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Roth-Rawald J, Maaß U, Mai S, Weck F. Exposure therapy for health anxiety: Effectiveness and response rates in routine care of an outpatient clinic. J Clin Psychol 2023; 79:2884-2898. [PMID: 37597253 DOI: 10.1002/jclp.23587] [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: 09/07/2022] [Revised: 07/16/2023] [Accepted: 08/08/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE Many randomized controlled trials (RCTs) have demonstrated the efficacy and benefits of exposure therapy in the treatment of health anxiety. However, the application of these research results to routine care has not been considered sufficiently. The aim of this study is to analyze the effectiveness of exposure therapy in the routine treatment of health anxiety patients. METHOD Data were available for 35 patients, who repeatedly filled in comprehensive general questionnaires, and those specific to health anxiety. RESULTS The data analysis showed that health anxiety symptoms decreased significantly both posttreatment (Cohen's d = 0.97-1.00) and at follow-up (Cohen's d = 1.33-1.34). In addition, the scores of depressiveness, somatic symptoms, and psychological distress showed improvements with effect sizes of d = 0.35-0.51. Regarding the primary outcome measures for health anxiety, response rates were 51%-63%, and remission rates were 29%-43%. CONCLUSION Exposure therapy is effective and sustainable regarding the treatment of health anxiety, even under naturalistic conditions, whereas response and remission rates are lower than for RCT.
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Affiliation(s)
- Julia Roth-Rawald
- Department of Clinical Psychology and Psychotherapy, University of Potsdam, Potsdam, Germany
| | - Ulrike Maaß
- Department of Clinical Psychology and Psychotherapy, University of Potsdam, Potsdam, Germany
| | - Stefanie Mai
- Department of Clinical Psychology and Psychotherapy, University of Potsdam, Potsdam, Germany
| | - Florian Weck
- Department of Clinical Psychology and Psychotherapy, University of Potsdam, Potsdam, Germany
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2
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Rozental A, Powers M. Cognitive Behaviour Therapy: 50 th anniversary. Cogn Behav Ther 2023; 52:163-175. [PMID: 36924452 DOI: 10.1080/16506073.2023.2189794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- A Rozental
- Department of Psychology, Uppsala University, Uppsal, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Solna, Sweden
| | - M Powers
- Baylor University Medical Center, Dallas, TX, USA
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3
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Validity and clinical utility of distinguishing between DSM-5 somatic symptom disorder and illness anxiety disorder in pathological health anxiety: Should we close the chapter? J Psychosom Res 2023; 165:111133. [PMID: 36624001 DOI: 10.1016/j.jpsychores.2022.111133] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the validity and clinical utility of distinguishing between DSM-5 somatic symptom disorder (SSD) and illness anxiety disorder (IAD) in pathological health anxiety: the excessive and recurrent fear of, or preoccupation with, having or developing a serious health condition. METHODS We compared SSD to IAD in pathological health anxiety (N = 334) with regard to concurrent, antecedent, and predictive validators. This was primarily a cross-sectional study, though we studied the effect of CBT longitudinally. Because we were interested in the discriminatory value of SSD and IAD over and above trait health anxiety, we used trait health anxiety as a covariate. RESULTS SSD (68%; 228/334) vs. IAD (32%; 106/334) differences were mostly non-significant and small in sociodemographics, core clinical characteristics, apparent course, etiological attribution, and physician visits (gs = -0.18-0.20; RRs = 0.84-1.09; IRRs = 0.87-0.99). However, SSD was associated with a significantly higher somatic symptom burden (gs = 0.20-0.72), more psychologist visits (IRR = 2.02, 95% CI: 1.24-3.28), and slightly higher disability (g = 0.22, 95% CI: 0.03-0.42). There was no significant difference in symptom reduction during CBT (g = -0.16, 95% CI: -0.37-0.05). CONCLUSION Although not all differences between SSD and IAD in pathological health anxiety seem to be explained by the level of trait health anxiety, the SSD vs. IAD distinction appears to convey little useful information in pathological health anxiety. Tentatively, considering the well-documented clinical characteristics and effective clinical interventions, it is probably most helpful to regard pathological health anxiety as a de facto anxiety or perhaps obsessive-compulsive spectrum disorder, regardless of the DSM-5 diagnosis of SSD or IAD.
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4
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An Q, Wang K, Sun F, Zhang A. The effectiveness of modified, group-based CBT for dementia worry among Chinese elders. J Affect Disord 2020; 274:76-84. [PMID: 32469835 DOI: 10.1016/j.jad.2020.05.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 04/15/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Dementias are highly prevalent among Chinese elders. This study examined the effectiveness of a modified group cognitive behavioral therapy (CBT) on dementia worry among Chinese older adults. METHODS Eighty-two older adults recruited from four elder group homes were randomly assigned to either intervention or control group. The intervention group (n= 44) received eight weekly 60-minute face-to-face CBT, while the control group (n=38) received treatment-as-usual. RESULTS Outcomes indicated that the modified group CBT has significantly reduced dementia worry and culturally biased beliefs about dementia (p<.001). Study findings supported both statistically and clinically significant effect of modified group CBT on dementia worry [g=-1.52, 95% CI (-2.01, -1.03)] and biased beliefs about dementia [g=-.95, 95% CI (-1.40, -.49)]. DISCUSSION The culturally adapted CBT is promising in alleviating worries and anxiety over dementia among Chinese older adults. Future research needs to include larger samples and participants from different regions to replicate findings.
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Affiliation(s)
- Qiuling An
- East China Normal University, School of Social Development, 500 DongChuan Rd., Shanghai, China
| | - Kaipeng Wang
- University of Denver, Graduate School of Social Work, Denver, CO, USA.
| | - Fei Sun
- Michigan State University, School of Social Work, East Lansing, MI, USA
| | - Anao Zhang
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
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5
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Titov N, Rock D, Bezuidenhout G, Webb N, Kayrouz R, Nielssen O, Williams L, Purtell C, Dear BF, Staples LG. Evaluation of The Practitioner Online Referral and Treatment Service (PORTS): the first 18 months of a state-wide digital service for adults with anxiety, depression, or substance use problems. Cogn Behav Ther 2019; 49:307-326. [PMID: 31553266 DOI: 10.1080/16506073.2019.1666162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The Practitioner Online Referral and Treatment Service (PORTS) is a new digital mental health service (DMHS) providing assessment, treatment, and consultation across Western Australia, for adults with anxiety, depression, or substance use problems, and experiencing financial hardship or geographical disadvantage. From July 2017 to December 2018, a total of 2,527 individuals were referred to PORTS. Of these, 150 (6%) did not give consent for their results to be analysed. Of the remaining 2,377 patients, 615 (26%) could not be contacted to confirm the referral, 596 (25%) received assessment or information from PORTS, 427 (18%) were referred to another service, and 739 (31%) commenced treatment at PORTS. Almost half (47%) of patients were from areas with significant socio-economic disadvantage. Those referred by another mental health service were more likely to engage in treatment than those referred by a General Practitioner (GP). Overall outcomes were excellent, with large effect sizes (Cohen's d: 1.1-1.4), from assessment to post-treatment and 3-month follow-up, reliable deterioration was low, and GP and patient satisfaction was high. These results indicate that the PORTS DMHS model is a promising method for engaging primary care patients with anxiety and depression, including those experiencing financial and geographical disadvantage.
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Affiliation(s)
- Nickolai Titov
- MindSpot Clinic, Macquarie University , Sydney, Australia
| | - Daniel Rock
- West Australian Primary Health Alliance (WAPHA) , Perth, Australia.,Psychiatry, Medical School, University of Western Australia , Perth, Australia
| | | | - Nick Webb
- MindSpot Clinic, Macquarie University , Sydney, Australia
| | - Rony Kayrouz
- MindSpot Clinic, Macquarie University , Sydney, Australia
| | - Olav Nielssen
- MindSpot Clinic, Macquarie University , Sydney, Australia
| | - Linda Williams
- MindSpot Clinic, Macquarie University , Sydney, Australia
| | - Carol Purtell
- MindSpot Clinic, Macquarie University , Sydney, Australia
| | - Blake F Dear
- MindSpot Clinic, Macquarie University , Sydney, Australia.,eCentreClinic, Department of Psychology, Macquarie University , Sydney, Australia
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6
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Titov N, Hadjistavropoulos HD, Nielssen O, Mohr DC, Andersson G, Dear BF. From Research to Practice: Ten Lessons in Delivering Digital Mental Health Services. J Clin Med 2019; 8:E1239. [PMID: 31426460 PMCID: PMC6722769 DOI: 10.3390/jcm8081239] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/10/2019] [Accepted: 08/15/2019] [Indexed: 12/17/2022] Open
Abstract
There is a large body of research showing that psychological treatment can be effectively delivered via the internet, and Digital Mental Health Services (DMHS) are now delivering those interventions in routine care. However, not all attempts to translate these research outcomes into routine care have been successful. This paper draws on the experience of successful DMHS in Australia and Canada to describe ten lessons learned while establishing and delivering internet-delivered cognitive behavioural therapy (ICBT) and other mental health services as part of routine care. These lessons include learnings at four levels of analysis, including lessons learned working with (1) consumers, (2) therapists, (3) when operating DMHS, and (4) working within healthcare systems. Key themes include recognising that DMHS should provide not only treatment but also information and assessment services, that DMHS require robust systems for training and supervising therapists, that specialist skills are required to operate DMHS, and that the outcome data from DMHS can inform future mental health policy. We also confirm that operating such clinics is particularly challenging in the evolving funding, policy, and regulatory context, as well as increasing expectations from consumers about DMHS. Notwithstanding the difficulties of delivering DMHS, we conclude that the benefits of such services for the broader community significantly outweigh the challenges.
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Affiliation(s)
- Nickolai Titov
- MindSpot Clinic and Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia.
| | - Heather D Hadjistavropoulos
- Online Therapy Unit, Department of Psychology, University of Regina, Regina, Saskatchewan, SK S4S 0A2, Canada
| | - Olav Nielssen
- MindSpot Clinic and Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping SE-581 83, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm 171 77, Sweden
| | - Blake F Dear
- MindSpot Clinic and Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
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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.
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8
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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.
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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
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9
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Sahlin H, Bjureberg J, Gratz KL, Tull MT, Hedman-Lagerlöf E, Bjärehed J, Jokinen J, Lundh LG, Hellner C, Ljótsson B. Predictors of improvement in an open-trial multisite evaluation of emotion regulation group therapy. Cogn Behav Ther 2018; 48:322-336. [DOI: 10.1080/16506073.2018.1509119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Hanna Sahlin
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kim L. Gratz
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Matthew T. Tull
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Erik Hedman-Lagerlöf
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Jussi Jokinen
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden
| | | | - Clara Hellner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Brjánn Ljótsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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10
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Titov N, Dear B, Nielssen O, Staples L, Hadjistavropoulos H, Nugent M, Adlam K, Nordgreen T, Bruvik KH, Hovland A, Repål A, Mathiasen K, Kraepelien M, Blom K, Svanborg C, Lindefors N, Kaldo V. ICBT in routine care: A descriptive analysis of successful clinics in five countries. Internet Interv 2018; 13:108-115. [PMID: 30206525 PMCID: PMC6112100 DOI: 10.1016/j.invent.2018.07.006] [Citation(s) in RCA: 154] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/24/2018] [Accepted: 07/24/2018] [Indexed: 12/22/2022] Open
Abstract
Clinical trials have demonstrated the efficacy of internet delivered cognitive behaviour therapy (ICBT) for anxiety and depression. However, relatively little is known about the context, operations, and outcomes of ICBT when administered as part of routine care. This paper describes the setting, relationship to existing health services, procedures for referral, assessment, treatment, patients and outcomes of ICBT clinics in Sweden, Denmark, Norway, Canada and Australia. All five clinics provide services free or at low cost to patients. All have systems of governance to monitor quality of care, patient safety, therapist performance and data security. All five clinics include initial assessments by clinicians and between 10 and 20 min of therapist support during each week. Published reports of outcomes all demonstrate large clinical improvement, low rates of deterioration, and high levels of patient satisfaction. Services that require a face to face assessment treat smaller numbers of patients and have fewer patients from remote locations. The paper shows that therapist-guided ICBT can be a valuable part of mental health services for anxiety and depression. Important components of successful ICBT services are rigorous governance to maintain a high standard of clinical care, and the measurement and reporting of outcomes.
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Affiliation(s)
- Nickolai Titov
- MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Blake Dear
- MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Olav Nielssen
- MindSpot Clinic, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Lauren Staples
- MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, Australia
| | | | - Marcie Nugent
- Department of Psychology, University of Regina, Regina, Canada
| | - Kelly Adlam
- Department of Psychology, University of Regina, Regina, Canada
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Norway
| | | | - Anders Hovland
- Solli District Psychiatric Centre, Nesttun, Norway
- Department of Clinical Psychology, University of Bergen, Norway
| | | | - Kim Mathiasen
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Denmark
- Centre for Telepsychiatry, Mental Health Services of Southern Denmark, Denmark
| | - Martin Kraepelien
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Kerstin Blom
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Cecilia Svanborg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Nils Lindefors
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Viktor Kaldo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Sweden
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
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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.
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12
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Hedman-Lagerlöf E, Axelsson E, Andersson E, Ljótsson B, Andreasson A, Lekander M. The impact of exposure-based cognitive behavior therapy for severe health anxiety on self-rated health: Results from a randomized trial. J Psychosom Res 2017; 103:9-14. [PMID: 29167052 DOI: 10.1016/j.jpsychores.2017.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 09/24/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Self-rated health (SRH) has been shown to be a stable predictor of illness and mortality. Improvement in SRH, even in the absence of change in objective health, predicts better health and reduced mortality. Severe health anxiety (SHA) is characterized by fear of illness and distorted health perception. The objective of the present study was to investigate if exposure-based cognitive behavior therapy (CBT) for SHA can lead to improvement in SRH and whether this improvement is mediated by reduced health anxiety. METHODS Data were collected from a randomized controlled trial where participants with SHA were allocated to 12weeks of exposure-based CBT (n=99) for SHA or to a no treatment control condition (n=33). The mediation analysis was based on SRH- and health anxiety data collected weekly during the treatment phase. RESULTS Linear mixed effects models analysis showed a significant interaction effect of group and time indicating superior improvements in SRH in exposure-based CBT compared to the control condition (Z=2.69, p=0.007). The controlled effect size was moderately large (d=0.64) and improvements were stable at 1-year follow-up. Reduced health anxiety was a significant mediator of improvement in SRH. CONCLUSIONS 12weeks of exposure-based CBT for SHA can lead to significant improvements in SRH. Considering the previously established importance of SRH as a predictor for disease and mortality, exposure-based CBT for severe health anxiety may lead to improvements on several important health parameters, possibly even increasing the likelihood of longevity.
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Affiliation(s)
- Erik Hedman-Lagerlöf
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
| | - Erland Axelsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Andreasson
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden; Department of Psychology, Macquarie University, North Ryde, NSW, Australia
| | - Mats Lekander
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden
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13
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Sahlin H, Bjureberg J, Gratz KL, Tull MT, Hedman E, Bjärehed J, Jokinen J, Lundh LG, Ljótsson B, Hellner C. Emotion regulation group therapy for deliberate self-harm: a multi-site evaluation in routine care using an uncontrolled open trial design. BMJ Open 2017; 7:e016220. [PMID: 28982814 PMCID: PMC5639990 DOI: 10.1136/bmjopen-2017-016220] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Emotion regulation group therapy (ERGT) has shown promising results in several efficacy trials. However, it has not been evaluated outside a research setting. In order to increase the availability of empirically supported treatments for individuals with borderline personality disorder and deliberate self-harm, an evaluation of ERGT in routine clinical care was conducted with therapists of different professional backgrounds who had received brief intensive training in ERGT prior to trial onset. DESIGN Multi-site evaluation, using an uncontrolled open trial design with assessments at pretreatment, post-treatment and 6-month follow-up. SETTING 14 adult outpatient psychiatric clinics across Sweden. PARTICIPANTS Ninety-five women (mean age=25.1 years) with borderline personality disorder (both threshold and subthreshold) and repeated self-harm were enrolled in the study. Ninety-three per cent of participants completed the post-treatment assessment and 88% completed the follow-up assessment. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was self-harm frequency as measured with the Deliberate Self-Harm Inventory. Secondary outcomes included self-harm versatility, emotion dysregulation, other self-destructive behaviours, depression, anxiety, stress symptoms and interpersonal and vocational difficulties. INTERVENTION ERGT is an adjunctive, 14-week, acceptance-based behavioural group treatment that directly targets both self-harm and its proposed underlying mechanism of emotion dysregulation. RESULTS At post-treatment, intent-to-treat analyses revealed a significant improvement associated with a moderate effect size on the primary outcome of self-harm frequency (51%, reduction; Cohen's d=0.52, p<0.001) as well as significant improvements in the secondary outcomes of self-harm versatility, emotion dysregulation, other self-destructive behaviours and general psychiatric symptomatology. These results were either maintained or further improved on at 6-month follow-up. CONCLUSIONS ERGT appears to be a feasible, transportable and useful treatment for deliberate self-harm and other self-destructive behaviours, emotion dysregulation and psychiatric symptoms when delivered by clinicians in the community. TRIAL REGISTRATION NUMBER NCT01986257; results.
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Affiliation(s)
- Hanna Sahlin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Johan Bjureberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kim L Gratz
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Erik Hedman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Jussi Jokinen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden
| | | | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Clara Hellner
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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14
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Hedman E, Axelsson E, Andersson E, Lekander M, Ljótsson B. Exposure-based cognitive-behavioural therapy via the internet and as bibliotherapy for somatic symptom disorder and illness anxiety disorder: randomised controlled trial. Br J Psychiatry 2016; 209:407-413. [PMID: 27491531 DOI: 10.1192/bjp.bp.116.181396] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 04/17/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND In DSM-5 two new diagnoses, somatic symptom disorder (SSD) and illness anxiety disorder (IAD), have replaced DSM-IV hypochondriasis. There are no previous treatment studies for these disorders. Cognitive-behavioural therapy (CBT) delivered as therapist-guided or unguided internet treatment or as unguided bibliotherapy could be used to increase treatment accessibility. AIMS To investigate the effect of CBT delivered as guided internet treatment (ICBT), unguided internet treatment (U-ICBT) and as unguided bibliotherapy. METHOD A randomised controlled trial (RCT) where participants (n = 132) with a diagnosis of SSD or IAD were randomised to ICBT, U-ICBT, bibliotherapy or to a control condition on a waiting list (trial registration: Clinicaltrials.gov identifier NCT01966705). RESULTS Compared with the control condition, all three treatment groups made large and significant improvements on the primary outcome Health Anxiety Inventory (between-group d at post-treatment was 0.80-1.27). CONCLUSIONS ICBT, U-ICBT and bibliotherapy can be highly effective in the treatment of SSD and IAD. This is the first study showing that these new DSM-5 disorders can be effectively treated.
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Affiliation(s)
- Erik Hedman
- Erik Hedman, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine & Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Erland Axelsson, MSc, Erik Andersson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Mats Lekander, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, and Stress Research Institute, Stockholm University, Stockholm, Sweden; Brjánn Ljósson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Erland Axelsson
- Erik Hedman, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine & Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Erland Axelsson, MSc, Erik Andersson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Mats Lekander, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, and Stress Research Institute, Stockholm University, Stockholm, Sweden; Brjánn Ljósson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Erik Andersson
- Erik Hedman, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine & Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Erland Axelsson, MSc, Erik Andersson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Mats Lekander, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, and Stress Research Institute, Stockholm University, Stockholm, Sweden; Brjánn Ljósson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lekander
- Erik Hedman, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine & Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Erland Axelsson, MSc, Erik Andersson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Mats Lekander, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, and Stress Research Institute, Stockholm University, Stockholm, Sweden; Brjánn Ljósson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Erik Hedman, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine & Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Erland Axelsson, MSc, Erik Andersson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Mats Lekander, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, and Stress Research Institute, Stockholm University, Stockholm, Sweden; Brjánn Ljósson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
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Lanoye A, Stewart KE, Rybarczyk BD, Auerbach SM, Sadock E, Aggarwal A, Waller R, Wolver S, Austin K. The Impact of Integrated Psychological Services in a Safety Net Primary Care Clinic on Medical Utilization. J Clin Psychol 2016; 73:681-692. [PMID: 27505218 DOI: 10.1002/jclp.22367] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 05/13/2016] [Accepted: 06/21/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The integration of psychological and behavioral health services into safety net primary care clinics has been viewed as a step toward reducing disparities in mental health treatment and addressing behavioral factors in chronic diseases. Though it is posited that integrated behavioral health (IBH) reduces preventable medical costs, this premise has yet to be tested in a safety net primary care clinic. METHOD Retrospective pre- and posttreatment analysis with quasi-experimental control group was constructed using propensity score matching. Participants included 1,440 adult patients at a safety net primary care clinic, 720 of whom received IBH services, and 720 of whom received medical treatment only. RESULTS Analysis showed that rates of preventable inpatient utilization decreased significantly among IBH-treated patients compared to no change among control patients. CONCLUSION IBH was associated with decreased rates of preventable inpatient visits. IBH may present opportunities to deliver improved holistic patient care while reducing unnecessary inpatient medical utilization.
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Henriksson S, Anclair M, Hiltunen AJ. Effectiveness of cognitive behavioral therapy on health-related quality of life: An evaluation of therapies provided by trainee therapists. Scand J Psychol 2016; 57:215-22. [PMID: 27119256 DOI: 10.1111/sjop.12291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 03/07/2016] [Indexed: 11/27/2022]
Abstract
The present study was carried out to examine the treatment effect of cognitive behavioral therapy provided by trainee therapists at a university clinic, focusing on health-related quality of life (HRQOL) optimism and symptoms. The study was conducted through a repeated measures design and included a treatment group (n = 21), which received cognitive behavioral therapy for an average of 10.7 therapy sessions and a control group (n = 14), that was put on a wait list for 8.6 weeks on average. After treatment, the treatment group improved significantly concerning general health (p = 0.028) and optimism (p = 0.027). In addition, clients improved in several areas within mental health and displayed some reduction in anxiety symptoms. Concurrently, the results also indicated some improvement within the control group, which may have been caused by the initial therapeutic contact, expectancy effects or spontaneous remission. The study concluded that cognitive behavioral therapy provided by trainee therapists may have a positive effect on areas within HRQOL and optimism.
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Affiliation(s)
- Sophie Henriksson
- Department of Social and Psychological Studies, Section of Psychology, Karlstad University, Sweden
| | - Malin Anclair
- Department of Social and Psychological Studies, Section of Psychology, Karlstad University, Sweden
| | - Arto J Hiltunen
- Department of Social and Psychological Studies, Section of Psychology, Karlstad University, Sweden
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Hedman E, Andersson E, Ljótsson B, Axelsson E, Lekander M. Cost effectiveness of internet-based cognitive behaviour therapy and behavioural stress management for severe health anxiety. BMJ Open 2016; 6:e009327. [PMID: 27113231 PMCID: PMC4854011 DOI: 10.1136/bmjopen-2015-009327] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Internet-delivered exposure-based cognitive behaviour therapy (ICBT) has been shown to be effective in the treatment of severe health anxiety. The health economic effects of the treatment have, however, been insufficiently studied and no prior study has investigated the effect of ICBT compared with an active psychological treatment. The aim of the present study was to investigate the cost effectiveness of ICBT compared with internet-delivered behavioural stress management (IBSM) for adults with severe health anxiety defined as Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) hypochondriasis. ICBT was hypothesised to be the more cost-effective treatment. SETTING This was a cost-effectiveness study within the context of a randomised controlled trial conducted in a primary care/university setting. Participants from all of Sweden could apply to participate. PARTICIPANTS Self-referred adults (N=158) with a principal diagnosis of DSM-IV hypochondriasis, of whom 151 (96%) provided baseline and post-treatment data. INTERVENTIONS ICBT or IBSM for 12 weeks. PRIMARY AND SECONDARY MEASURES The primary outcome was the Health Anxiety Inventory. The secondary outcome was the EQ-5D. Other secondary measures were used in the main outcome study but were not relevant for the present health economic analysis. RESULTS Both treatments led to significant reductions in gross total costs, costs of healthcare visits, direct non-medical costs and costs of domestic work cutback (p=0.000-0.035). The incremental cost-effectiveness ratio (ICER) indicated that the cost of one additional case of clinically significant improvement in ICBT compared with IBSM was $2214. The cost-utility ICER, that is, the cost of one additional quality-adjusted life year, was estimated to be $10,000. CONCLUSIONS ICBT is a cost-effective treatment compared with IBSM and treatment costs are offset by societal net cost reductions in a short time. A cost-benefit analysis speaks for ICBT to play an important role in increasing access to effective treatment for severe health anxiety. TRIAL REGISTRATION NUMBER NCT01673035; Results.
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Affiliation(s)
- Erik Hedman
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Erland Axelsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lekander
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
- Stress Research Institute, Stockholm University, Stockholm, Sweden
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Proudfoot J, Klein B, Barak A, Carlbring P, Cuijpers P, Lange A, Ritterband L, Andersson G. Establishing guidelines for executing and reporting Internet intervention research. Cogn Behav Ther 2015; 40:82-97. [PMID: 25155812 DOI: 10.1080/16506073.2011.573807] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The field of Internet interventions is growing rapidly. New programs are continually being developed to facilitate health and mental health promotion, disease and emotional distress prevention, risk factor management, treatment, and relapse prevention. However, a clear definition of Internet interventions, guidelines for research, and evidence of effectiveness have been slower to follow. This article focuses on the quality standardization of research on Internet-delivered psychological and behavioural interventions. Although the science underpinning Internet interventions is just starting to be established, across research studies there are often conceptual and methodological difficulties. The authors argue that this situation is due to the lack of universally accepted operational guidelines and evaluation methods. Following a critical appraisal of existing codes of conduct and guidelines for Internet-assisted psychological and health interventions, the authors developed a framework of guidelines for Internet intervention research utilizing aspects of facet theory (Guttman & Greenbaum, 1998). The framework of facets, elements, and guidelines of best practice in reporting Internet intervention research was then sent to several leading researchers in the field for their comment and input, so that a consensus framework could be agreed on. The authors outline 12 key facets to be considered when evaluating and reporting Internet intervention studies. Each facet consists of a range of recommended elements, designed as the minimum features for reporting Internet intervention studies. The authors propose that this framework be utilized when designing and reporting Internet intervention research, so results across studies can be replicated, extended, compared, and contrasted with greater ease and clarity.
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Affiliation(s)
- Judith Proudfoot
- a Black Dog Institute and School of Psychiatry, University of New South Wales , Sydney , New South Wales , Australia
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Weck F, Gropalis M, Hiller W, Bleichhardt G. Effectiveness of cognitive-behavioral group therapy for patients with hypochondriasis (health anxiety). J Anxiety Disord 2015; 30:1-7. [PMID: 25589453 DOI: 10.1016/j.janxdis.2014.12.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/23/2014] [Accepted: 12/25/2014] [Indexed: 01/28/2023]
Abstract
Cognitive behavioral therapy (CBT) has been shown to be highly effective in the treatment of health anxiety. However, little is known about the effectiveness of group CBT in the treatment of health anxiety. The current study is the largest study that has investigated the effectiveness of combined individual and group CBT for patients with the diagnosis of hypochondriasis (N=80). Therapy outcomes were evaluated by several questionnaires. Patients showed a large improvement on these primary outcome measures both post-treatment (Cohen's d=0.82-1.08) and at a 12-month follow-up (Cohen's d=1.09-1.41). Measures of general psychopathology and somatic symptoms showed significant improvements, with small to medium effect sizes. Patients with more elevated hypochondriacal characteristics at therapy intake showed a larger therapy improvement, accounting for 7-8% of the variance in therapy outcome. CBT group therapy has therefore been shown to be an appropriate and cost-effective treatment for health anxiety.
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Affiliation(s)
- Florian Weck
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University of Mainz, Wallstraße 3, D-55122 Mainz, Germany.
| | - Maria Gropalis
- Department of Psychology, Johannes Gutenberg University of Mainz, Wallstraße 3, D-55122 Mainz, Germany.
| | - Wolfgang Hiller
- Department of Clinical Psychology and Psychotherapy, Johannes Gutenberg University of Mainz, Wallstraße 3, D-55122 Mainz, Germany.
| | - Gaby Bleichhardt
- Department of Clinical Psychology and Psychotherapy, Philipps University Marburg, Gutenbergstraße 18, D-35037 Marburg, Germany.
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Hedman E, Andersson E, Lekander M, Ljótsson B. Predictors in Internet-delivered cognitive behavior therapy and behavioral stress management for severe health anxiety. Behav Res Ther 2015; 64:49-55. [DOI: 10.1016/j.brat.2014.11.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/07/2014] [Accepted: 11/28/2014] [Indexed: 10/24/2022]
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Hedman E, Andersson G, Lindefors N, Gustavsson P, Lekander M, Rück C, Andersson E, Ljótsson B. Personality change following internet-based cognitive behavior therapy for severe health anxiety. PLoS One 2014; 9:e113871. [PMID: 25437150 PMCID: PMC4250052 DOI: 10.1371/journal.pone.0113871] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 11/02/2014] [Indexed: 11/23/2022] Open
Abstract
Personality traits have traditionally been viewed as stable, but recent studies suggest that they could be affected through psychological treatment. Internet-based cognitive behavior therapy (ICBT) for severe health anxiety (DSM-IV hypochondriasis) has been shown to be effective in reducing health anxiety, but its effect on measures of personality traits has not been investigated. The main aim of this study was to investigate the impact of ICBT on personality traits in the three broad dimensions - neuroticism, extraversion and aggression. We hypothesized that participants in ICBT would reduce their level of neuroticism compared to controls that did not receive the active treatment. No specific predictions were made regarding extraversion and aggression. Data from a randomized controlled trial were used in which participants were allocated to 12 weeks of ICBT (n = 40) or to a basic attention control condition (n = 41). Personality traits were assessed with the Swedish Universities Scales of Personality and the primary outcome of health anxiety was the Health Anxiety Inventory. There was a significant interaction effect of group and time on neuroticism-related scales, indicating larger pre- to post-treatment reductions in the Internet-based CBT group compared to the control condition. Analyses at 6-month follow-up showed that changes were stable. Traits relating to extraversion and aggression were largely unchanged. This study is the first to demonstrate that a brief ICBT intervention for severe health anxiety causes long-term changes in measures of personality traits related to neuroticism. The treatment thus has a broader impact than just reducing health anxiety. Trial Registration Clinicaltrials.gov (ID NCT00828152)
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Affiliation(s)
- Erik Hedman
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Swedish Institute for Disability Research, Linköping University, Linköping, Sweden
| | - Nils Lindefors
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Petter Gustavsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lekander
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Christian Rück
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
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Hedman E, Axelsson E, Görling A, Ritzman C, Ronnheden M, El Alaoui S, Andersson E, Lekander M, Ljótsson B. Internet-delivered exposure-based cognitive-behavioural therapy and behavioural stress management for severe health anxiety: randomised controlled trial. Br J Psychiatry 2014; 205:307-14. [PMID: 25104835 DOI: 10.1192/bjp.bp.113.140913] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Exposure-based cognitive-behavioural therapy (CBT) delivered via the internet has been shown to be effective for severe health anxiety (hypochondriasis) but has not been compared with an active, effective and credible psychological treatment, such as behavioural stress management (BSM). AIMS To investigate two internet-delivered treatments - exposure-based CBT v. BSM - for severe health anxiety in a randomised controlled trial (trial registration: NCT01673035). METHOD Participants (n = 158) with a principal diagnosis of severe health anxiety were allocated to 12 weeks of exposure-based CBT (n = 79) or BSM (n = 79) delivered via the internet. The Health Anxiety Inventory (HAI) was the primary outcome. RESULTS Internet-delivered exposure-based CBT led to a significantly greater improvement on the HAI compared with BSM. However, both treatment groups made large improvements on the HAI (pre-to-post-treatment Cohen's d: exposure-based CBT, 1.78; BSM, 1.22). CONCLUSIONS Exposure-based CBT delivered via the internet is an efficacious treatment for severe health anxiety.
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Affiliation(s)
- Erik Hedman
- Erik Hedman, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, and Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Erland Axelsson, MSc, Anders Görling, MSc, Carina Ritzman, MSc, Markus Ronnheden, MSc, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Samir El Alaoui, MSc, Erik Andersson, MSc, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Mats Lekander, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, and Stress Research Institute, Stockholm University, Stockholm; Brjánn Ljótsson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Erland Axelsson
- Erik Hedman, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, and Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Erland Axelsson, MSc, Anders Görling, MSc, Carina Ritzman, MSc, Markus Ronnheden, MSc, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Samir El Alaoui, MSc, Erik Andersson, MSc, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Mats Lekander, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, and Stress Research Institute, Stockholm University, Stockholm; Brjánn Ljótsson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Görling
- Erik Hedman, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, and Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Erland Axelsson, MSc, Anders Görling, MSc, Carina Ritzman, MSc, Markus Ronnheden, MSc, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Samir El Alaoui, MSc, Erik Andersson, MSc, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Mats Lekander, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, and Stress Research Institute, Stockholm University, Stockholm; Brjánn Ljótsson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Carina Ritzman
- Erik Hedman, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, and Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Erland Axelsson, MSc, Anders Görling, MSc, Carina Ritzman, MSc, Markus Ronnheden, MSc, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Samir El Alaoui, MSc, Erik Andersson, MSc, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Mats Lekander, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, and Stress Research Institute, Stockholm University, Stockholm; Brjánn Ljótsson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Markus Ronnheden
- Erik Hedman, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, and Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Erland Axelsson, MSc, Anders Görling, MSc, Carina Ritzman, MSc, Markus Ronnheden, MSc, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Samir El Alaoui, MSc, Erik Andersson, MSc, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Mats Lekander, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, and Stress Research Institute, Stockholm University, Stockholm; Brjánn Ljótsson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Samir El Alaoui
- Erik Hedman, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, and Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Erland Axelsson, MSc, Anders Görling, MSc, Carina Ritzman, MSc, Markus Ronnheden, MSc, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Samir El Alaoui, MSc, Erik Andersson, MSc, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Mats Lekander, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, and Stress Research Institute, Stockholm University, Stockholm; Brjánn Ljótsson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Erik Andersson
- Erik Hedman, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, and Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Erland Axelsson, MSc, Anders Görling, MSc, Carina Ritzman, MSc, Markus Ronnheden, MSc, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Samir El Alaoui, MSc, Erik Andersson, MSc, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Mats Lekander, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, and Stress Research Institute, Stockholm University, Stockholm; Brjánn Ljótsson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lekander
- Erik Hedman, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, and Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Erland Axelsson, MSc, Anders Görling, MSc, Carina Ritzman, MSc, Markus Ronnheden, MSc, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Samir El Alaoui, MSc, Erik Andersson, MSc, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Mats Lekander, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, and Stress Research Institute, Stockholm University, Stockholm; Brjánn Ljótsson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Erik Hedman, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, and Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Erland Axelsson, MSc, Anders Görling, MSc, Carina Ritzman, MSc, Markus Ronnheden, MSc, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Samir El Alaoui, MSc, Erik Andersson, MSc, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Mats Lekander, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, and Stress Research Institute, Stockholm University, Stockholm; Brjánn Ljótsson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
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Abstract
Psychotherapy is an effective and often highly cost-effective medical intervention for many serious psychiatric conditions. Psychotherapy can also lead to savings in other medical and societal costs. It is at times the firstline and most important treatment and at other times augments the efficacy of psychotropic medication. Many patients are in need of more prolonged and intensive psychotherapy, including those with personality disorders and those with chronic complex psychiatric conditions often with severe anxiety and depression. Many patients with serious and complex psychiatric illness have experienced severe early life trauma in an atmosphere in which family members or caretakers themselves have serious psychiatric disorders. Children and adolescents with learning disabilities and those with severe psychiatric disorders can also require more than brief treatment. Other diagnostic groups for whom psychotherapy is effective and cost-effective include patients with schizophrenia, anxiety disorders (including posttraumatic stress disorder), depression, and substance abuse. In addition, psychotherapy for the medically ill with concomitant psychiatric illness often lowers medical costs, improves recovery from medical illness, and at times even prolongs life compared to similar patients not given psychotherapy. While "cost-effective" treatments can yield savings in healthcare costs, disability claims, and other societal costs, "cost-effective" by no means translates to "cheap" but instead describes treatments that are clinically effective and provided at a cost that is considered reasonable given the benefit they provide, even if the treatments increase direct expenses. In the current insurance climate in which Mental Health Parity is the law, insurers nonetheless often use their own non-research and non-clinically based medical necessity guidelines to subvert it and limit access to appropriate psychotherapeutic treatments. Many patients, especially those who need extended and intensive psychotherapy, are at risk of receiving substandard care due to inadequate insurance reimbursement. These patients remain vulnerable to residual illness and the concomitant sequelae in lost productivity, dysfunctional interpersonal and family relationships, comorbidity including increased medical and surgical services, and increased mortality.
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Affiliation(s)
- Susan G Lazar
- Clinical Professor of Psychiatry: Georgetown University School of Medicine, George Washington University School of Medicine, Uniformed Services University of the Health Sciences; Supervising and Training Analyst, Washington Psychoanalytic Institute
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Abstract
Hypochondriasis is characterized by intensive fears of serious disease. Most patients with hypochondriasis worry about physical diseases like cancer, although in rare cases, patients report severe fears of mental disorders (e.g., schizophrenia), a phenomenon described in the literature as mental hypochondriasis. However, little is known about this rare subtype of hypochondriasis and experts have questioned whether mental hypochondriasis has much in common with the type of hypochondriasis in which somatic diseases are the focus of preoccupation. This paper presents, a case report of a woman with a fear of schizophrenia, which was treated with cognitive therapy. This patient fulfills the DSM-IV criteria of hypochondriasis and exhibits many characteristics (e.g., selective attention, safety behavior) considered to be maintaining factors in well-established cognitive-behavioral models of hypochondriasis. Cognitive treatment strategies for hypochondriasis (e.g., attention training, behavioral experiments) also proved effective in this case of mental hypochondriasis.
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Hedman E, Ljótsson B, Kaldo V, Hesser H, El Alaoui S, Kraepelien M, Andersson E, Rück C, Svanborg C, Andersson G, Lindefors N. Effectiveness of Internet-based cognitive behaviour therapy for depression in routine psychiatric care. J Affect Disord 2014; 155:49-58. [PMID: 24238951 DOI: 10.1016/j.jad.2013.10.023] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/17/2013] [Accepted: 10/18/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Efficacy of guided Internet-based cognitive behaviour therapy (ICBT) for depression has been demonstrated in several randomised controlled trials. Knowledge on the effectiveness of the treatment, i.e. how it works when delivered within routine care, is however scarce. The aim of this study was to investigate the effectiveness of ICBT for depression. METHODS We conducted a cohort study investigating all patients (N=1203) who had received guided ICBT for depression between 2007 and 2013 in a routine care setting at an outpatient psychiatric clinic providing Internet-based treatment. The primary outcome measure was the Montgomery Åsberg Depression Rating Scale-Self rated (MADRS-S). RESULTS Patients made large improvements from pre-treatment assessments to post-treatment on the primary outcome (effect size d on the MADRS-S=1.27, 99% CI, 1.14-1.39). Participants were significantly improved in terms of suicidal ideation and sleep difficulties. Improvements were sustained at 6-month follow-up. LIMITATIONS Attrition was rather large at 6-month follow-up. However, additional data was collected through telephone interviews with dropouts and advanced statistical models indicated that missing data did not bias the findings. CONCLUSIONS ICBT for depression can be highly effective when delivered within the context of routine psychiatric care. This study suggests that the effect sizes are at least as high when the treatment is delivered in routine psychiatric care by qualified staff as when delivered in a controlled trial setting.
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Affiliation(s)
- Erik Hedman
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Sweden; Department of Clinical Neuroscience, Osher Center for Integrative Medicine Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Sweden; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Viktor Kaldo
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Sweden
| | - Hugo Hesser
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Samir El Alaoui
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Sweden
| | - Martin Kraepelien
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Sweden
| | - Evelyn Andersson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Sweden
| | - Christian Rück
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Sweden
| | - Cecilia Svanborg
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Sweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Sweden; Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Nils Lindefors
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Sweden
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Höfling V, Weck F. Assessing Bodily Preoccupations is sufficient: clinically effective screening for hypochondriasis. J Psychosom Res 2013; 75:526-31. [PMID: 24290041 DOI: 10.1016/j.jpsychores.2013.10.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 10/11/2013] [Accepted: 10/21/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Hypochondriasis is a persistent psychiatric disorder and is associated with increased utilisation of health care services. However, effective psychiatric consultation interventions and CBT treatments are available. In the present study, we provide evidence of clinically effective screening for hypochondriasis. We describe the clinically effective identification of patients with a high probability of suffering from hypochondriasis. This identification is achieved by means of two brief standardised screening instruments, namely the Bodily Preoccupation (BP) Scale with 3 items and the Whiteley-7 (WI-7) with 7 items. METHODS Both the BP scale and the WI-7 were examined in a sample of 228 participants (72 with hypochondriasis, 80 with anxiety disorders and 76 healthy controls) in a large psychotherapy outpatients' unit, applying the DSM-IV criteria. Cut-off values for the BP scale and the WI-7 were computed to identify patients with a high probability of suffering from hypochondriasis. Additionally, other self-report symptom severity scales were completed in order to examine discriminant and convergent validity. Data was collected from June 2010 to March 2013. RESULTS The BP scale and the WI-7 discriminated significantly between patients with hypochondriasis and those with an anxiety disorder (d=2.42 and d=2.34). Cut-off values for these two screening scales could be provided, thus identifying patients with a high probability of suffering from hypochondriasis. CONCLUSIONS In order to reduce costs, the BP scale or the WI-7 should be applied in medical or primary care settings, to screen for patients with a high probability of hypochondriasis and to transfer them to further assessment and effective treatment.
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Affiliation(s)
- Volkmar Höfling
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Germany.
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Barsky AJ, Ahern DK, Bauer MR, Nolido N, Orav EJ. A randomized trial of treatments for high-utilizing somatizing patients. J Gen Intern Med 2013; 28:1396-404. [PMID: 23494213 PMCID: PMC3797340 DOI: 10.1007/s11606-013-2392-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 01/09/2013] [Accepted: 01/23/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND Somatization and hypochondriacal health anxiety are common sources of distress, impairment, and costly medical utilization in primary care practice. A range of interventions is needed to improve the care of these patients. OBJECTIVE To determine the effectiveness of two cognitive behavioral interventions for high-utilizing, somatizing patients, using the resources found in a routine care setting. DESIGN Patients were randomly assigned to a two-step cognitive behavioral treatment program accompanied by a training seminar for their primary care physicians, or to relaxation training. Providers routinely working in these patients' primary care practices delivered the cognitive behavior therapy and relaxation training. A follow-up assessment was completed immediately prior to treatment and 6 and 12 months later. SUBJECTS Eighty-nine medical outpatients with elevated levels of somatization, hypochondriacal health anxiety, and medical care utilization. MEASUREMENTS Somatization and hypochondriasis, overall psychiatric distress, and role impairment were assessed with well-validated, self-report questionnaires. Outpatient visits and medical care costs before and after the intervention were obtained from the encounter claims database. RESULTS At 6 month and 12 month follow-up, both intervention groups showed significant improvements in somatization (p < 0.01), hypochondriacal symptoms (p < 0.01), overall psychiatric distress (p < 0.01), and role impairment (p < 0.01). Outcomes did not differ significantly between the two groups. When both groups were combined, ambulatory visits declined from 10.3 to 8.8 (p = 0.036), and mean ambulatory costs decreased from $3,574 to $2,991 (pp = 0.028) in the year preceding versus the year following the interventions. Psychiatric visits and costs were unchanged. CONCLUSIONS Two similar cognitive behavioral interventions, delivered with the resources available in routine primary care, improved somatization, hypochondriacal symptoms, overall psychiatric distress, and role function. They also reduced the ambulatory visits and costs of these high utilizing outpatients.
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Affiliation(s)
- Arthur J Barsky
- Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA,
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Hedman E, Andersson E, Andersson G, Lindefors N, Lekander M, Rück C, Ljótsson B. Mediators in internet-based cognitive behavior therapy for severe health anxiety. PLoS One 2013; 8:e77752. [PMID: 24147073 PMCID: PMC3798404 DOI: 10.1371/journal.pone.0077752] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 09/05/2013] [Indexed: 11/18/2022] Open
Abstract
According to the cognitive behavioral model of severe health anxiety (hypochondriasis) four central maintaining mechanisms are how the individual perceives the risk of disease and how negative its consequences would be, attention to bodily sensations, and intolerance of uncertainty. The aim of the present study was to investigate the mediating role of these putative mechanisms in Internet-delivered CBT for severe health anxiety. We analyzed data from an RCT where participants were randomized to Internet-delivered CBT (n=40) or to a control condition (n=41). Mediators and outcome, i.e. health anxiety, were assessed weekly throughout the treatment, enabling fulfillment of the criterion of temporal precedence of changes occurring in the mediator in relation to the outcome to be met. The results showed that reduced perceived risk of disease, less attention to bodily symptoms, and reduced intolerance of uncertainty significantly mediated improvement in health anxiety. The study supports the validity of the cognitive behavioral model of health anxiety. The findings have theoretical and clinical implications as they indicate processes that may be causally related to the improvements observed after CBT for health anxiety.
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Affiliation(s)
- Erik Hedman
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Erik Andersson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
- Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden
| | - Nils Lindefors
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lekander
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Christian Rück
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
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Hedman E, Lindefors N, Andersson G, Andersson E, Lekander M, Rück C, Ljótsson B. Predictors of outcome in Internet-based cognitive behavior therapy for severe health anxiety. Behav Res Ther 2013; 51:711-7. [DOI: 10.1016/j.brat.2013.07.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 07/30/2013] [Accepted: 07/30/2013] [Indexed: 10/26/2022]
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Mewton L, Andrews G. Poor self-rated health and its associations with somatisation in two Australian national surveys. BMJ Open 2013; 3:bmjopen-2013-002965. [PMID: 23811174 PMCID: PMC3696865 DOI: 10.1136/bmjopen-2013-002965] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES It is hypothesised that across two national surveys poor self-rated health will be independently associated with somatisation and will result in high rates of service use after adjusting for established diagnoses. DESIGN Two cross-sectional population-based surveys were conducted in 1997 and 2007. The use of both surveys allowed replication of results. SETTING Australia. PARTICIPANTS The 1997 and 2007 National Surveys of Mental Health and Well-Being were based on stratified, multistage area probability samples of persons living in private dwellings in Australia. The 1997 survey included 10 641 respondents aged 18-75 years, a response rate of 78%. The 2007 survey included 8841 respondents aged 16-85 years, a response rate of 60%. MAIN OUTCOME MEASURES Self-rated health. RESULTS Approximately 15% of the Australian population rated their health as fair or poor in both surveys. The independent relationship between self-rated health and somatisation was replicated across both surveys in multivariate analyses. Individuals with negative self-rated health were 4.1 times as likely to screen positive for health anxiety (OR 4.1, 95% CI 2.8 to 5.9) and 3.4 times as likely to be diagnosed with neurasthenia (OR 3.4, 95% CI 2.2 to 5.2), when compared with individuals who rated their health positively. Individuals with negative self-rated health were also more likely to use health services after controlling for demographics and mental and physical illness. CONCLUSIONS These results confirm both of the study hypotheses: (1) that negative self-rated health was powerfully and independently associated with somatisation and (2) that this relationship manifested itself in high rates of service use, even after adjusting for an extensive range of demographics and psychiatric and physical conditions.
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Affiliation(s)
- Louise Mewton
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Gavin Andrews
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent's Hospital, Sydney, New South Wales, Australia
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Bourgault-Fagnou MD, Hadjistavropoulos HD. A Randomized Trial of Two Forms of Cognitive Behaviour Therapy for an Older Adult Population with Subclinical Health Anxiety. Cogn Behav Ther 2013. [DOI: 10.1080/16506073.2012.717302] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Weck F, Neng JMB, Stangier U. The Effects of Attention Training on the Perception of Bodily Sensations in Patients with Hypochondriasis: A Randomized Controlled Pilot Trial. COGNITIVE THERAPY AND RESEARCH 2012. [DOI: 10.1007/s10608-012-9482-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Hedman E, Andersson G, Andersson E, Ljótsson B, Rück C, Asmundson GJG, Lindefors N. Internet-based cognitive-behavioural therapy for severe health anxiety: randomised controlled trial. Br J Psychiatry 2011; 198:230-6. [PMID: 21357882 DOI: 10.1192/bjp.bp.110.086843] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Hypochondriasis, characterised by severe health anxiety, is a common condition associated with functional disability. Cognitive-behavioural therapy (CBT) is an effective but not widely disseminated treatment for hypochondriasis. Internet-based CBT, including guidance in the form of minimal therapist contact via email, could be a more accessible treatment, but no study has investigated internet-based CBT for hypochondriasis. AIMS To investigate the efficacy of internet-based CBT for hypochondriasis. METHOD A randomised controlled superiority trial with masked assessment comparing internet-based CBT (n = 40) over 12 weeks with an attention control condition (n = 41) for people with hypochondriasis. The primary outcome measure was the Health Anxiety Inventory. This trial is registrated with ClinicalTrials.gov (NCT00828152). RESULTS Participants receiving internet-based CBT made large and superior improvements compared with the control group on measures of health anxiety (between-group Cohen's d range 1.52-1.62). CONCLUSIONS Internet-based CBT is an efficacious treatment for hypochondriasis that has the potential to increase accessibility and availability of CBT for hypochodriasis.
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Affiliation(s)
- Erik Hedman
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden.
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