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Psychotherapies for hypochondriasis
Open accessAbstract
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 SELECTION CRITERIA: All randomised controlled studies, both published and unpublished, in any language, in which adults with hypochondriasis were treated with a psychological intervention.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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“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
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“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
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“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]
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“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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Metadata
- 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)
- 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
- bronze
- doi.org
- 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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