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Sustained benefit of cognitive behaviour therapy for health anxiety in medical patients (CHAMP) over 8 years: a randomised-controlled trial

Published online by Cambridge University Press:  16 March 2020

P. Tyrer Open the ORCID record for P. Tyrer [Opens in a new window] ,
D. Wang ,
M. Crawford ,
S. Dupont ,
S. Cooper ,
S. Nourmand ,
V. Lazarevic ,
A. Philip  and
H. Tyrer
P. Tyrer*
Affiliation:
Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
D. Wang
Affiliation:
Department of Statistics, Liverpool School of Tropical Medicine, Liverpool, UK
M. Crawford
Affiliation:
Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
S. Dupont
Affiliation:
Central Northwest London Foundation NHS Trust, London, UK
S. Cooper
Affiliation:
Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
S. Nourmand
Affiliation:
Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
V. Lazarevic
Affiliation:
Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
A. Philip
Affiliation:
South London and Maudsley NHS Foundation Trust, London, UK
H. Tyrer
Affiliation:
Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
*
Author for correspondence: P. Tyrer, E-mail: [email protected]
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Abstract

Background

Health anxiety is an under-recognised but a frequent cause of distress. It is particularly common in general hospitals.

Methods

We carried out an 8-year follow-up of medical out-patients with health anxiety (hypochondriasis) enrolled in a randomised-controlled trial in five general hospitals in London, Middlesex and Nottinghamshire. Randomisation was to a mean of six sessions of cognitive behaviour therapy adapted for health anxiety (CBT-HA) or to standard care in the clinics. The primary outcome was a change in score on the Short Health Anxiety Inventory, with generalised anxiety and depression as secondary outcomes. Of 444 patients aged 16–75 years seen in cardiology, endocrinology, gastroenterology, neurology and respiratory medicine clinics, 306 (68.9%) were followed-up 8 years after randomisation, including 36 who had died. The study is registered with controlled-trials.com, ISRCTN14565822.

Results

There was a significant difference in the HAI score in favour of CBT-HA over standard care after 8 years [1.83, 95% confidence interval (CI) 0.25–3.40, p = 0.023], between group differences in generalised anxiety were less (0.54, 95% CI −0.29 to 1.36), p = 0.20, ns), but those for depression were greater at 8 years (1.22, 95% CI 0.42–2.01, p < 0.003) in CBT-HA than in standard care, most in standard care satisfying the criteria for clinical depression. Those seen by nurse therapists and in cardiology and gastrointestinal clinics achieved the greatest gains with CBT-HA, with greater improvement in both symptoms and social function.

Conclusions

CBT-HA is a highly long-term effective treatment for pathological health anxiety with long-term benefits. Standard care for health anxiety in medical clinics promotes depression. Nurse therapists are effective practitioners.

Keywords

Cognitive behaviour therapyfollow-uphealth anxietymedical literacynurse therapistsrandomised-controlled trialreassurance
Type
Original Article
Information
Psychological Medicine , Volume 51 , Issue 10 , July 2021 , pp. 1714 - 1722
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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Footnotes

NIHR Health Technology Assessment programme.

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