Therapist differences in a randomised trial of the outcome of cognitive behaviour therapy for health anxiety in medical patients
Open accessAbstract
Background Health anxiety is common in medical settings and can be treated successfully by cognitive behaviour therapy. However it is not clear who might be best placed to deliver this therapy.Objectives In a planned secondary analysis of data from a randomised trial of adapted cognitive behaviour therapy for health anxiety we compared outcomes of therapy delivered by nurses and other professional groups.Design A randomised controlled trial with two treatment arms, 5-10 sessions of cognitive behaviour therapy adapted health anxiety or standard care.Setting Cardiology, endocrine, gastroenterology, neurological and respiratory clinics in six general hospitals in the UK covering urban, suburban and rural areas.Participants Medical patients attending the clinics who had pathological health anxiety and also scored for a diagnosis of hypochondriasis.Methods Patients were randomised to one of two treatment arms, 5-10 sessions of cognitive behaviour therapy adapted health anxiety or standard care delivered by naive therapists (not randomised) who were trained in advance before delivering the treatment. Independent assessment of outcomes by researchers masked to allocation status at 3m, 6m, 12m and 24m.Results 444 patients were randomised in the trial, 219 to cognitive behaviour therapy adapted health anxiety and 225 to standard care. 373 (84%) completed assessments after two years. Those treated by nurses (n=66) had improvement in health anxiety, generalised anxiety and depression outcomes that were significantly better and twice as great as those of the professional groups of assistant psychologists (n=87) and graduate workers (n=66) (P<0.01 over all time points). The number needed to treat to show superiority of nurse-delivered treatment over other treatment delivery was 4 at 6 months and 6 at one year.Conclusion General nurses, after suitable training, are very effective therapists for patients with health anxiety in medical clinics and should be the therapists of choice for patients in these settings.
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General nurses may be superior to psychologists as therapists because they have more credibility with patients averse to mental health professionals.
“They may even be superior to psychologists in that they have more credibility with those patients who are averse to mental health professionals.19”
From Why health anxiety needs to be recognised in hospital practice (2020) · cites this paper as [19]
The Discussion (page unavailable) suggests that patients might have more confidence in a nurse than a psychologist and notes lower dropout among nurse-treated patients. But it says greater acceptance was not tested, does not identify patients averse to mental health professionals, and limits the comparison to nurses and largely assistant psychologists delivering CBT for health anxiety in medical clinics. (LLM, conf=0.87)
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- Authors
- Tyrer, H., Tyrer, P., Lisseman-Stones, Y., McAllister, S., Cooper, S., Salkovskis, P., Crawford, M. J., Dupont, S., Green, J., Murphy, D., & Wang, D.
- Affiliations
- Centre for Mental Health (GB)
- Kings Mill Hospital (GB)
- King Faisal Specialist Hospital & Research Centre (SA)
- University of Bath (GB)
- Hillingdon Hospital (GB)
- Central and North West London NHS Foundation Trust (GB)
- Charing Cross Hospital (GB)
- Liverpool School of Tropical Medicine (GB)
- Corresponding author
- Tyrer, Peter
- Venue
- International Journal of Nursing Studies
- Publisher
- Elsevier BV
- Published
- 2015-03
- Volume
- 52
- Issue
- 3
- Pages
- 686-694
- ISSN
- 0020-7489 (ISSN-L)
- OpenAlex
- W2100924888
- Cited by
- 32
- References
- 31
- Citations by year
- 2026: 3 · 2024: 1 · 2023: 3 · 2022: 4 · 2021: 2 · 2020: 4 · 2019: 3 · 2018: 3 · 2017: 2 · 2016: 6 · 2015: 1
- FWCI
- 4.17
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- International Journal of Nursing Studies (publishedVersion)
- PubMed (publishedVersion)
- The University of Bath Online Publications Store (The University of Bath) (submittedVersion)
- Pure (University of Bath) (submittedVersion, other-oa)
- LSTM Online Archive (Liverpool School of Tropical Medicine) (submittedVersion)
- Funders
- National Institute for Health Research
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- health anxiety, cognitive behavioral therapy, medical patients, generalized anxiety disorder, depression, number needed to treat
- MeSH terms
- Workforce, Anxiety Disorders, Humans, Nurses, Cognitive Behavioral Therapy, Treatment Outcome
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