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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.

References

Cameron, I. M., Cardy, A., Crawford, J. R., du Toit, S. W., Hay, S., Lawton, K., Mitchell, K., … Reid, I. C. (2011). Measuring depression severity in general practice: Discriminatory performance of the PHQ-9, HADS-D, and BDI-II. British Journal of General Practice, 61, e419–e426.CrossRefGoogle ScholarPubMed
Clark, D. M., Salkovskis, P. M., Hackmann, A., Wells, A., Fennell, M., Ludgate, J., Ahmad, S., … Gelder, M. (1998). Two psychological treatments for hypochondriasis: A randomized controlled trial. British Journal of Psychiatry, 173, 218–225.CrossRefGoogle Scholar
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. (1996). Structured clinical interview for the DSM-IV axis I disorders. Washington, DC, USA: American Psychiatric Publishing Inc.Google Scholar
Gasteiger, C., Sherriff, R., Fraser, A., Shedden-Mora, M. C., Petrie, K. J., & Serlachius, A. S. (2018). Predicting patient reassurance after colonoscopy: The role of illness beliefs. Journal of Psychosomatic Research, 114, 58–66.CrossRefGoogle ScholarPubMed
Hedman, E., Andersson, G., Andersson, E., Ljotsson, B., Ruck, C., Asmundson, G. J., & Lindefors, N. (2011). Internet-based cognitive-behavioural therapy for severe health anxiety: Randomised controlled trial. British Journal of Psychiatry, 198, 230–236.CrossRefGoogle ScholarPubMed
Hedman, E., Axelsson, E., Andersson, E., Lekander, M., & Ljótsson, B. (2016). Exposure-based cognitive-behavioural therapy via the internet and as bibliotherapy for somatic symptom disorder and illness anxiety disorder: Randomised controlled trial. British Journal of Psychiatry, 209, 407–413.CrossRefGoogle ScholarPubMed
Hedman, E., Axelsson, E., Görling, A., Ritzman, C., Ronnheden, M., El Alaoui, S., Andersson, E., … Ljótsson, B. (2014). Internet-delivered cognitive-behavioural therapy and behavioural stress management for severe health anxiety: Randomised controlled trial. British Journal of Psychiatry, 205, 307–314.CrossRefGoogle ScholarPubMed
Hedman, E., Lekander, M., Ljótsson, B., Lindefors, N., Rück, C., Andersson, G., & Andersson, E. (2015). Optimal cut-off points on the Health Anxiety Inventory, Illness Attitude Scales and Whiteley Index to identify severe health anxiety. PLoS One, 10, e0123412.CrossRefGoogle ScholarPubMed
Kanwar, A., Malik, S., Prokop, L. J., Sim, L. A., Feldstein, D., & Wang, Z. (2010). The association between anxiety disorders and suicidal behaviour: A systematic review. Depression and Anxiety, 30, 917–929.Google Scholar
Mathes, B. M., Norr, A. M., Allan, N. P., Albanese, B. J., & Schmidt, N. B. (2018). Cyberchondria: Overlap with health anxiety and unique relations with impairment, quality of life, and service utilization. Psychiatry Research, 261, 204–211.CrossRefGoogle ScholarPubMed
McManus, F., Surawy, C., Muse, K., Vazquez-Montes, M., & Williams, J. M. (2012). A randomized trial of mindfulness-based cognitive therapy versus unrestricted services for health anxiety (hypochondriasis). Journal of Consulting and Clinical Psychology, 80, 817–828.CrossRefGoogle Scholar
Morriss, R., Patel, S., Malins, S., Guo, B., Higton, F., James, M., Wu, M., … Tyrer, H. (2019). Clinical and economic outcomes of remotely delivered cognitive behaviour therapy versus treatment as usual for repeat unscheduled care users with severe health anxiety: A multi-centre randomised controlled trial. BMC Medicine, 17, 16.CrossRefGoogle Scholar
Salkovskis, P. M., Rimes, K. A., Warwick, H. M. C., & Clark, D. M. (2002). The Health Anxiety Inventory: Development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine, 32, 843–853.CrossRefGoogle ScholarPubMed
Scarella, T. M., Laferton, J. A., Ahern, D. K., Fallon, B. A., & Barsky, A. (2016). The relationship of hypochondriasis to anxiety, depressive and somatoform disorders. Psychosomatics, 57, 200–207.CrossRefGoogle ScholarPubMed
Seivewright, H., Green, J., Salkovskis, P., Barrett, B., Nur, U., & Tyrer, P. (2008). Randomised controlled trial of cognitive behaviour therapy in the treatment of health anxiety in a genitourinary medicine clinic. British Journal of Psychiatry, 192, 332–337.CrossRefGoogle Scholar
Sørensen, P., Birket-Smith, M., Wattar, U., Buemann, I., & Salkovskis, P. A. (2011). Randomized clinical trial of cognitive behavioural therapy versus short-term psychodynamic psychotherapy versus no intervention for patients with hypochondriasis. Psychological Medicine, 41, 431–441.CrossRefGoogle ScholarPubMed
Stein, D. J., Kogan, C. S., Atmaca, M., Fineberg, N. A., Fontenelle, L. E., Grant, J. E., Matsunaga, H., … Reed, G. M. (2016). The classification of obsessive-compulsive and related disorders in the ICD-11. Journal of Affective Disorders, 190, 663–674.CrossRefGoogle ScholarPubMed
Te Poel, F., Baumgartner, S. E., Hartmann, T., & Tanis, M. (2016). The curious case of cyberchondria: A longitudinal study on the reciprocal relationship between health anxiety and online health information seeking. Journal of Anxiety Disorders, 43, 32–40.CrossRefGoogle ScholarPubMed
Tyrer, P., Cooper, S., Salkovskis, P., Tyrer, H., Crawford, M., Byford, S., Dupont, S., … Barrett, B. (2014). Clinical and cost-effectiveness of cognitive behaviour therapy for health anxiety in medical patients: Randomized controlled trial. Lancet (London, England), 383, 219–225.CrossRefGoogle Scholar
Tyrer, P., Cooper, S., Tyrer, H., Wang, D., & Bassett, P. (2019). Increase in the prevalence of health anxiety in medical clinics: Possible cyberchondria. International Journal of Social Psychiatry, 65, 566–569.CrossRefGoogle ScholarPubMed
Tyrer, P., Nur, U., Crawford, M., Karlsen, S., McLean, C., Rao, B., & Johnson, T. (2005). The Social Functioning Questionnaire: A rapid and robust measure of perceived functioning. International Journal of Social Psychiatry, 51, 265–275.CrossRefGoogle ScholarPubMed
Tyrer, P., Salkovskis, P., Tyrer, H., Wang, D., Crawford, M. J., Dupont, S., Cooper, S., … Barrett, B. (2017). Cognitive behaviour therapy for health anxiety in medical patients (CHAMP): Randomised controlled trial with outcomes to five years. Health Technology Assessment, 21, 50.CrossRefGoogle Scholar
Tyrer, H., Tyrer, P., Lisseman-Stones, Y., McAllister, S., Cooper, S., Salkovskis, P., Crawford, M. J., … Wang, D. (2015). Therapist differences in a randomised trial of the outcome of cognitive behaviour therapy for health anxiety in medical patients. International Journal of Nursing Studies, 52, 686–694.CrossRefGoogle Scholar
Van Beek, M. H., Zuidersma, M., Lappenschaar, M., Pop, G., Roest, A. M., Van Balkom, A. J., Speckens, A. E., … Voshaar, R. C. (2016). Prognostic association of cardiac anxiety with new cardiac events and mortality following myocardial infarction. British Journal of Psychiatry, 209, 400–406.CrossRefGoogle ScholarPubMed
Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 57, 361–370.CrossRefGoogle Scholar
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