Cognitive behavioral therapy (CBT) may be effective for reducing health anxiety in patients with hypochondriacal disorder, with symptom improvements maintained over 10 years of follow-up, according to study data published in BJPsych Open. Characterized by excessive worry about health, hypochondriacal disorder is associated with significant comorbidity, distress, and functional impairment.
Kari-Elise Frøystad Veddegjærde, MD, of the department of clinical science, University of Bergen, Norway, led study efforts to assess patients who received care at the Hypochondriac Clinic at Haraldsplass Deaconal Hospital between 1996 and 2001. Patients received 16 sessions of individual CBT over 8 to 12 weeks, with all sessions administered by the same specialist.
At 3 timepoints (pre-CBT, immediately post-CBT, and 10 years post-CBT), patients completed a battery of self-report questionnaires. The 14-item Whiteley Index was used to assess hypochondriacal symptoms and the Short Form 36 Health Survey (SF-36) captured quality of life. Somatic symptoms, anxiety, and depression were also assessed. The pre- and post-CBT assessments were conducted at the clinic, whereas the 10-year follow-up survey was administered by postal mail and/or telephone interview. Linear mixed models for repeated measurements were used to assess symptom changes across each timepoint. The magnitude of symptom improvement was expressed as the standardized mean difference (SMD) between scores.
The study cohort comprised 50 patients (mean age at baseline, 35±8.8 years; 82% women), with mean time of diagnosis at 11.3±8.1 years prior to study inclusion. The most common subjects of worry were cancer, heart-related diseases, and neurological diseases. A total of 34 (68%) participants also had lifetime comorbid mental disorders, including depression (n=17) and generalized anxiety disorder (N=14).
Between the pre- and post-CBT timepoints, significant reductions in hypochondriacal disorder scores were observed (SMD range, 0.45-2.06). No significant differences were observed between post-CBT scores and 10-year follow-up scores, suggesting that CBT effects were maintained in the long term. Patients displayed improvements in all 8 SF-36 subscales (SMD range, 0.55-1.65). They also experienced significant reductions in somatic symptoms (SMD range, 0.89-1.23), depression (SMD, 1.11), trait anxiety (SMD, 0.69), and state anxiety (SMD, 0.79).
Overall, these improvements remained significant at long term follow-up. At the 10-year survey, 29 (58%) patients reported that they no longer had hypochondriacal disorder, 12 (24%) reported that they still ruminated on their health, and 10 (20%) reported using antidepressants. The majority of patients (68%) reported that they had not received any other therapy since study participation.
These data support the long term efficacy of CBT for hypochondriacal disorder, even if treatment is administered for a short period of time. However, the lack of a control group and the small sample size limit the strength of these findings.
“As the condition in many patients…is left undetected and untreated, there may therefore be substantial socioeconomic benefits in improved diagnostic practices and treatment availability for this patient group,” the investigators concluded.
Veddegjærde KF, Sivertsen B, Skogen JC, Smith ORF, Wilhelmsen I. Long-term effect of cognitive-behavioral therapy in patients with Hypochondriacal Disorder. BJPsych Open. 2020;6(3):e42