Cognitive behavior therapy adapted for health anxiety (CBT-HA) may be a highly effective long-term treatment for pathological health anxiety, according to the results of a study published in Psychological Medicine. Patients with health anxiety, a growing societal problem and cause of distress, fear undetected medical illness, resulting in frequent consultations, requests for tests, and appeals for reassurance from medical professionals and relatives.
The CHAMP (Cognitive Behavioral Therapy for Health Anxiety in Medical Patients) trial recruited patients who had had an illness and suffered from health anxiety, randomly assigning them on a 1:1 basis to CBT-HA or standard care in clinics. Data at 2 years showed greater clinical benefit for anxiety symptoms in the CBT-HA group, and as a result, the study received funding to extend the follow-up to 8 years after randomization.
Peter Tyrer, FMedSci, FRCPsych, from the Centre for Mental Health, Faculty of Medicine, Imperial College, London, United Kingdom, and colleagues followed 306 patients from cardiology, endocrinology, gastroenterology, neurology, and respiratory medicine clinics for 8 years. These patients constituted 68.9% of the original group of 444 patients (age range, 16-75 years).
Each patient in the CBT-HA group received 5 to 10 sessions of treatment initially, with an overall mean of 6 sessions. Booster sessions were allowed, although few were taken. Therapists were trained at workshops run by the CHAMP team, and assessments were carried out by researchers unaware of the treatment allocation. Efficacy measures included the Health Anxiety Inventory (HAI), Hospital Anxiety and Depression Scale (HADS), and Social Function Questionnaire (SFQ).
At 8 years, the adjusted HAI score still showed a significant difference between the 2 groups, favoring CBT-HA over standard care (score difference, 1.83; 95% CI, 0.25-3.40; P =.023). Furthermore, there had been no loss of efficacy between years 2 and 8. During the entire 8-year period, scores for generalized anxiety and depression were significantly lower in the CBT-HA group compared with the standard care group (HADS-A: P =.0114; HADS-D: P =.0027). No statistically significant differences were found between the groups in terms of social functioning. Better outcomes were found with nurse therapists than with assistant psychologists and other graduate health professionals.
This last finding was unexpected, and the study authors suggested that perhaps the nurses were seen as more appropriate therapists because of their training and perceived medical knowledge. As therapists were not randomized, no conclusions could be drawn regarding this finding.
The researchers noted that the study is limited by the selective nature of the participants — only 444 patients were recruited of 5224 subjects screened — suggesting that many patients may have been reluctant to try the therapy and that perhaps those selected were more aware of the value of the intervention.
Overall, the researchers noted that the findings “demonstrate a sustained benefit for a brief psychological treatment given for a mean of only six sessions” and suggested that “standard care” may have a “negative influence on health anxiety.”
Tyrer P, Wang D, Crawfod M, et al. Sustained benefit of cognitive behavioural therapy for health anxiety in medical patients (CHAMP) over 8 years: a randomised-controlled trial [published online March 16, 2020]. Psychological Med. doi:10.1017/S003329172000046X