Predicting outcomes and sudden gains from initial in‐session interactions during remote cognitive–behavioural therapy for severe health anxiety

BackgroundHealth anxiety and medically unexplained symptoms cost the National Health Service (NHS) an estimated £3 billion per year in unnecessary costs with little evidence of patient benefit. Effective treatment is rarely taken up due to issues such as stigma or previous negative experiences with mental health services. An approach to overcome this might be to offer remotely delivered psychological therapy, which can be just as effective as face-to-face therapy and may be more accessible and suitable.AimsTo investigate the clinical outcomes and cost-effectiveness of remotely delivered cognitive–behavioural therapy (CBT) to people with high health anxiety repeatedly accessing unscheduled care (trial registration: NCT02298036).MethodA multicentre randomised controlled trial (RCT) will be undertaken in primary and secondary care providers of unscheduled care across the East Midlands. One hundred and forty-four eligible participants will be equally randomised to receive either remote CBT (6–12 sessions) or treatment as usual (TAU). Two doctoral research studies will investigate the barriers and facilitators to delivering the intervention and the factors contributing to the optimisation of therapeutic outcome.ResultsThis trial will be the first to test the clinical outcomes and cost-effectiveness of remotely delivered CBT for the treatment of high health anxiety.ConclusionsThe findings will enable an understanding as to how this intervention might fit into a wider care pathway to enhance patient experience of care.

Download Full-text

A cognitive–behavioural therapy assessment model for use in everyday clinical practice

Advances in Psychiatric Treatment ◽

10.1192/apt.8.3.172 ◽

2002 ◽

Vol 8 (3) ◽

pp. 172-179 ◽

Cited By ~ 80

Author(s):

Chris Williams ◽

Anne Garland

Keyword(s):

Cognitive Behavioural Therapy ◽

Clinical Skills ◽

Health Anxiety ◽

Antidepressant Medication ◽

Bipolar Disorders ◽

Behavioural Therapy ◽

Assessment Model ◽

Therapy Assessment ◽

Compulsive Disorder ◽

Cognitive Behavioural

Cognitive–behavioural therapy (CBT) is a shortterm, problem-focused psychosocial intervention. Evidence from randomised controlled trials and metaanalyses shows that it is an effective intervention for depression, panic disorder, generalised anxiety and obsessive–compulsive disorder (Department of Health, 2001). Increasing evidence indicates its usefulness in a growing range of other psychiatric disorders such as health anxiety/hypochondriasis, social phobia, schizophrenia and bipolar disorders. CBT is also of proven benefit to patients who attend psychiatric clinics (Paykel et al, 1999). The model is fully compatible with the use of medication, and studies examining depression have tended to confirm that CBT used together with antidepressant medication is more effective than either treatment alone (Blackburn et al, 1981) and that CBT treatment may lead to a reduction in future relapse (Evans et al, 1992). Generic CBT skills provide a readily accessible model for patient assessment and management and can usefully inform general clinical skills in everyday practice.

Download Full-text

A Complex Interplay: Cognitive Behavioural Therapy for Severe Health Anxiety in Addison's Disease to Reduce Emergency Department Admissions

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465817000182 ◽

2017 ◽

Vol 45 (4) ◽

pp. 419-426 ◽

Cited By ~ 5

Author(s):

Jo Daniels ◽

Elizabeth Sheils

Keyword(s):

Emergency Department ◽

Cognitive Behavioural Therapy ◽

Single Case ◽

Health Anxiety ◽

Addison’S Disease ◽

Behavioural Therapy ◽

Adrenal Crisis ◽

Addison's Disease ◽

Complex Interplay ◽

Cognitive Behavioural

Background: Addison's disease (AD) is a rare chronic illness caused by adrenocortical insufficiency. Due to the pivotal role of the regulating hormone cortisol in AD, there is a common symptom overlap between the presentation of anxiety and adrenal crisis. Previous literature has identified the prevalence of anxiety in endocrinological disorders, however there is a paucity of research examining the complex interplay between AD and anxiety. Aims: This paper describes a single case study of a patient with severe health anxiety and co-morbid AD. The aims of the study were to establish if standard cognitive behavioural therapy for health anxiety in AD can lead to a reduction in psychological distress, and whether this approach is an effective intervention for the reduction of Emergency Department admissions. Method: A single case design was used, with pre- and post-measures of health anxiety, general anxiety and depression. Data on Emergency Department admissions prior to and following treatment were used to assess change in this domain. Results: Reliable and clinically significant reductions were seen across all measures, from severe to sub-clinical levels. There was a complete amelioration of Emergency Department admissions in the 12 months following completion of treatment. Conclusions: This preliminary study provides a sound rationale for further research into AD complicated by anxiety. Findings support the clinical utility of the cognitive behavioural therapy model for complex presentations of AD, offering a potential treatment option where anxiety is elevated and interfering with self-management and leading to high levels of health service use.

Download Full-text

The uptake and outcomes of Internet cognitive behavioural therapy for health anxiety symptoms during the COVID-19 pandemic

Journal of Anxiety Disorders ◽

10.1016/j.janxdis.2021.102494 ◽

2021 ◽

pp. 102494

Author(s):

Maria J. Sharrock ◽

Alison E.J. Mahoney ◽

Hila Haskelberg ◽

Michael Millard ◽

Jill Newby

Keyword(s):

Cognitive Behavioural Therapy ◽

Health Anxiety ◽

Behavioural Therapy ◽

Anxiety Symptoms ◽

Cognitive Behavioural ◽

Internet Cognitive Behavioural Therapy

Download Full-text

The uptake and outcomes of Internet cognitive behavioural therapy for health anxiety symptoms during the COVID-19 pandemic

10.31234/osf.io/6udqp ◽

2021 ◽

Author(s):

Maria J. Sharrock ◽

Alison Mahoney ◽

Hila Haskelberg ◽

Michael Millard ◽

Jill Newby

Keyword(s):

Mental Health ◽

Cognitive Behavioural Therapy ◽

Health Anxiety ◽

Course Completion ◽

Behavioural Therapy ◽

Community Members ◽

Cognitive Behavioural ◽

Patient Health ◽

Reported Health ◽

Internet Cognitive Behavioural Therapy

Background: Internet cognitive behavioural therapy (iCBT) for health anxiety hasdemonstrated efficacy but has not been evaluated during the COVID-19 pandemic. Thisstudy presents the first evaluation of the uptake and outcomes of iCBT for health anxietyduring the COVID-19 pandemic.Methods: THIS WAY UP is an Australian digital mental health service which delivers iCBTinterventions to community members. We compared the uptake of THIS WAY UP’s iCBTcourse for health anxiety in an Australian adult sample who started the course before thepandemic (12th September 2019 to 11th March 2020) to during the pandemic (12th March to11th June 2020). The course was accessible to Australian adults over 18 years old, with noinclusion criteria. Outcomes included course registrations and commencements, lesson andcourse completion, and self-reported health anxiety (Short Health Anxiety Inventory),depression (Patient Health Questionnaire 9-item) and distress (Kessler-10).Results: From March to June 2020, we observed significant increases in course registrations(N=238 vs N=1057); and course commencements (N=126 vs. N= 778). Large, significantimprovements in health anxiety (g= 0.89), and distress (K10: g=0.91), and mediumimprovements in depression (g=0.55) were found. Course completion during COVID was30.5%.Conclusions: iCBT improved health anxiety during the COVID-19 pandemic, and providesscalable intervention that can address increased demands for mental health services in thecommunity.

Download Full-text

A feasibility trial of cognitive behavioural therapy for COVID-related health anxiety: The COVID Anxiety Project

http://isrctn.com/ ◽

10.1186/isrctn14973494 ◽

2021 ◽

Author(s):

Mike Crawford

Keyword(s):

Cognitive Behavioural Therapy ◽

Health Anxiety ◽

Behavioural Therapy ◽

Feasibility Trial ◽

Cognitive Behavioural

Download Full-text

Internet-delivered exposure-based cognitive–behavioural therapy and behavioural stress management for severe health anxiety: randomised controlled trial

The British Journal of Psychiatry ◽

10.1192/bjp.bp.113.140913 ◽

2014 ◽

Vol 205 (4) ◽

pp. 307-314 ◽

Cited By ~ 53

Author(s):

Erik Hedman ◽

Erland Axelsson ◽

Anders Görling ◽

Carina Ritzman ◽

Markus Ronnheden ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Stress Management ◽

Cognitive Behavioural Therapy ◽

Psychological Treatment ◽

Controlled Trial ◽

Health Anxiety ◽

Behavioural Therapy ◽

The Internet ◽

Cognitive Behavioural ◽

Randomised Controlled

BackgroundExposure-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).AimsTo investigate two internet-delivered treatments – exposure-based CBTv.BSM – for severe health anxiety in a randomised controlled trial (trial registration: NCT01673035).MethodParticipants (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.ResultsInternet-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'sd: exposure-based CBT, 1.78; BSM, 1.22).ConclusionsExposure-based CBT delivered via the internet is an efficacious treatment for severe health anxiety.Declarations of interestNone.

Download Full-text