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Cognitive Behaviour Therapy for Health Anxiety: A Systematic Review and Meta-Analysis

Published online by Cambridge University Press:  23 February 2017

Kate Cooper
Affiliation:
Department of Psychology, University of Bath, Claverton Down, Bath BA2 7AY
James D. Gregory
Affiliation:
Department of Psychology, University of Bath, Claverton Down, Bath BA2 7AY
Ian Walker
Affiliation:
Department of Psychology, University of Bath, Claverton Down, Bath BA2 7AY
Sinead Lambe
Affiliation:
Department of Psychology, University of Bath, Claverton Down, Bath BA2 7AY
Paul M. Salkovskis
Affiliation:
Department of Psychology, University of Bath, Claverton Down, Bath BA2 7AY

Abstract

Background: Health anxiety (HA), or hypochondriasis, is a psychological problem characterized by a preoccupation with the belief that one is physically unwell. A 2007 Cochrane review (Thomson and Page, 2007) found cognitive behavioural therapy (CBT) to be an effective intervention for individuals with HA. Similar findings were reported in a recent meta-analysis (Olatunji et al., 2014), which did not employ a systematic search strategy. The current review aimed to investigate the efficacy of CBT for HA, and to update the existing reviews. Method: A systematic search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance, including randomized controlled trials that compared CBT with a control condition for people with HA. Five hundred and sixty-seven studies were found in the original search, of which 14 were included in the meta-analysis. Results: Meta-analysis was conducted on 21 comparisons and a large effect size for CBT compared with a control condition was found at post therapy d = 1.01 (95% confidence interval 0.77–1.25), as well as at 6- and 12-month follow-up. Conclusions: This systematic review and meta-analysis provides support for the hypothesis that CBT is an effective intervention for HA when compared with a variety of control conditions, e.g. treatment-as-usual, waiting list, medication, and other psychological therapies.

Type
Accelerated Publication
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2017 

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References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th edn). Washington, DC.Google Scholar
Barsky, A. J. and Ahern, D. K. (2004). Cognitive behavior therapy for hypochondriasis: a randomized controlled trial. Journal of the American Medical Association, 291, 14641470.Google Scholar
Barsky, A. J., Orav, E. J. and Bates, D. W. (2005). Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Archives of General Psychiatry, 62, 903910.Google Scholar
Bouman, T. K. and Visser, S. (1998). Cognitive and behavioural treatment of hypochondriasis. Psychotherapy and Psychosomatics, 67, 214221.CrossRefGoogle ScholarPubMed
Bouman, T. (2014). Psychological treatments for hypochondriasis: a narrative review. Current Psychiatry Reviews, 10, 5869.Google Scholar
Bourgault-Fagnou, M. D. and Hadjistavropoulos, H. D. (2013). A randomized trial of two forms of cognitive behaviour therapy for an older adult population with subclinical health anxiety. Cognitive Behaviour Therapy, 42, 3144.Google Scholar
Buwalda, F. M., Bouman, T. K. and van Duijn, M. A. J. (2007). Psychoeducation for hypochondriasis: a comparison of a cognitive-behavioural approach and a problem-solving approach. Behaviour Research and Therapy, 45, 887899.Google Scholar
Clark, D. M., Salkovskis, P. M., Hackmann, A., Wells, A., Fennell, M., Ludgate, J., Ahmad, S., Richards, H. C. and Gelder, M. (1998). Two psychological treatments for hypochondriasis. A randomised controlled trial. The British Journal of Psychiatry, 173, 218225.Google Scholar
Creed, F. and Barsky, A. (2004). A systematic review of the epidemiology of somatisation disorder and hypochondriasis. Journal of Psychosomatic Research, 56, 391408.Google Scholar
Greeven, A., van Balkom, A. J., Visser, S., Merkelbach, J. W., van Rood, Y. R., van Dyck, R., Van der Does, A. J., Zitman, F. G. and Spinhoven, P. (2007). Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a randomized controlled trial. American Journal of Psychiatry, 164, 9199.Google Scholar
Gureje, O., Ustun, T. B. and Simon, G. E. (1997). The syndrome of hypochondriasis: a cross-national study in primary care. Psychological Medicine, 27, 10011010.Google Scholar
Hedman, E., Andersson, G., Andersson, E., Ljotsson, B., Ruck, C., Asmundson, G. J. G. and Lindefors, N. (2011). Internet-based cognitive-behavioural therapy for severe health anxiety: randomised controlled trial. British Journal of Psychiatry, 198, 230236.CrossRefGoogle ScholarPubMed
Hedman, E., Axelsson, E., Gorling, A., Ritzman, C., Ronnheden, M., El Alaoui, S., Andersson, E., Lekander, M. and Ljotsson, B. (2014). Internet-delivered exposure-based cognitive-behavioural therapy and behavioural stress management for severe health anxiety: randomised controlled trial. British Journal of Psychiatry, 205, 307314.Google Scholar
Higgins, J. P., Altman, D. G., Gøtzsche, P. C., Jüni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., Sterne, J. A., Cochrane Bias Methods Group, Cochrane Statistical Methods Group (2011). The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. British Medical Journal, 343.Google Scholar
Higgins, J. P. and Green, S. (2008). Cochrane Handbook for Systematic Reviews of Interventions, vol. 5. Wiley Online Library.Google Scholar
Jones, F. A. (2002). The role of bibliotherapy in health anxiety: an experimental study. British Journal of Community Nursing, 7, 498504.Google Scholar
Moher, D., Liberati, A., Tetzlaff, J. and Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of Internal Medicine, 151, 264269.Google Scholar
Olatunji, B. O., Kauffman, B. Y., Meltzer, S., Davis, M. L., Smits, J. A. and Powers, M. B. (2014). Cognitive-behavioral therapy for hypochondriasis/health anxiety: a meta-analysis of treatment outcome and moderators. Behaviour Research and Therapy, 58, 6574.Google Scholar
olde Hartman, T. C., Borghuis, M. S., Lucassen, P. L., van de Laar, F. A., Speckens, A. E. and van Weel, C. (2009). Medically unexplained symptoms, somatisation disorder and hypochondriasis: course and prognosis. A systematic review. Journal of Psychosomatic Research, 66, 363377.Google Scholar
Robbins, J. M. and Kirmayer, L. J. (1996). Transient and persistent hypochondriacal worry in primary care. Psychological Medicine, 26, 575589.Google Scholar
Salkovskis, P. M. and Warwick, H. M. (1986). Morbid preoccupations, health anxiety and reassurance: a cognitive-behavioural approach to hypochondriasis. Behaviour Research and Therapy, 24, 597602.CrossRefGoogle ScholarPubMed
Salkovskis, P. M., Warwick, H. M. C. and Deale, A. C. (2003). Cognitive-behavioral treatment for severe and persistent health anxiety (hypochondriasis). Brief Treatment and Crisis Intervention, 3, 353367.Google Scholar
Seivewright, H., Green, J., Salkovskis, P., Barrett, B., Nur, U. and Tyrer, P. (2008). Cognitive-behavioural therapy for health anxiety in a genitourinary medicine clinic: randomised controlled trial. British Journal of Psychiatry, 193, 332337.Google Scholar
Sorensen, P., Birket-Smith, M., Wattar, U., Buemann, I. and Salkovskis, P. (2011). A randomized clinical trial of cognitive behavioural therapy versus short-term psychodynamic psychotherapy versus no intervention for patients with hypochondriasis. Psychological Medicine, 41, 431441.Google Scholar
Thomson, A. B. and Page, L. A. (2007). Psychotherapies for hypochondriasis. Cochrane Database of Systematic Reviews (4). doi: 10.1002/14651858.CD006520.pub2 CrossRefGoogle Scholar
Tyrer, P., Cooper, S., Salkovskis, P., Tyrer, H., Crawford, M., Byford, S., Dupont, S., Finnis, S., Green, J., McLaren, E., Murphy, D., Reid, S., Smith, G., Wang, D., Warwick, H., Petkova, H. and Barrett, B. (2014). Clinical and cost-effectiveness of cognitive behaviour therapy for health anxiety in medical patients: a multicentre randomised controlled trial. The Lancet, 383, 219225.Google Scholar
Visser, S. and Bouman, T. K. (2001). The treatment of hypochondriasis: exposure plus response prevention vs cognitive therapy. Behaviour Research and Therapy, 39, 423442.Google Scholar
Warwick, H. M., Clark, D. M., Cobb, A. M. and Salkovskis, P. M. (1996). A controlled trial of cognitive-behavioural treatment of hypochondriasis. British Journal of Psychiatry, 169, 189195.Google Scholar
Warwick, H. M. and Marks, I. M. (1988). Behavioural treatment of illness phobia and hypochondriasis. A pilot study of 17 cases. British Journal of Psychiatry, 152, 239241.CrossRefGoogle ScholarPubMed
Warwick, H. M. and Salkovskis, P. M. (1990). Hypochondriasis. Behaviour Research and Therapy, 28, 105117.Google Scholar
Weck, F., Neng, J., Richtberg, S., Jakob, M. and Stangier, U. (2014). Cognitive therapy versus exposure therapy for hypochondriasis (health anxiety): a randomized controlled trial. Journal of Consulting and Clinical Psychology. Advance online publication: http://dx.doi.org/10.1037/ccp0000013.CrossRefGoogle Scholar
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