of elevated health anxiety in the context of coronavirus disease-2019 (COVID-19) were also discussed.
Collapse
Affiliation(s)
- Congrong Shi
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Steven Taylor
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Xiayu Du
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Tao Zhang
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Shan Lu
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Zhihong Ren
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| |
Collapse
|
9
|
Risør BW, Frydendal DH, Villemoes MK, Nielsen CP, Rask CU, Frostholm L. Cost Effectiveness of Internet-Delivered Acceptance and Commitment Therapy for Patients with Severe Health Anxiety: A Randomised Controlled Trial. PHARMACOECONOMICS - OPEN 2022; 6:179-192. [PMID: 34997899 PMCID: PMC8864054 DOI: 10.1007/s41669-021-00319-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/19/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Health anxiety is a prevalent and debilitating disorder associated with extensive use of healthcare services and reduced quality of life (QoL). Regional variability in specialised clinics or specialist healthcare providers limits access to evidence-based treatment, which may be overcome by internet-delivered Acceptance and Commitment Therapy (iACT). OBJECTIVE This study investigated the cost effectiveness of iACT for severe health anxiety in adults. METHODS Based on a Danish randomised controlled trial (March 2016-March 2017), the economic evaluation compared costs and effects between iACT and an active control condition (iFORUM). Effectiveness was measured using self-report questionnaires. The cost analysis applied a societal perspective. Resource use and healthcare costs were extracted from the Danish National Registries. Linear regression analysis was applied using change in costs/effectiveness outcomes as the dependant variable. Time, group, and interaction between time and group were independent variables. The primary outcome was the proportion of clinically significant improvements, defined as a ≥ 25% reduction in two measures of health anxiety. The probability of cost effectiveness was presented in a cost-effectiveness acceptability curve for a range of threshold values for willingness to pay. RESULTS No significant differences were detected in healthcare costs between groups; however, the iACT group significantly improved in all effectiveness outcomes. The economic analysis showed that, from the healthcare perspective, iACT was associated with an incremental cost-effectiveness ratio of €33 per additional case of clinically significant improvement compared with iFORUM and that, from the societal perspective, iACT dominated iFORUM because it was more effective and less expensive. CONCLUSIONS We found no statistically significant differences in costs between groups; however, iACT for severe health anxiety may be cost effective, as evidenced by significant differences in effect. TRIAL REGISTRY NUMBER Clinicaltrials.gov, no. NCT02735434.
Collapse
Affiliation(s)
- Bettina Wulff Risør
- DEFACTUM, Central Denmark Region, Olof Palmes Allé 15, 8200, Aarhus N, Denmark.
| | - Ditte Hoffmann Frydendal
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, University City 21 and 23, 8000, Aarhus C, Denmark
| | | | - Camilla Palmhøj Nielsen
- DEFACTUM, Central Denmark Region, Olof Palmes Allé 15, 8200, Aarhus N, Denmark
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Palle Juul Jensens Boulevard 175, Entrance K, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Incuba Skejby, Building 2, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Lisbeth Frostholm
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, University City 21 and 23, 8000, Aarhus C, Denmark
- Department of Clinical Medicine, Aarhus University, Incuba Skejby, Building 2, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| |
Collapse
|
10
|
Hoffmann D, Rask CU, Hedman-Lagerlöf E, Jensen JS, Frostholm L. Efficacy of internet-delivered acceptance and commitment therapy for severe health anxiety: results from a randomized, controlled trial. Psychol Med 2021; 51:2685-2695. [PMID: 32404226 PMCID: PMC8579157 DOI: 10.1017/s0033291720001312] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 04/06/2020] [Accepted: 04/21/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Health anxiety is common, disabling and costly due to patients' extensive use of health care services. Internet-delivered treatment may overcome barriers of accessibility to specialized treatment. We aimed to evaluate the efficacy of internet-delivered acceptance and commitment therapy (iACT). METHODS A randomized, controlled trial of iACT versus an internet-delivered discussion forum (iFORUM), performed in a Danish university hospital setting. Patients self-referred and underwent video-diagnostic assessment. Eligible patients (≥18 years) with health anxiety were randomized to 12 weeks of intervention. The randomization was blinded for the assessor. The primary outcome was between-group unadjusted mean differences in health anxiety symptoms measured by the Whiteley-7 Index (WI-7, range 0-100) from baseline to 6-month follow-up (6-MFU) using intention to treat and a linear mixed model. The study is registered at clinicaltrials.gov, number NCT02735434. RESULTS A total of 151 patients self-referred, and 101 patients were randomized to iACT (n = 53) or iFORUM (n = 48). A mean difference in change over time of 19.0 points [95% confidence interval (CI) 10.8-27.2, p < 0.001] was shown on the WI-7, and a large standardized effect size of d = 0.80 (95% CI 0.38-1.23) at 6-MFU. The number needed to treat was 2.8 (95% CI 1.8-6.1, p < 0.001), and twice as many patients in iACT were no longer clinical cases (35% v. 16%; risk ratio 2.17, 95% CI 1.00-4.70, p = 0.050). Adverse events were few and insignificant. CONCLUSIONS iACT for health anxiety led to sustained effects at 6-MFU. The study contributes to the development of easily accessible treatment options and deserves wider application.
Collapse
Affiliation(s)
- Ditte Hoffmann
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, bldg. 2C, 1, 8000Aarhus C, Denmark
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 175, ent. K, 8200Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200, Aarhus, Denmark
| | - Erik Hedman-Lagerlöf
- Department of Clinical Neuroscience, Karolinska Institute, Tomtebodavägen 18A, 5, 171 77Stockholm, Sweden
| | - Jens Søndergaard Jensen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, bldg. 2C, 1, 8000Aarhus C, Denmark
| | - Lisbeth Frostholm
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, bldg. 2C, 1, 8000Aarhus C, Denmark
| |
Collapse
|
11
|
Abstract
Health anxiety, formerly part of hypochondriasis, but now reformulated as excessive concern about health and, by extension, illness, comprises a large proportion of consultations in hospital practice. For too long it has been ignored in practice and not formally treated. This belief is no longer tenable, and in the last few years a number of easily administered psychological treatments have shown consistent benefit that help patients, practitioners and planners of services. A stepped care approach in which physicians and nurses are first helped to identify health anxiety, explain its significance to patients and then, if necessary, administer these treatments in the clinical setting without referral to psychiatric services, is recommended as a way forward. This approach should be embraced in secondary care.
Collapse
|
12
|
Sica C, Caudek C, Cerea S, Colpizzi I, Caruso M, Giulini P, Bottesi G. Health Anxiety Predicts the Perceived Dangerousness of COVID-19 over and above Intrusive Illness-Related Thoughts, Contamination Symptoms, and State and Trait Negative Affect. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1933. [PMID: 33671223 PMCID: PMC7922316 DOI: 10.3390/ijerph18041933] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/03/2021] [Accepted: 02/12/2021] [Indexed: 02/07/2023]
Abstract
This study sought to evaluate the specificity of health anxiety, relative to other forms of psychopathology, in perceptions of COVID-19 as dangerous. Measures of health anxiety, COVID-19 perceived dangerousness, negative affect, anxiety, depression, stress, contamination-related obsessions and compulsions, and intrusive illness-related thoughts were administered online to 742 community individuals during the Italian national lockdown. Results showed that, after controlling for demographic variables and other internalizing problems, health anxiety was the single most important factor associated with the perceived dangerousness of COVID-19. Moreover, a comparison between the current sample's scores on various symptom measures and scores from prepandemic Italian samples revealed that, whereas other internalizing symptoms increased by a large or very large magnitude during the pandemic, levels of health anxiety and negative affect increased by a medium amount. This result may indicate that health anxiety is relatively trait-like, increasing the likelihood that our correlational data support the model of health anxiety as a vulnerability rather than an outcome. Together, these results indicate that health anxiety may be a specific risk factor for COVID-related maladjustment and support the distinction of health anxiety from other psychological problems.
Collapse
Affiliation(s)
- Claudio Sica
- Department of Health Sciences, Psychology Section, University of Firenze, Via San Salvi, 12, 50135 Firenze, Italy; (C.S.); (I.C.); (M.C.); (P.G.)
| | - Corrado Caudek
- Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Firenze, Via San Salvi, 12, 50135 Firenze, Italy;
| | - Silvia Cerea
- Department of General Psychology, University of Padova, Via Venezia, 8, 35131 Padova, Italy;
| | - Ilaria Colpizzi
- Department of Health Sciences, Psychology Section, University of Firenze, Via San Salvi, 12, 50135 Firenze, Italy; (C.S.); (I.C.); (M.C.); (P.G.)
| | - Maria Caruso
- Department of Health Sciences, Psychology Section, University of Firenze, Via San Salvi, 12, 50135 Firenze, Italy; (C.S.); (I.C.); (M.C.); (P.G.)
| | - Paolo Giulini
- Department of Health Sciences, Psychology Section, University of Firenze, Via San Salvi, 12, 50135 Firenze, Italy; (C.S.); (I.C.); (M.C.); (P.G.)
| | - Gioia Bottesi
- Department of General Psychology, University of Padova, Via Venezia, 8, 35131 Padova, Italy;
| |
Collapse
|
13
|
Sauer KS, Witthöft M. Krankheitsängste und Hypochondrische Störung. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2020; 88:730-744. [PMID: 33187009 DOI: 10.1055/a-1165-7461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Fears of getting a severe disease (health anxiety) are widespread and their pathological manifestation as Hypochondriacal disorder (ICD-10) is cost-intensive for the health care system. In recent years advances in the research on and development of effective psychotherapeutic treatments have been made. Cognitive-behavioral therapy concepts currently are treatments of choice for Hypochondriacal disorder.
Collapse
|
14
|
Osaji J, Ojimba C, Ahmed S. The Use of Acceptance and Commitment Therapy in Substance Use Disorders: A Review of Literature. J Clin Med Res 2020; 12:629-633. [PMID: 33029268 PMCID: PMC7524566 DOI: 10.14740/jocmr4311] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/18/2020] [Indexed: 12/18/2022] Open
Abstract
Background Acceptance and commitment therapy (ACT) is a form of behavioral therapy that teaches people to learn to accept rather than avoid challenging situations in their lives. ACT has shown to be an intervention with great success in the reduction of various mental disorders and substance use disorders (SUDs). The core of ACT when used in SUD treatment is guiding people to accept the urges and symptoms associated with substance misuse (acceptance) and use psychological flexibility and value-based interventions to reduce those urges and the symptoms (commitment). The purpose of this study is to review the existing literature to examine the evidence on the use of ACT in the management of SUD. Methods A thorough search of four databases (CINAHL, PubMed.gov, PsycINFO and PsycNET) from 2011 to 2020 was conducted using search terms like ACT, ACT and SUD, ACT, and substance misuse. The articles retrieved were critically appraised using the Critically Appraised Topic (CAT) Checklist. Results Most of the studies showed that ACT was effective in the management of SUD showing significant evidence of a reduction in substance use or total discontinuation with subsequent abstinence. Conclusions The literature review concluded that success has been achieved using ACT either as monotherapy or in combination with other therapy in the treatment of individuals with SUD.
Collapse
Affiliation(s)
- Joy Osaji
- Texas Tech University Health Science Center, Lubbock, TX, USA
| | | | - Saeed Ahmed
- Rutland Regional Medical Center, Rutland, VT, USA
| |
Collapse
|
15
|
Menon V, Kar SK, Tripathi A, Nebhinani N, Varadharajan N. Cyberchondria: conceptual relation with health anxiety, assessment, management and prevention. Asian J Psychiatr 2020; 53:102225. [PMID: 32585634 DOI: 10.1016/j.ajp.2020.102225] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/06/2020] [Accepted: 06/11/2020] [Indexed: 01/25/2023]
Abstract
There is a need to synthesize available information on the emerging construct of cyberchondria to guide evidence informed practice. With this in mind, electronic search of databases including MEDLINE via PubMed, Cochrane Library, ScienceDirect and Google scholar were carried out from inception till March 2020 to identify relevant English language peer reviewed articles related to cyberchondria. Generated abstracts were grouped according to their thematic focus and summarized. A total of 49 articles were reviewed. Articles directly evaluating cyberchondria were very few and most of the treatment evidence was extrapolated from trials on health anxiety. Cyberchondria appears to be a phenomenologically overlapping entity with, yet distinguishable from, health anxiety and there may be merit in studying the two constructs separately. Four validated self-assessment measures for cyberchondria are available in literature. Cognitive behaviour therapy (CBT) delivered either physically or through the internet (iCBT) have been found to be effective for both health anxiety and cyberchondria. Pharmacologic strategies for health anxiety have mainly involved the use of Selective Serotonin Reuptake Inhibitors, with mean effective dosages higher than for depression/anxiety. Prevention of cyberchondria needs to focus on appropriate harm reduction strategies as well as supply and demand side measures. Internet based CBT therapies hold promise for management of cyberchondria. This finding must be considered preliminary due to limited evidence. Further study is required to establish the diagnostic validity of cyberchondria.
Collapse
Affiliation(s)
- Vikas Menon
- Dept of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India.
| | - Sujita Kumar Kar
- Dept of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Adarsh Tripathi
- Dept of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Naresh Nebhinani
- Dept of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Natarajan Varadharajan
- Dept of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India
| |
Collapse
|
16
|
Landi G, Pakenham KI, Boccolini G, Grandi S, Tossani E. Health Anxiety and Mental Health Outcome During COVID-19 Lockdown in Italy: The Mediating and Moderating Roles of Psychological Flexibility. Front Psychol 2020; 11:2195. [PMID: 32982888 PMCID: PMC7488226 DOI: 10.3389/fpsyg.2020.02195] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/05/2020] [Indexed: 12/22/2022] Open
Abstract
The COVID-19 emergency has severely affected the Italian population. During a pandemic, those with high health anxiety are at risk of adverse mental health outcomes, including peritraumatic distress and mood disturbance. No prior research has explored the role of psychological flexibility in protecting people at high risk of poorer mental health impacts due to health anxiety during a pandemic. Psychological flexibility is the cornerstone of psychological health and resiliency. According to acceptance and commitment therapy (ACT), it involves behaving consistently with one's chosen values even in the presence of emotional and mental discomfort. This study examined the mediating and moderating roles of psychological flexibility in the link between trait health anxiety and three mental health outcomes: COVID-19 peritraumatic distress, anxiety, and depression. We hypothesized that higher psychological flexibility would decrease the negative impacts of trait health anxiety on mental health outcomes. During the mandatory national lockdown (M = 35.70 days, SD = 8.41), 944 Italian adults (75.5% female, M = 38.86 years, SD = 13.20) completed an online survey consisting of standardized measures of psychological flexibility, trait health anxiety, COVID-19 distress, anxiety, and depression. Results indicated that psychological flexibility did not moderate the link between trait health anxiety and mental health outcomes. Rather, greater psychological flexibility mediated decreases in the adverse effects of trait health anxiety on COVID-19 distress, anxiety, and depression. In particular, two psychological flexibility processes, observing unhelpful thoughts rather than taking them literally (defusion) and values-based action (committed action), mediated decreases in the negative effects of trait health anxiety on all mental health outcomes. In contrast, the psychological flexibility process acceptance, which involves openness to inner discomfort, mediated increases in negative mental health outcomes. Overall, the combination of these processes mitigated the detrimental impacts of trait health anxiety on mental health during the emergency mandatory COVID-19 nationwide lockdown. Consistent with the ACT conceptualization of psychological flexibility, findings suggest embracing (rather than avoiding) inner discomfort and observing associated unhelpful thoughts, while also engaging in values-based action, increases resilience during adversity. Evidenced-based large-scale online public health interventions that target psychological flexibility in those experiencing health anxiety in the context of a pandemic are urgently needed. Many empirically-based ACT interventions are suited for this purpose.
Collapse
Affiliation(s)
- Giulia Landi
- Department of Psychology, University of Bologna, Bologna, Italy
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Cesena, Italy
| | - Kenneth I. Pakenham
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Giada Boccolini
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Cesena, Italy
| | - Silvana Grandi
- Department of Psychology, University of Bologna, Bologna, Italy
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Cesena, Italy
| | - Eliana Tossani
- Department of Psychology, University of Bologna, Bologna, Italy
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Cesena, Italy
| |
Collapse
|
17
|
Maass U, Kühne F, Maas J, Unverdross M, Weck F. Psychological Interventions for Health Anxiety and Somatic Symptoms. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1027/2151-2604/a000400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. This study examined the effectiveness of psychological interventions for severe health anxiety (SHA) regarding somatic symptoms (SS) and health anxiety (HA). The databases Web of Science, EBSCO, and CENTRAL were searched on May 15, 2019, May 16, 2019, and August 5, 2019, respectively. Eighteen randomized controlled trials ( N = 2,050) met the inclusion criteria (i.e., hypochondriasis, illness anxiety disorder or somatic symptom disorder with elevated HA being assessed with validated interviews; use of standardized outcome measures). Two reviewers independently evaluated the studies’ risk of bias using the Revised Cochrane Risk-of-Bias Tool for randomized trials (RoB-2) tool. Overall, psychological interventions were significantly more effective than waitlist, treatment-as-usual, or placebo post-treatment ( gSS = 0.70, gHA = 1.11) and at follow-up ( gSS = 0.33, gHA = 0.70). CBT outperformed other psychological interventions or pharmacotherapy for HA post-treatment (Hedge’s gHA = 0.81). The number of sessions did not significantly predict the effect sizes. In sum, psychological interventions were effective for SHA, but the generalizability of the results for SS is limited, because only two high-quality trials contributed to the comparisons.
Collapse
Affiliation(s)
- Ulrike Maass
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Potsdam, Germany
| | - Franziska Kühne
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Potsdam, Germany
| | - Jana Maas
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Potsdam, Germany
| | - Maria Unverdross
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Potsdam, Germany
| | - Florian Weck
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Potsdam, Germany
| |
Collapse
|
18
|
Hoffmann D, Rask CU, Hedman-Lagerlöf E, Eilenberg T, Frostholm L. Accuracy of self-referral in health anxiety: comparison of patients self-referring to internet-delivered treatment versus patients clinician-referred to face-to-face treatment. BJPsych Open 2019; 5:e80. [PMID: 31496462 PMCID: PMC6737511 DOI: 10.1192/bjo.2019.54] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 06/28/2019] [Accepted: 06/28/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Severe health anxiety is a chronic and costly disorder if untreated. Patient self-referral may lower barriers to treatment and decrease diagnostic delay. AIMS This study evaluated the accuracy of self-referral for severe health anxiety and compared characteristics of patients self-referred to internet-delivered treatment with patients referred by a clinician to face-to-face treatment. METHOD Two trials in the same clinic employed different referral methods for health anxiety, namely self-referral and clinician-referral (trial registration: clinicaltrials.gov: NCT01158430 and NCT02735434). The trials were conducted at different time points but with largely comparable eligibility criteria. The accuracy of the recruitment methods was compared by looking at the number of eligible patients in the two trials. Patients completed a baseline questionnaire and subsequently underwent a diagnostic interview by experienced clinicians. Mean differences in self-report and clinical data explored between-group demographic and clinical characteristics. RESULTS In total, 101/151 (67%) self-referred patients were eligible compared with 126/254 (50%) clinician-referred patients (P = 0.001). Self-referred patients were 3.4 years older (P = 0.008) and had a somewhat higher educational level (P = 0.030). Patients who self-referred reported significantly higher levels of health anxiety, emotional distress and somatic symptoms compared with clinician-referred patients. Yet, they had less clinician-assessed comorbid anxiety disorders (P<0.001) and better physical health-related quality of life (P<0.001) suggesting a more distinct symptom profile. CONCLUSIONS Self-referral was found to be an accurate method to recruit highly relevant patients with treatment-demanding health anxiety. Thus, both self-referral and clinician-referral seem feasible and valid referral methods, but they may recruit patients with slightly different characteristics. DECLARATION OF INTEREST None.
Collapse
Affiliation(s)
- Ditte Hoffmann
- Postdoctoral Researcher, The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - Charlotte Ulrikka Rask
- Professor, Child and Adolescent Psychiatric Centre, Risskov, Aarhus University Hospital, Denmark
| | - Erik Hedman-Lagerlöf
- Associate Professor, Department of Clinical Neuroscience, Karolinska Institute, Sweden
| | - Trine Eilenberg
- Clinical Psychologist, Department of Occupational Medicine, Aarhus University Hospital, Denmark
| | - Lisbeth Frostholm
- Associate Professor, The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| |
Collapse
|
19
|
Abstract
Illness anxiety disorder is a primary disorder of anxiety about having or developing a serious illness. The core feature is the cycle of worry and reassurance seeking regarding health, as opposed to a focus on relief of distress caused by somatic symptoms (as in Somatic Symptom Disorder). Clinically significant health anxiety is common, with estimates ranging up to 13% in the general adult population. There are evidence-based treatments, including psychopharmacology and cognitive behavioral therapy, that can significantly alleviate symptoms. An understanding of the core psychopathology and clinical features of illness anxiety disorder is essential to fostering a working alliance with patients with health anxiety, as is the maintenance of an empathic, curious, and nonjudgmental stance toward their anxiety. Collaboration between medical providers is essential to avoid the pitfalls of excess testing and medical treatment.
Collapse
|
20
|
Rimvall MK, Jespersen CP, Clemmensen L, Munkholm A, Skovgaard AM, Verhulst F, van Os J, Rask CU, Jeppesen P. Psychotic experiences are associated with health anxiety and functional somatic symptoms in preadolescence. J Child Psychol Psychiatry 2019; 60:524-532. [PMID: 30289180 DOI: 10.1111/jcpp.12986] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Health anxiety (HA) is an increasing public health problem related to increased health service costs, and associated with functional somatic symptoms (FSS) and considerable personal suffering. Abnormal bodily experiences which may resemble HA and FSS are common in psychotic disorders, but a potential link between HA and psychosis vulnerability in childhood is largely unexplored. The current study estimates the association between subclinical psychotic experiences (PE) and HA and FSS in a general population cohort of preadolescents. METHODS The study population consisted of 1,572 11-12-year-old children from the Copenhagen Child Cohort 2000. PE were comprehensibly assessed as either present or not present using the Kiddie Schedule of Affective Disorders and Schizophrenia psychosis section. HA and FSS were assessed by self-report on validated questionnaires. Additional variables on general psychopathology, puberty, and chronic somatic illness were also obtained. RESULTS Psychotic experiences were associated with the top 10% high scores of HA (Odds Ratio (OR) 3.2; 95% CI: 2.1-4.8) and FSS (OR 4.6; 95% CI: 3.1-6.9) in univariate analyses. After mutual adjustment, the association was reduced to (HA: OR 2.3; 95% CI: 1.5-3.5; FSS: OR 3.7; 95% CI: 2.4-4.7), suggesting interdependence. Further adjustment for potential confounders and general psychopathology only reduced the associations slightly: HA OR 2.2 (95% CI: 1.4-3.4); FSS OR 3.3 (95% CI: 2.1-5.2). Secondary analyses of subdimensions of HA showed that PE were associated with fears (OR 3.0; 95% CI: 2.0-4.6) and daily impact of HA symptoms (OR 5.0; 95% CI: 3.4-7.5), but not help seeking (OR 1.2; 95% CI: 0.7-2.1). CONCLUSIONS This is the first study to investigate the associations between PE and HA and FSS, respectively. PE were significantly associated with HA and FSS over and above general psychopathology in preadolescence. Individuals with PE expressed high levels of health-related fears and daily impact, but no corresponding help-seeking behavior.
Collapse
Affiliation(s)
- Martin K Rimvall
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Cecilia Pihl Jespersen
- Department of Child and Adolescent Psychiatry, Research Unit, Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Clemmensen
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Glostrup, Denmark
| | - Anja Munkholm
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Glostrup, Denmark
| | - Anne Mette Skovgaard
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Frank Verhulst
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jim van Os
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands.,Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Psychosis Studies, King's College London, King's Health Partners, Institute of Psychiatry, London, UK
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Research Unit, Psychiatry, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Pia Jeppesen
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
21
|
Pedersen HF, Agger JL, Frostholm L, Jensen JS, Ørnbøl E, Fink P, Schröder A. Acceptance and Commitment group Therapy for patients with multiple functional somatic syndromes: a three-armed trial comparing ACT in a brief and extended version with enhanced care. Psychol Med 2019; 49:1005-1014. [PMID: 29941062 DOI: 10.1017/s0033291718001666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Psychological treatment for functional somatic syndromes (FSS) has been found moderately effective. Information on how much treatment is needed to obtain improvement is sparse. We assessed the efficacy of a brief and extended version of group-based Acceptance and Commitment Therapy (ACT) v. enhanced care (EC) for patients with multiple FSS operationalised as Bodily Distress Syndrome multi-organ type. METHODS In a randomised controlled three-armed trial, consecutively referred patients aged 20-50 with multiple FSS were randomly assigned to either (1) EC; (2) Brief ACT: EC plus 1-day workshop and one individual consultation; or (3) Extended ACT: EC plus nine 3-h group-based sessions. Primary outcome was patient-rated overall health improvement on the five-point clinical global improvement scale 14 months after randomisation. A proportional odds model was used for the analyses. RESULTS A total of 180 patients were randomised; 60 to EC, 61 to Brief ACT, and 59 to Extended ACT. Improvement on the primary outcome after Extended ACT was significantly greater than after EC with an unadjusted OR of 2.9 [95% CI (1.4-6.2), p = 0.006]. No significant differences were found between Brief ACT and EC. Of the 18 secondary outcomes, the only significant difference found was for physical functioning in the comparison of Extended ACT with EC. CONCLUSIONS Patients rated their overall health status as more improved after Extensive ACT than after EC; however, clinically relevant secondary outcome measures did not support this finding. Discrepancies between primary and secondary outcomes in this trial are discussed.
Collapse
Affiliation(s)
- Heidi Frølund Pedersen
- The Research Clinic for Functional Disorders and Psychosomatics,Aarhus University Hospital,Noerrebrogade 44,8000 Aarhus C.,Denmark
| | - Johanne L Agger
- The Research Clinic for Functional Disorders and Psychosomatics,Aarhus University Hospital,Noerrebrogade 44,8000 Aarhus C.,Denmark
| | - Lisbeth Frostholm
- The Research Clinic for Functional Disorders and Psychosomatics,Aarhus University Hospital,Noerrebrogade 44,8000 Aarhus C.,Denmark
| | - Jens S Jensen
- The Research Clinic for Functional Disorders and Psychosomatics,Aarhus University Hospital,Noerrebrogade 44,8000 Aarhus C.,Denmark
| | - Eva Ørnbøl
- The Research Clinic for Functional Disorders and Psychosomatics,Aarhus University Hospital,Noerrebrogade 44,8000 Aarhus C.,Denmark
| | - Per Fink
- The Research Clinic for Functional Disorders and Psychosomatics,Aarhus University Hospital,Noerrebrogade 44,8000 Aarhus C.,Denmark
| | - Andreas Schröder
- The Research Clinic for Functional Disorders and Psychosomatics,Aarhus University Hospital,Noerrebrogade 44,8000 Aarhus C.,Denmark
| |
Collapse
|
22
|
Third Wave Treatments for Functional Somatic Syndromes and Health Anxiety Across the Age Span: A Narrative Review. CLINICAL PSYCHOLOGY IN EUROPE 2019. [DOI: 10.32872/cpe.v1i1.32217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Functional disorders (FD) are present across the age span and are commonly encountered in somatic health care. Psychological therapies have proven effective, but mostly the effects are slight to moderate. The advent of third wave cognitive behavioural therapies launched an opportunity to potentially improve treatments for FD.A narrative review of the literature on the application of mindfulness-based therapies (MBT) and Acceptance & Commitment Therapy (ACT) in children and adult populations with FD.There were very few and mainly preliminary feasibility studies in children and adolescents. For adults there were relatively few trials of moderate to high methodological quality. Ten MBT randomised trials and 15 ACT randomised trials of which 8 were internet-delivered were identified for more detailed descriptive analysis. There was no evidence to suggest higher effects of third wave treatments as compared to CBT. For MBT, there seemed to be minor effects comparable to active control conditions. A few interventions combining second and third wave techniques found larger effects, but differences in outcomes, formats and dosage hamper comparability.Third wave treatments are getting established in treatment delivery and may contribute to existing treatments for FD. Future developments could further integrate second and third wave treatments across the age span. Elements unambiguously targeting specific illness beliefs and exposure should be included. The benefit of actively engaging close relatives in the treatment not only among younger age groups but also in adults, as well as the effect of more multimodal treatment programmes including active rehabilitation, needs to be further explored.The methodological quality of third wave interventions for FD should be improved, especially in younger age groups.The effect of ACT interventions may be comparable to CBT in adults with FD.The evidence for third wave interventions in young people with FD is still very limited.Newer studies combining second and third wave treatments show some promise.Agreement on, and for child populations further development of, core outcomes, could help determine effect across studies.The methodological quality of third wave interventions for FD should be improved, especially in younger age groups.The effect of ACT interventions may be comparable to CBT in adults with FD.The evidence for third wave interventions in young people with FD is still very limited.Newer studies combining second and third wave treatments show some promise.Agreement on, and for child populations further development of, core outcomes, could help determine effect across studies.
Collapse
|
23
|
Skjernov M, Fink P, Fallon B, Rasmussen F, Simonsen E. Feasibility Study of Group Cognitive Behavioral Therapy for Severe Health Anxiety. J Cogn Psychother 2018; 32:223-240. [PMID: 32746404 DOI: 10.1891/0889-8391.32.4.223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Severe health anxiety (SHA) is prevalent, often undiagnosed, persistent untreated, and costly. Meta-analyses have shown effectiveness of mostly individual cognitive behavioral therapy (CBT), whereas Group-CBT has only been studied and shown feasibility in one uncontrolled study of psychiatric outpatients also including self-referrals. We aimed to examine feasibility of Group-CBT for physician-referred psychiatric outpatients with SHA and a future randomized controlled trial (RCT). Group-CBT was conducted in two groups of seven participants. Feasibility was examined about recruitment rate, attrition, organization, and effectiveness. Effectiveness was measured by standardized self-report questionnaires: Whiteley Index-7 (WI-7) and Short Health Anxiety Inventory, and clinician rated remission and functioning from baseline to 3-month follow-up (3FU). Recruitment rate was 1.4 participant per month. Attrition showed dropout of 7%. Organization harbored only one senior therapist. Group-CBT showed effectiveness on all measures except WI-7 at 3FU; this latter explained by participants with concurrent borderline personality disorder. Group-CBT seems feasible for physician-referred psychiatric outpatients with SHA. With modifications, an RCT seems feasible.
Collapse
Affiliation(s)
- Mathias Skjernov
- Clinic for Liaison Psychiatry in Koege, Region Zealand, Denmark .,Psychiatric Research Unit, Region Zealand, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus, Denmark
| | - Brian Fallon
- Columbia University Medical Center, New York City, New York
| | | | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| |
Collapse
|
24
|
Abstract
PURPOSE OF REVIEW To examine the diagnosis of health anxiety, its prevalence in different settings, public health significance, treatment, and outcome. RECENT FINDINGS Health anxiety is similar to hypochondriasis but is characterized by fear of, rather than conviction of, illness. Lifetime prevalence rates are 6% in the population and as high as 20% in hospital out-patients, leading to greater costs to health services through unnecessary medical contacts. Its prevalence may be increasing because of excessive internet browsing (cyberchondria). Drug treatment with antidepressants has some efficacy but is not well-liked, but psychological treatments, including cognitive behavior therapy, stress management, mindfulness training, and acceptance and commitment therapy, given either individually, in groups, or over the Internet, have all proved efficacious in both the short and longer term. Untreated health anxiety leads to premature mortality. Health anxiety has become an increasing clinical and public health issue at a time when people are being formally asked to take more responsibility in monitoring their own health. More attention by health services is needed.
Collapse
|
25
|
Tyrer P, Salkovskis P, Tyrer H, Wang D, Crawford MJ, Dupont S, Cooper S, Green J, Murphy D, Smith G, Bhogal S, Nourmand S, Lazarevic V, Loebenberg G, Evered R, Kings S, McNulty A, Lisseman-Stones Y, McAllister S, Kramo K, Nagar J, Reid S, Sanatinia R, Whittamore K, Walker G, Philip A, Warwick H, Byford S, Barrett B. Cognitive-behaviour therapy for health anxiety in medical patients (CHAMP): a randomised controlled trial with outcomes to 5 years. Health Technol Assess 2018; 21:1-58. [PMID: 28877841 DOI: 10.3310/hta21500] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Health anxiety is an under-recognised but frequent cause of distress that is potentially treatable, but there are few studies in secondary care. OBJECTIVE To determine the clinical effectiveness and cost-effectiveness of a modified form of cognitive-behaviour therapy (CBT) for health anxiety (CBT-HA) compared with standard care in medical outpatients. DESIGN Randomised controlled trial. SETTING Five general hospitals in London, Middlesex and Nottinghamshire. PARTICIPANTS A total of 444 patients aged 16-75 years seen in cardiology, endocrinology, gastroenterology, neurology and respiratory medicine clinics who scored ≥ 20 points on the Health Anxiety Inventory (HAI) and satisfied diagnostic requirements for hypochondriasis. Those with current psychiatric disorders were excluded, but those with concurrent medical illnesses were not. INTERVENTIONS Cognitive-behaviour therapy for health anxiety - between 4 and 10 1-hour sessions of CBT-HA from a health professional or psychologist trained in the treatment. Standard care was normal practice in primary and secondary care. MAIN OUTCOME MEASURES Primary - researchers masked to allocation assessed patients at baseline, 3, 6, 12, 24 months and 5 years. The primary outcome was change in the HAI score between baseline and 12 months. Main secondary outcomes - costs of care in the two groups after 24 and 60 months, change in health anxiety (HAI), generalised anxiety and depression [Hospital Anxiety and Depression Scale (HADS)] scores, social functioning using the Social Functioning Questionnaire and quality of life using the EuroQol-5 Dimensions (EQ-5D), at 6, 12, 24 and 60 months, and deaths over 5 years. RESULTS Of the 28,991 patients screened over 21 months, 5769 had HAI scores of ≥ 20 points. Improvement in HAI scores at 3 months was significantly greater in the CBT-HA group (mean number of sessions = 6) than in the standard care, and this was maintained over the 5-year period (overall p < 0.0001), with no loss of efficacy between 2 and 5 years. Differences in the generalised anxiety (p = 0.0018) and depression scores (p = 0.0065) on the HADS were similar in both groups over the 5-year period. Gastroenterology and cardiology patients showed the greatest CBT gains. The outcomes for nurses were superior to those of other therapists. Deaths (n = 24) were similar in both groups; those in standard care died earlier than those in CBT-HA. Patients with mild personality disturbance and higher dependence levels had the best outcome with CBT-HA. Total costs were similar in both groups over the 5-year period (£12,590.58 for CBT-HA; £13,334.94 for standard care). CBT-HA was not cost-effective in terms of quality-adjusted life-years, as measured using the EQ-5D, but was cost-effective in terms of HAI outcomes, and offset the cost of treatment. LIMITATIONS Many eligible patients were not randomised and the population treated may not be representative. CONCLUSIONS CBT-HA is a highly effective treatment for pathological health anxiety with lasting benefit over 5 years. It also improves generalised anxiety and depressive symptoms more than standard care. The presence of personality abnormality is not a bar to successful outcome. CBT-HA may also be cost-effective, but the high costs of concurrent medical illnesses obscure potential savings. This treatment deserves further research in medical settings. TRIAL REGISTRATION Current Controlled Trials ISRCTN14565822. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 50. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Peter Tyrer
- Centre for Psychiatry, Imperial College London, London, UK
| | | | - Helen Tyrer
- Centre for Psychiatry, Imperial College London, London, UK
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Simon Dupont
- Central and North West London NHS Foundation Trust, London, UK
| | - Sylvia Cooper
- Centre for Psychiatry, Imperial College London, London, UK
| | - John Green
- Central and North West London NHS Foundation Trust, London, UK
| | - David Murphy
- Imperial College Healthcare NHS Trust, London, UK
| | - Georgina Smith
- Central and North West London NHS Foundation Trust, London, UK
| | | | | | - Valentina Lazarevic
- East Midlands & South Yorkshire Mental Health Research Network, Nottingham, UK
| | | | - Rachel Evered
- North London Hub, Mental Health Research Network, London, UK
| | - Stephanie Kings
- East Midlands & South Yorkshire Mental Health Research Network, Nottingham, UK
| | | | | | | | - Kofi Kramo
- Centre for Psychiatry, Imperial College London, London, UK
| | - Jessica Nagar
- North London Hub, Mental Health Research Network, London, UK
| | - Steven Reid
- Central and North West London NHS Foundation Trust, London, UK
| | | | | | - Gemma Walker
- Centre for Psychiatry, Imperial College London, London, UK
| | - Aaron Philip
- Centre for Psychiatry, Imperial College London, London, UK
| | - Hilary Warwick
- Centre for Psychiatry, Imperial College London, London, UK
| | - Sarah Byford
- King's Health Economics, King's College London, London, UK
| | | |
Collapse
|
26
|
Hoffmann D, Rask CU, Hedman-Lagerlöf E, Ljótsson B, Frostholm L. Development and Feasibility Testing of Internet-Delivered Acceptance and Commitment Therapy for Severe Health Anxiety: Pilot Study. JMIR Ment Health 2018; 5:e28. [PMID: 29625957 PMCID: PMC5938695 DOI: 10.2196/mental.9198] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 02/05/2018] [Accepted: 02/14/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Severe health anxiety (hypochondriasis), or illness anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, is characterized by preoccupation with fear of suffering from a serious illness in spite of medical reassurance. It is a debilitating, prevalent disorder associated with increased health care utilization. Still, there is a lack of easily accessible specialized treatment for severe health anxiety. OBJECTIVE The aims of this paper were to (1) describe the development and setup of a new internet-delivered acceptance and commitment therapy (iACT) program for patients with severe health anxiety using self-referral and a video-based assessment; and (2) examine the feasibility and potential clinical efficacy of iACT for severe health anxiety. METHODS Self-referred patients (N=15) with severe health anxiety were diagnostically assessed by a video-based interview. They received 7 sessions of clinician-supported iACT comprising self-help texts, video clips, audio files, and worksheets over 12 weeks. Self-report questionnaires were obtained at baseline, post-treatment, and at 3-month follow-up. The primary outcome was Whiteley-7 Index (WI-7) measuring health anxiety severity. Depressive symptoms, health-related quality of life (HRQoL), life satisfaction, and psychological flexibility were also assessed. A within-group design was employed. Means, standard deviations, and effect sizes using the standardized response mean (SRM) were estimated. Post-treatment interviews were conducted to evaluate the patient experience of the usability and acceptability of the treatment setup and program. RESULTS The self-referral and video-based assessments were well received. Most patients (12/15, 80%) completed the treatment, and only 1 (1/15, 7%) dropped out. Post-treatment (14/15, 93%) and 3-month follow-up (12/15, 80%) data were available for almost all patients. Paired t tests showed significant improvements on all outcome measures both at post-treatment and 3-month follow-up, except on one physical component subscale of HRQoL. Health anxiety symptoms decreased with 33.9 points at 3-month follow-up (95% CI 13.6-54.3, t11= 3.66, P=.004) with a large within-group effect size of 1.06 as measured by the SRM. CONCLUSIONS Treatment adherence and potential efficacy suggest that iACT may be a feasible treatment for health anxiety. The uncontrolled design and small sample size of the study limited the robustness of the findings. Therefore, the findings should be replicated in a randomized controlled trial. Potentially, iACT may increase availability and accessibility of specialized treatment for health anxiety. TRIAL REGISTRATION Danish Data Protection Agency, Central Denmark Region: 1-16-02-427-14; https://www.rm.dk/sundhed/faginfo/forskning/datatilsynet/ (Archived by Webcite at http://www.webcitation.org/6yDA7WovM).
Collapse
Affiliation(s)
- Ditte Hoffmann
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.,Child and Adolescent Psychiatric Centre, Aarhus University Hospital, Aarhus, Denmark
| | | | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre for Psychiatry Research, Karolinska Institute, Stockholm, Sweden
| | - Lisbeth Frostholm
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
27
|
Ong CW, Lee EB, Twohig MP. A meta-analysis of dropout rates in acceptance and commitment therapy. Behav Res Ther 2018; 104:14-33. [PMID: 29477890 DOI: 10.1016/j.brat.2018.02.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 01/02/2018] [Accepted: 02/13/2018] [Indexed: 12/19/2022]
Abstract
Many psychotherapies, including cognitive behavioral therapy and acceptance and commitment therapy (ACT), have been found to be effective interventions for a range of psychological and behavioral health concerns. Another aspect of treatment utility to consider is dropout, as interventions only work if clients are engaged in them. To date, no research has used meta-analytic methods to examine dropout in ACT. Thus, the objectives of the present meta-analysis were to (1) determine the aggregate dropout rate for ACT in randomized controlled trials, (2) compare dropout rates in ACT to those in other psychotherapies, and (3) identify potential moderators of dropout in ACT. Our literature search yielded 68 studies, representing 4,729 participants. The weighted mean dropout rates in ACT exclusive conditions and ACT inclusive conditions (i.e., those that included an ACT intervention) were 15.8% (95% CI: 11.9%, 20.1%) and 16.0% (95% CI: 12.5%, 19.8%), respectively. ACT dropout rates were not significantly different from those of established psychological treatments. In addition, dropout rates did not vary by client characteristics or study methodological quality. However, master's-level clinicians/therapists (weighted mean = 29.9%, CI: 17.6%, 43.8%) were associated with higher dropout than psychologists (weighted mean = 12.4%, 95% CI: 6.7%, 19.4%). More research on manipulable, process variables that influence dropout is needed.
Collapse
Affiliation(s)
- Clarissa W Ong
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84322, USA.
| | - Eric B Lee
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84322, USA
| | - Michael P Twohig
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84322, USA
| |
Collapse
|
28
|
Abstract
SUMMARYHealth anxiety is an important new diagnosis that is increasing in frequency because of changing attitudes towards health, particularly excessive use of health information on the internet (cyberchondria). People with abnormal health anxiety become over-diligent monitors of their health, misinterpret most somatic sensations as evidence of disease, consult medical professionals unnecessarily and frequently, and are often over-investigated. Relatively few patients with health anxiety present to psychiatrists; most are seen in primary and secondary medical care. This paper reviews the diagnosis and presenting features of health anxiety, its identification in practice and its treatment. A range of simple psychological treatments have been shown to have long-lasting benefit for the disorder but are greatly under-used.LEARNING OBJECTIVES•To be able to identify abnormal health anxiety with the aid of probe questions•To respond to people whom you have identified with excessive health anxiety in a way that facilitates its treatment•To learn a few simple techniques derived from cognitive–behavioural therapy that can lead to long-term benefitDECLARATION OF INTERESTNone.
Collapse
|
29
|
Abstract
Acceptance and commitment therapy (ACT) is a modern form of cognitive behavioral therapy based on a distinct philosophy and basic science of cognition. This article reviews the core features of ACT's theoretic model of psychopathology and treatment and its therapeutic approach. It provides a systematic review of randomized controlled trials (RCTs) evaluating ACT for depression and anxiety disorders. Summarizing 36 RCTs, ACT appears to be more efficacious than waitlist conditions and treatment-as-usual, with largely equivalent effects relative to traditional cognitive behavioral therapy. Evidence indicates that ACT treatment outcomes are mediated through increases in psychological flexibility, its theorized process of change.
Collapse
|
30
|
Thorgaard MV, Frostholm L, Rask CU. Childhood and family factors in the development of health anxiety: A systematic review. CHILDRENS HEALTH CARE 2017. [DOI: 10.1080/02739615.2017.1318390] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mette Viller Thorgaard
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Lisbeth Frostholm
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Centre for Child & Adolescent Psychiatry, Research Department, Aarhus University Hospital, Risskov, Denmark
| |
Collapse
|
31
|
Fallon BA, Ahern DK, Pavlicova M, Slavov I, Skritskya N, Barsky AJ. A Randomized Controlled Trial of Medication and Cognitive-Behavioral Therapy for Hypochondriasis. Am J Psychiatry 2017; 174:756-764. [PMID: 28659038 PMCID: PMC5957509 DOI: 10.1176/appi.ajp.2017.16020189] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Prior studies of hypochondriasis demonstrated benefits for pharmacotherapy and for cognitive-behavioral therapy (CBT). This study examined whether joint treatment offers additional benefit. METHOD Patients with DSM-IV hypochondriasis (N=195) were randomly assigned to one of four treatments-placebo, CBT, fluoxetine, or joint treatment with both fluoxetine and CBT. Evaluations assessed hypochondriasis, other psychopathology, adverse events, functional status, and quality of life. The primary analysis assessed outcome at week 24 among the intent-to-treat sample, with responders defined as having a 25% or greater improvement over baseline on both the Whiteley Index and a modified version of the Yale-Brown Obsessive Compulsive Scale for hypochondriasis (H-YBOCS-M). The Cochran-Armitage trend test assessed the hypothesized pattern of response: joint treatment > CBT or fluoxetine treatment > placebo treatment. RESULTS The predicted pattern of response was statistically significant, as shown by the following responder rates: joint treatment group, 47.2%; single active treatment group, 41.8%; and placebo group, 29.6%. Responder rates for each active treatment were not significantly different from the rate for placebo. Secondary analyses of the Whiteley Index as a continuous measure revealed that, compared with placebo, fluoxetine (but not CBT) was significantly more effective at week 24 in reducing hypochondriasis and had a significantly faster rate of improvement over 24 weeks. Fluoxetine also resulted in significantly less anxiety and better quality of life than placebo. Dropout rates did not differ between groups, and treatment-emergent adverse events were evenly distributed. CONCLUSIONS This study supports the safety, tolerance, and efficacy of fluoxetine for hypochondriasis. Joint treatment provided a small incremental benefit. Because approximately 50% of patients did not respond to the study treatments, new or more intensive approaches are needed.
Collapse
Affiliation(s)
- Brian A Fallon
- From the New York State Psychiatric Institute, New York; and Brigham and Women's Hospital, Boston
| | - David K Ahern
- From the New York State Psychiatric Institute, New York; and Brigham and Women's Hospital, Boston
| | - Martina Pavlicova
- From the New York State Psychiatric Institute, New York; and Brigham and Women's Hospital, Boston
| | - Iordan Slavov
- From the New York State Psychiatric Institute, New York; and Brigham and Women's Hospital, Boston
| | - Natalia Skritskya
- From the New York State Psychiatric Institute, New York; and Brigham and Women's Hospital, Boston
| | - Arthur J Barsky
- From the New York State Psychiatric Institute, New York; and Brigham and Women's Hospital, Boston
| |
Collapse
|
32
|
Eilenberg T, Hoffmann D, Jensen JS, Frostholm L. Intervening variables in group-based acceptance & commitment therapy for severe health anxiety. Behav Res Ther 2017; 92:24-31. [PMID: 28196772 DOI: 10.1016/j.brat.2017.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 01/11/2017] [Accepted: 01/17/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The present study is based on a previously reported successful randomized controlled trial (RCT) on Acceptance and Commitment Group therapy (ACT-G) for severe health anxiety (HA) and investigates intervening variables of ACT for HA. The process primarily targeted by ACT is psychological flexibility (PF). No randomized study has yet examined the possible intervening variables of ACT for HA. METHODS 126 patients diagnosed with severe HA were enrolled in the RCT of which 107 were included in the analyses. The outcome measure was illness worry (Whiteley Index) and included process variables were PF and facets of mindfulness. RESULTS Statistically significant indirect effects (IE) of ACT-G on the outcome of illness worry 6 months after treatment were found for PF (IE = -5.5, BCa 99% CI -12.3;-1.2) and one mindfulness subscale, namely 'non-react' (IE = -6.5 BCa 99% CI -15.3: 1.0). CONCLUSION In line with the ACT model of change, PF may have a small to moderate IE on decrease in illness worry. Of the mindfulness scales, only 'non-react' showed a significant IE. Although tentative, due to no active comparison control condition, these results support that PF is a intervening variable in ACT treatment aimed at reducing illness worry in patients with severe HA.
Collapse
Affiliation(s)
- Trine Eilenberg
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Barthsgade 5.1, Aarhus N, Denmark; Department of Occupational Medicine, Aarhus University Hospital, Norrebrogade 44, Aarhus C, Denmark.
| | - Ditte Hoffmann
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Barthsgade 5.1, Aarhus N, Denmark
| | - Jens S Jensen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Barthsgade 5.1, Aarhus N, Denmark
| | - Lisbeth Frostholm
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Barthsgade 5.1, Aarhus N, Denmark
| |
Collapse
|
33
|
Brown M, Glendenning A, Hoon AE, John A. Effectiveness of Web-Delivered Acceptance and Commitment Therapy in Relation to Mental Health and Well-Being: A Systematic Review and Meta-Analysis. J Med Internet Res 2016; 18:e221. [PMID: 27558740 PMCID: PMC5039035 DOI: 10.2196/jmir.6200] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 07/20/2016] [Accepted: 07/20/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The need for effective interventions to improve mental health and emotional well-being at a population level are gaining prominence both in the United Kingdom and globally. Advances in technology and widespread adoption of Internet capable devices have facilitated rapid development of Web-delivered psychological therapies. Interventions designed to manage a range of affective disorders by applying diverse therapeutic approaches are widely available. OBJECTIVE The main aim of this review was to evaluate the evidence base of acceptance and commitment therapy (ACT) in a Web-based delivery format. METHOD A systematic review of the literature and meta-analysis was conducted. Two electronic databases were searched for Web-delivered interventions utilizing ACT for the management of affective disorders or well-being. Only Randomized Controlled Trials (RCTs) were included. RESULTS The search strategy identified 59 articles. Of these, 10 articles met the inclusion criteria specified. The range of conditions and outcome measures that were identified limited the ability to draw firm conclusions about the efficacy of Web-delivered ACT-based intervention for anxiety or well-being. CONCLUSIONS ACT in a Web-based delivery format was found to be effective in the management of depression. Rates of adherence to study protocols and completion were high overall suggesting that this therapeutic approach is highly acceptable for patients and the general public.
Collapse
Affiliation(s)
- Menna Brown
- Swansea University, Medical School, Swansea, United Kingdom.
| | | | | | | |
Collapse
|