The effectiveness of internet-delivered cognitive behavioural therapy for health anxiety in routine care
Abstract
Introduction Randomised controlled trials have shown that internet-delivered cognitive behavioural treatment (iCBT) is an effective treatment for health anxiety, but the effectiveness of these programs in routine care has not been investigated. This study examined the effectiveness of iCBT for health anxiety symptoms in routine care settings in the community.Methods Using an open-trial design, we investigated adherence to, and effectiveness of a 6-lesson iCBT program for health anxiety symptoms amongst individuals (n = 391, mean age 41 years, 64% female) who enrolled in the program either self-guided (n = 312) or under the supervision of community clinicians (general practitioners, psychologists and other allied health professionals) (n = 79). Primary outcome was health anxiety severity on the Short Health Anxiety Inventory (SHAI), and secondary outcomes were depression severity on the Patient Health Questionnaire 9-item (PHQ-9) (depression) and distress (Kessler-10: K-10).Results Adherence to the iCBT program was modest (45.6% in the clinician-supervised group, 33.0% in the unguided group), but within-subjects effect sizes were large (SHAI: g = 1.66, 95%CI: 1.45-1.88; PHQ-9: g = 1.12, 95%CI: 0.92-1.32; K-10: g = 1.35, 95%CI: 1.15-1.56).Limitations No control group, lack of follow-up data.Conclusions iCBT is an effective treatment for health anxiety symptoms in routine care, but methods to increase adherence are needed to optimise benefits to participants. Randomised controlled effectiveness trials with long-term follow-up are needed.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Evidence supports the delivery of CBT for health anxiety and IAD online, with large effect sizes when delivered in routine care.
“Evidence also supports the delivery of CBT for health anxiety and IAD online [26, 58, 77], with large effect sizes when delivered in routine care [78, 79].”
From Illness Anxiety Disorder: A Review of the Current Research and Future Directions (2024) · cites this paper as [78]
Cites
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910 · see citing works
Elm, E. V., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2007) · BMJ · doi:10.1136/bmj.39335.541782.ad · Cited by 10,766 · see citing works
KESSLER, R. C., ANDREWS, G., COLPE, L. J., HIRIPI, E., MROCZEK, D. K., NORMAND, S.-L. T., WALTERS, E. E., & ZASLAVSKY, A. M. (2002) · Psychological Medicine · doi:10.1017/s0033291702006074 · Cited by 10,327 · see citing works
Self-citationJacobson, N. S., & Truax, P. (1991) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.59.1.12 · Cited by 7,770 · see citing works
Interpreting scores on the Kessler Psychological Distress Scale (K10)
Andrews, G., & Slade, T. (2001) · Australian and New Zealand Journal of Public Health · doi:10.1111/j.1467-842x.2001.tb00310.x · Cited by 2,021 · see citing works
Self-citationInternet-based cognitive behaviour therapy for symptoms of depression and anxiety: A meta-analysis
SPEK, V., CUIJPERS, P., NYKLÍČEK, I., RIPER, H., KEYZER, J., & POP, V. (2007) · Psychological Medicine · doi:10.1017/s0033291706008944 · Cited by 1,586 · see citing works
FURUKAWA, T. A., KESSLER, R. C., SLADE, T., & ANDREWS, G. (2003) · Psychological Medicine · doi:10.1017/s0033291702006700 · Cited by 1,570 · see citing works
Self-citationDIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, FIFTH EDITION
Abbas, A., & Aminoroaia, M. (2013) · Cited by 1,478 · see citing works
Linear Mixed Models: A Practical Guide Using Statistical Software
West, B. T., Welch, K. B., & Gałecki, A. T. (2006) · Thammasat University Digital Collections · Cited by 1,392 · see citing works
SALKOVSKIS, P. M., RIMES, K. A., WARWICK, H. M. C., & CLARK, D. M. (2002) · Psychological Medicine · doi:10.1017/s0033291702005822 · Cited by 1,351 · see citing works
Warwick, H. M. C., & Salkovskis, P. M. (1990) · Behaviour Research and Therapy · doi:10.1016/0005-7967(90)90023-c · Cited by 587 · cited 1× · see citing works
“…and avoidance of feared situations, emotions, thoughts and sensations, that are theorised to maintain and worsen health anxiety (Warwick & Salkovskis, 1990), and the majority were not exposed to relapse prevention, which is thought to be critical for anticipating and Downloaded…”
BackgroundDiagnostic accuracy of the mood module of the patient health questionnaire: a systematic review
Wittkampf, K. A., Naeije, L., Schene, A. H., Huyser, J., & van Weert, H. C. (2007) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2007.06.004 · Cited by 493 · see citing works
Abramowitz, J. S., Deacon, B. J., & Valentiner, D. P. (2007) · Cognitive Therapy and Research · doi:10.1007/s10608-006-9058-1 · Cited by 308 · see citing works
Health anxiety in Australia: prevalence, comorbidity, disability and service use
Sunderland, M., Newby, J. M., & Andrews, G. (2013) · British Journal of Psychiatry · doi:10.1192/bjp.bp.111.103960 · Cited by 280 · see citing works
Self-citationThe Short Health Anxiety Inventory: A systematic review and meta-analysis
Alberts, N. M., Hadjistavropoulos, H. D., Jones, S. L., & Sharpe, D. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2012.10.009 · Cited by 267 · see citing works
Zuithoff, N. P., Vergouwe, Y., King, M., Nazareth, I., van Wezep, M. J., Moons, K. G., & Geerlings, M. I. (2010) · BMC Family Practice · doi:10.1186/1471-2296-11-98 · Cited by 218 · see citing works
Internet-based cognitive-behavioural therapy for severe health anxiety: randomised controlled trial
Hedman, E., Andersson, G., Andersson, E., Ljótsson, B., Rück, C., Asmundson, G. J. G., & Lindefors, N. (2011) · British Journal of Psychiatry · doi:10.1192/bjp.bp.110.086843 · Cited by 212 · see citing works
Hilvert-Bruce, Z., Rossouw, P. J., Wong, N., Sunderland, M., & Andrews, G. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.04.001 · Cited by 193 · see citing works
Self-citationThe effects of safety behaviors on health anxiety: An experimental investigation
Olatunji, B. O., Etzel, E. N., Tomarken, A. J., Ciesielski, B. G., & Deacon, B. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.07.008 · Cited by 192 · see citing works
Newby, J. M., Mackenzie, A., Williams, A. D., McIntyre, K., Watts, S., Wong, N., & Andrews, G. (2013) · Psychological Medicine · doi:10.1017/s0033291713000111 · Cited by 181 · see citing works
Self-citationWilliams, A. D., & Andrews, G. (2013) · PLoS ONE · doi:10.1371/journal.pone.0057447 · Cited by 149 · see citing works
Self-citationNordgren, L. B., Hedman, E., Etienne, J., Bodin, J., Kadowaki, Å., Eriksson, S., Lindkvist, E., Andersson, G., & Carlbring, P. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.05.007 · Cited by 145 · cited 1× · see citing works
“approaches may be useful, where the participant can choose which module to complete first depending on their needs; this approach has been demonstrated effective in mixed anxiety disorder samples (Nordgren et al., 2014).”
BackgroundHedman, E., Axelsson, E., Andersson, E., Lekander, M., & Ljótsson, B. (2016) · British Journal of Psychiatry · doi:10.1192/bjp.bp.116.181396 · Cited by 119 · see citing works
Cognitive Behaviour Therapy for Health Anxiety: A Systematic Review and Meta-Analysis
Cooper, K., Gregory, J. D., Walker, I., Lambe, S., & Salkovskis, P. M. (2017) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465816000527 · Cited by 118 · see citing works
Hedman, E., Axelsson, E., Görling, A., Ritzman, C., Ronnheden, M., Alaoui, S. E., Andersson, E., Lekander, M., & Ljótsson, B. (2014) · British Journal of Psychiatry · doi:10.1192/bjp.bp.113.140913 · Cited by 103 · see citing works
Hedman, E., Andersson, E., Lindefors, N., Andersson, G., Rück, C., & Ljótsson, B. (2013) · Psychological Medicine · doi:10.1017/s0033291712001079 · Cited by 98 · see citing works
Mewton, L., Wong, N., & Andrews, G. (2012) · Depression and Anxiety · doi:10.1002/da.21995 · Cited by 94 · see citing works
Self-citationNewby, J. M., Mewton, L. R., Williams, A. D., & Andrews, G. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.04.037 · Cited by 91 · see citing works
Self-citationNewby, J. M., Smith, J., Uppal, S., Mason, E., Mahoney, A. E. J., & Andrews, G. (2018) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000248 · Cited by 84 · cited 16× · see citing works
“RCTs show internet CBT (iCBT) is effective for treating health anxiety.”
BackgroundMethodResultInfluentialSelf-citationSunderland, M., Wong, N., Hilvert-Bruce, Z., & Andrews, G. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.03.005 · Cited by 84 · see citing works
Self-citationNewby, J. M., Mewton, L., & Andrews, G. (2017) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.06.002 · Cited by 75 · see citing works
Self-citationBoettcher, J., Berger, T., & Renneberg, B. (2012) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465812000501 · Cited by 61 · see citing works
Morgan, C., Mason, E., Newby, J. M., Mahoney, A. E. J., Hobbs, M. J., McAloon, J., & Andrews, G. (2017) · Internet Interventions · doi:10.1016/j.invent.2017.10.003 · Cited by 58 · see citing works
Hobbs, M., Joubert, A., Mahoney, A. E. J., & Andrews, G. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.09.026 · Cited by 53 · see citing works
Self-citationSunderland, M., Hobbs, M. J., Anderson, T. M., & Andrews, G. (2011) · International Psychogeriatrics · doi:10.1017/s1041610211001852 · Cited by 48 · see citing works
Self-citationHealth anxiety: the silent, disabling epidemic
Tyrer, P., Eilenberg, T., Fink, P., Hedman, E., & Tyrer, H. (2016) · BMJ · doi:10.1136/bmj.i2250 · Cited by 47 · cited 1× · see citing works
“One in twenty individuals experience excessive and disabling anxiety about their health during their lifetime (Sunderland, Newby, & Andrews, 2013), but despite the high prevalence rates, it often goes undetected and untreated (Tyrer, Eilenberg, Fink, Hedman, & Tyrer, 2016).”
BackgroundHobbs, M., Mahoney, A. E. J., & Andrews, G. (2017) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2017.09.003 · Cited by 39 · see citing works
Self-citationNewby, J. M., Mahoney, A. E. J., Mason, E. C., Smith, J., Uppal, S., & Andrews, G. (2016) · Internet Interventions · doi:10.1016/j.invent.2016.09.007 · Cited by 18 · see citing works
Self-citation
Flagged first, then by citations
1 of the 39 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Baig, M., Jameel, T., Alzahrani, S. H., Mirza, A. A., Gazzaz, Z. J., Ahmad, T., Baig, F., & Almurashi, S. H. (2020) · PLoS ONE · doi:10.1371/journal.pone.0243526 · Cited by 127 · see citing works
Roberts, A., Davenport, T. A., Wong, T., Moon, H.-W., Hickie, I. B., & LaMonica, H. M. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100379 · Cited by 99 · see citing works
Haig-Ferguson, A., Cooper, K., Cartwright, E., Loades, M. E., & Daniels, J. (2021) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465820000636 · Cited by 84 · see citing works
Sharrock, M. J., Mahoney, A. E. J., Haskelberg, H., Millard, M., & Newby, J. M. (2021) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2021.102494 · Cited by 46 · see citing works
Self-citationIntegrating internet CBT into clinical practice: a practical guide for clinicians
Newby, J., Mason, E., Kladnistki, N., Murphy, M., Millard, M., Haskelberg, H., Allen, A., & Mahoney, A. (2021) · Clinical Psychologist · doi:10.1080/13284207.2020.1843968 · Cited by 45 · see citing works
Self-citationIllness Anxiety Disorder: A Review of the Current Research and Future Directions
Kikas, K., Werner-Seidler, A., Upton, E., & Newby, J. (2024) · Current Psychiatry Reports · doi:10.1007/s11920-024-01507-2 · Cited by 31 · see citing works
“Evidence also supports the delivery of CBT for health anxiety and IAD online [26, 58, 77], with large effect sizes when delivered in routine care [78, 79].”
BackgroundSelf-citationLuu, J., Millard, M., Newby, J. M., Haskelberg, H., Hobbs, M. J., & Mahoney, A. (2020) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2020.100561 · Cited by 25 · see citing works
Self-citationLim, D. Z., Newby, J. M., Gardner, T., Haskelberg, H., Schultz, R., Faux, S. G., & Shiner, C. T. (2020) · Pain Medicine · doi:10.1093/pm/pnaa458 · Cited by 24 · see citing works
Self-citationSkaczkowski, G., van der Kruk, S., Loxton, S., Hughes-Barton, D., Howell, C., Turnbull, D., Jensen, N., Smout, M., & Gunn, K. (2022) · JMIR Mental Health · doi:10.2196/31018 · Cited by 9 · see citing works
Axelsson, E., & Hedman-Lagerlöf, E. (2023) · Expert review of pharmacoeconomics & outcomes research · doi:10.1080/14737167.2023.2250915 · Cited by 7 · see citing works
Österman, S., Axelsson, E., Forsell, E., Svanborg, C., Lindefors, N., Hedman‐Lagerlöf, E., & Ivanov, V. Z. (2024) · Internet Interventions · doi:10.1016/j.invent.2024.100780 · Cited by 7 · see citing works
Hurwitz, C., Shiner, C. T., Sharrock, M. J., Millard, M., & Mahoney, A. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.08.073 · Cited by 5 · see citing works
Self-citationÖsterman, S., Hentati, A., Forsell, E., Axelsson, E., Hedman‐Lagerlöf, E., Lindefors, N., Ivanov, V. Z., & Kraepelien, M. (2023) · BMJ Open · doi:10.1136/bmjopen-2023-077376 · Cited by 3 · see citing works
Need to see a psychologist? How to find one that’s right for you
Mazzucchelli, T. G. (2026) · doi:10.64628/aa.k7e9dm7jc · Cited by 3 · see citing works
Bakanaitė, R., Bakanienė, I., & Kanyeredzi, A. (2025) · Telemedicine Journal and e-Health · doi:10.1177/15305627251358855 · Cited by 2 · see citing works
Al-Wahedi, M., Ismail, S., Alkhofani, W., & Azman, A. (2024) · Psychology · doi:10.4236/psych.2024.159087 · Cited by 1 · see citing works
Digital Therapies for Insomnia
Jackson, M. L., Meaklim, H., & Mason, E. C. (2023) · Springer eBooks · doi:10.1007/978-3-031-10698-9_6 · Cited by 2 · see citing works
Self-citationSafa, M., Zomorodi, S., Boroujerdi, F. G., & Gholami, R. (2023) · Journal of Health Reports and Technology · doi:10.5812/jhrt-136050 · Cited by 1 · see citing works
Exercise and Psychotherapy in the Treatment of Anxiety Disorders
Loomes, M., & Rosenbaum, S. (2023) · Advances in psychology, mental health, and behavioral studies (APMHBS) book series · doi:10.4018/978-1-6684-6040-5.ch001 · Cited by 1 · see citing works
A Comparative Analysis of the Anxiety in Offenders of the Law Based on Structural Equational Models
López, C. Q., Vera, V. D. G., Bustamante-Hernández, A., & Martinez, L. E. D. A. (2020) · Modern Applied Science · doi:10.5539/mas.v14n2p65 · Cited by 1 · see citing works
Somatische Belastungsstörung und verwandte Störungen
Hennemann, S., Böhme, K., & Witthöft, M. (2023) · Springer eBooks · doi:10.1007/978-3-662-65816-1_9
A clinician’s quick guide to evidence-based approaches: health anxiety
Mahoney, A., Dobinson, K. A., Millard, M., & Newby, J. M. (2024) · Clinical Psychologist · doi:10.1080/13284207.2024.2402333
Self-citation7 ways to manage your #coronaphobia
Newby, J. M., & Werner‐Seidler, A. (2020) · doi:10.64628/aa.4u4jpk3rq
Self-citation
- Authors
- Newby, J. M., Haskelberg, H., Hobbs, M. J., Mahoney, A. E. J., Mason, E., & Andrews, G.
- Affiliations
- UNSW Sydney (AU)
- St Vincent's Hospital Sydney (AU)
- Corresponding author
- Newby, Jill M.
- ORCID
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2020-03
- Volume
- 264
- Pages
- 535-542
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2984091325
- Cited by
- 23
- References
- 39
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 4 · 2023: 7 · 2022: 1 · 2021: 3 · 2020: 6
- FWCI
- 2.82
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- RUNE (Research UNE) (submittedVersion)
- Funders
- NHMRC (APP1145382)
- Medical Research Future Fund
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- internet-based cognitive behavioral therapy, health anxiety, usual care, community mental health services, medication adherence, depression, psychological distress, Short Health Anxiety Inventory
- MeSH terms
- Adult, Anxiety, Anxiety Disorders, Female, Humans, Male, Cognitive Behavioral Therapy, Treatment Outcome, Internet
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
