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Cited by 141Psychosomatic Disorders and Their TreatmentsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

Psychotherapies for hypochondriasis

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Thomson, AB, Page, L·2007·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd006520.pub2PMC PMC6956615
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Abstract

BACKGROUND: Hypochondriasis is associated with significant medical morbidity and high health resource use. Recent studies have examined the treatment of hypochondriasis using various forms of psychotherapy. OBJECTIVES: To examine the effectiveness and comparative effectiveness of any form of psychotherapy for the treatment of hypochondriasis. SEARCH STRATEGY: 1. CCDANCTR-Studies and CCDANCTR-References were searched on 7/8/2007, CENTRAL, Medline, PsycINFO, EMBASE, Cinahl, ISI Web of Knowledge, AMED and WorldCat Dissertations; Current Controlled Trials meta-register (mRCT), CenterWatch, NHS National Research Register and clinicaltrials.gov; 2. Communication with authors of relevant studies and other clinicians in the field; 3. Handsearching reference lists of included studies and relevant review articles, and electronic citation search in ISI Web of Knowledge for all included studies. SELECTION CRITERIA: All randomised controlled studies, both published and unpublished, in any language, in which adults with hypochondriasis were treated with a psychological intervention. DATA COLLECTION AND ANALYSIS: Data were extracted independently by two authors using a standardised extraction sheet. Study quality was assessed independently by the two authors qualitatively and using a standardised scale. Meta-analyses were performed using RevMan software. Standardised or weighted mean differences were used to pool data for continuous outcomes and odds ratios were used to pool data for dichotomous outcomes, together with 95% confidence intervals. MAIN RESULTS: Six studies were included, with a total of 440 participants. The interventions examined were cognitive therapy (CT), behavioural therapy (BT), cognitive behavioural therapy (CBT), behavioural stress management (BSM) and psychoeducation. All forms of psychotherapy except psychoeducation showed a significant improvement in hypochondriacal symptoms compared to waiting list control (SMD (random) [95% CI] = -0.86 [-1.25 to -0.46]). For some therapies, significant improvements were found in the secondary outcomes of general functioning (CBT), resource use (psychoeducation), anxiety (CT, BSM), depression (CT, BSM) and physical symptoms (CBT). These secondary outcome findings were based on smaller numbers of participants and there was significant heterogeneity between studies. AUTHORS' CONCLUSIONS: Cognitive therapy, behavioural therapy, cognitive behavioural therapy and behavioural stress management are effective in reducing symptoms of hypochondriasis. However, studies included in the review used small numbers of participants and do not allow estimation of effect size, comparison between different types of psychotherapy or whether people are "cured". Most long-term outcome data were uncontrolled. Further studies should make use of validated rating scales, assess treatment acceptability and effect on resource use, and determine the active ingredients and nonspecific factors that are important in psychotherapy for hypochondriasis.

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  • Existing psychological treatments for severe health anxiety have limited effects.

    “Severe health anxiety (hypochondriasis) is a common and disabling condition for which existing psychological treatments have limited effects (Thomson & Page, 2007).”

    From Mindfulness-based cognitive therapy for severe health anxiety (hypochondriasis): An interpretative phenomenological analysis of patients' experiences (2011) · cites this paper as Thomson & Page, 2007

    The Authors’ conclusions (page not available in our copy) say that several psychological therapies are effective in reducing symptoms of hypochondriasis, rather than that their effects are limited. The review cautions that the small studies cannot establish the size of those effects or whether patients are cured; that is a limitation of the evidence, not a finding of limited treatment effects. (LLM, conf=0.87)

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  • A recent Cochrane review failed to find any superiority of cognitive-behavioural treatments over non-specific therapies for health anxiety.

    “To date, the effects of psychological treatments for HA have been limited, with a recent Cochrane review failing to find any superiority of cognitive-behavioural treatments (CBT) over non-specific therapies (Thomson & Page, 2007).”

    From Mindfulness-based cognitive therapy for severe health anxiety (hypochondriasis): An interpretative phenomenological analysis of patients' experiences (2011) · cites this paper as Thomson & Page, 2007

    The Discussion (page unavailable) reports no significant difference at 12 months between cognitive therapy and a non-specific behavioural stress management treatment. But it also reports earlier, larger improvements with cognitive therapy, and the Authors’ conclusions say the small studies do not allow comparisons between psychotherapy types. The review therefore supports a narrower finding, not a general conclusion that CBT showed no superiority over non-specific therapies. (LLM, conf=0.84)

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  • Systematic reviews and meta-analyses have established the effectiveness of different psychological interventions for health anxiety.

    “Systematic reviews and meta-analyses have established the effectiveness of different psychological interventions [6, 11–17]”

    From Cost Effectiveness of Internet-Delivered Acceptance and Commitment Therapy for Patients with Severe Health Anxiety: A Randomised Controlled Trial (2022) · cites this paper as [11]

  • Despite the high prevalence of severe health anxiety and the existence of effective psychological treatments, the disorder is still rarely diagnosed in the health care setting.

    “Despite the high prevalence and the existence of effective psychological treatments [7], the disorder is still rarely diagnosed in the health care setting [8].”

    From Development and Feasibility Testing of Internet-Delivered Acceptance and Commitment Therapy for Severe Health Anxiety: Pilot Study. (2018) · cites this paper as [7]

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4 of the 74 references couldn’t be matched to a known paper.

Research works printed but not linked: 7

  1. Anderson 1996 {published data only} Anderson MC. Effect of exposure and response prevention on target symptoms present in hypochondriasis. Thesis (Ph.D.). Hofstra University, 1996.
  2. Fried 1978 {published data only} Fried, JM. The effect of biofeedback-assisted relaxation training on hypochondriasis. Thesis (M.A.). California State University, Northridge, 1978.
  3. Hassan 1989 {published data only} Hassan, FM. Cognitive-behavioral treatment for DSM-III-R hypochodriasis. Thesis (Ph.D.). The Chicago Medical School, 1989.
  4. Bouman TK, Luteijn F, Albersnagel FA, Van der Ploeg F. Some experiences with the Beck depression inventory [Enige ervaringen met de Beck depression inventory (BDI)]. Gedrag 1985;13:13-21.
  5. Higgins JPT, Green S Editors. Cochrane Handbook for Systematic Reviews of Interventions 4.2.6. The Cochrane Library. Chichester, UK: John Wiley & Sons, 2006.
  6. Jenkinson C, Layte R, Wright L, Coulter A. The UK SF-36: An Analysis and Interpretation Manual. Oxford: Health Services Research Unit, 1996.
  7. Karnofsky D, AbelmannW, Craver L, Burchenal J. The use of nitrogen mustards in the palliative treatment of carcinoma. Cancer 1948;1:634-56.

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Authors
Thomson, A., & Page, L.
Affiliations
King's College London (GB)
ORCID
Page, L
Venue
Cochrane Database of Systematic Reviews
Publisher
John Wiley & Sons, Ltd
Published
2007-04-18
Issue
4
Pages
CD006520-CD006520
ISSN
1361-6137 (ISSN-L)
DOI
10.1002/14651858.cd006520.pub2
PMC
PMC6956615
OpenAlex
W1577594729
Cited by
141
References
74
Citations by year
2025: 2 · 2024: 3 · 2023: 5 · 2022: 6 · 2021: 4 · 2020: 4 · 2019: 8 · 2018: 4 · 2017: 10 · 2016: 5 · 2015: 15 · 2014: 17 · 2013: 12 · 2012: 13
Type
reference entry
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • King's College London
  • Menzies Centre for Australian Studies, King's College London, University of London
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
health anxiety, psychotherapy, cognitive therapy, behavior therapy, cognitive behavioral therapy, psychoeducation, anxiety, depression, somatic symptoms, health care utilization, waitlist control, treatment effectiveness, comparative effectiveness, general functioning, health-related quality of life, health-related costs
MeSH terms
Humans, Hypochondriasis, Psychotherapy, Stress, Physiological, Waiting Lists, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic

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