Cognitive behavioural therapy (CBT) is substantially more effective than standard care at reducing symptoms of health anxiety, a study has found.

The findings are good news for the 10 to 20 per cent of hospital patients who excessively worry that they have a serious, undiagnosed illness.

Published in The Lancet, this is the first large-scale trial to test the effectiveness of CBT for health anxiety.

CBT aims to change thought patterns and behaviour. Earlier studies have shown that it is an effective treatment for other anxiety disorders, but there is a shortage of specialist clinicians and therapists to deliver CBT and waiting lists can be long.

The new study demonstrates that a modified cognitive behavioural treatment for health anxiety (CBT-HA) can be delivered by non-specialist staff with minimal training at little extra cost.

“Health anxiety or hypochondria is costly for healthcare providers, and an effective treatment could potentially save money by reducing the need for unnecessary tests and emergency hospital admissions,” said study leader Professor Peter Tyrer, from the Department of Medicine at Imperial College London.

“As health anxiety is also a source of considerable suffering that currently is undetected, our treatment has great public health potential. But to make full use of its value we need to improve its detection in medical and other hospital clinics.” 

The trial involved 444 people aged 16–75 with abnormal health anxiety who were being treated in six general hospitals in the UK. They were randomly assigned to receive either five to 10 sessions of CBT-HA or standard care, consisting of reassurance and support in secondary and primary care.

Treatment was delivered at outpatient clinics by non-CBT experts who had been trained in just two workshops and then supervised by more experienced CBT therapists. The researchers compared the difference in health anxiety, generalised anxiety, depression, social function, quality of life, and costs between the groups over two years.

One year after the start of treatment, 13.9 per cent of patients given CBT-HA achieved normal levels of health anxiety compared with 7.3 per cent of patients given standard care, and these differences were considerably greater at six months. CBT-HA also significantly improved generalised anxiety and depression compared with standard treatment. Crucially, the improvements were sustained at two years, with no significant differences in cost.

“Until now, we had no evidence that health anxiety in medical settings could be successfully treated,” said Professor Tyrer. “Our results indicate that CBT-HA is relatively cheap, can be delivered by general nurses with minimal training, and could be easily rolled out in hospital settings. This is a treatment that is appropriate for mental health services to train and support but not provide directly. If we are to maintain the principle of an NHS service that provides treatment at the point of need, it is best given in the clinics where it presents so frequently.”

The research was funded by the National Coordinating Centre for Health Technology Assessment (NCCHTA) programme.

Reference

P Tyrer et al. ‘Clinical and cost-effectiveness of cognitive behaviour therapy for health anxiety in medical patients: a multicentre randomised controlled trial.’ The Lancet, Published Online October 18, 2013 http://dx.doi.org/10.1016/S0140-6736(13)61905-4