Clinical and cost-effectiveness of cognitive–behaviour therapy for health anxiety in medical patients: a multicentre randomised controlled trial
Open accessAbstract
Background Health anxiety has been treated by therapists expert in cognitive behaviour therapy with some specific benefit in some patients referred to psychological services. Those in hospital care have been less often investigated. Following a pilot trial suggesting efficacy we carried out a randomised study in hospital medical clinics.Methods We undertook a multicentre, randomised trial on health anxious patients attending cardiac, endocrine, gastroenterological, neurological, and respiratory medicine clinics in secondary care. We included those aged 16-75 years, who satisfied the criteria for excessive health anxiety, and were resident in the area covered by the hospital, were not under investigation for new pathology or too medically unwell to take part. We used a computer-generated random scheme to allocate eligible medical patients to an active treatment group of five-to-ten sessions of adapted cognitive behaviour therapy (CBT-HA group) delivered by hospital-based therapists or to standard care in the clinics. The primary outcome was change in health anxiety symptoms measured by the Health Anxiety Inventory at 1 year and the main secondary hypothesis was equivalence of total health and social care costs over 2 years, with an equivalence margin of £150. Analysis was by intention to treat. The study is registered with controlled-trials.com, ISRCTN14565822.Findings Of 28,991 patients screened, 444 were randomly assigned to receive either adapted cognitive behaviour therapy (CBT-HA group, 219 participants) or standard care (standard care group, 225), with 205 participants in the CBT-HA group and 212 in the standard care group included in the analyses of the primary endpoints. At 1 year, improvement in health anxiety in the patients in the CBT-HA group was 2·98 points greater than in those in the standard care group (95% CI 1·64-4·33, p<0·0001), and twice as many patients receiving cognitive behaviour therapy achieved normal levels of health anxiety compared with those in the control group (13·9% vs 7·3%; odds ratio 2·15, 95% CI 1·09-4·23, p=0·0273). Similar differences were observed at 6 months and 2 years, and there were concomitant reductions in generalised anxiety and, to a lesser extent, depression. Of nine deaths, six were in the control group; all were due to pre-existing illness. Social functioning or health-related quality of life did not differ significantly between groups. Equivalence in total 2-year costs was not achieved, but the difference was not significant (adjusted mean difference £156, 95% CI -1446 to 1758, p=0·848).Interpretation This form of adapted cognitive behaviour therapy for health anxiety led to sustained symptomatic benefit over 2 years, with no significant effect on total costs. It deserves wider application in medical care.Funding National Institute for Health Research Health Technology Assessment Programme.
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- Authors
- Tyrer, P., Cooper, S., Salkovskis, P., Tyrer, H., Crawford, M., Byford, S., Dupont, S., Finnis, S., Green, J., McLaren, E., Murphy, D., Reid, S., Smith, G., Wang, D., Warwick, H., Petkova, H., & Barrett, B.
- Affiliations
- Centre for Mental Health (GB)
- University of Bath (GB)
- King's College London (GB)
- Hillingdon Hospital (GB)
- Central and North West London NHS Foundation Trust (GB)
- Charing Cross Hospital (GB)
- London School of Hygiene & Tropical Medicine (GB)
- Corresponding author
- Tyrer, Peter
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2014-01
- Volume
- 383
- Issue
- 9913
- Pages
- 219-225
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2164561117
- Cited by
- 167
- References
- 31
- Citations by year
- 2026: 4 · 2025: 11 · 2024: 10 · 2023: 10 · 2022: 12 · 2021: 8 · 2020: 15 · 2019: 17 · 2018: 12 · 2017: 19 · 2016: 21 · 2015: 11 · 2014: 14 · 2013: 3
- FWCI
- 21.90
- Type
- journal article
- Language
- en
- Update notices
- erratum (2014-01-18)
- Open access
- Licence
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- The University of Bath Online Publications Store (The University of Bath) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Pure (University of Bath) (submittedVersion, other-oa)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (submittedVersion)
- Funders
- National Institute for Health and Care Research (07/01/26)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- anxiety, cognitive behavioral therapy, cost-effectiveness, Health Anxiety Inventory, generalized anxiety disorder, depression, social functioning, hospital costs, patient satisfaction, patient dropout, patient recruitment
- MeSH terms
- Adolescent, Adult, Aged, Anxiety Disorders, Cost-Benefit Analysis, England, Female, Humans, Hypochondriasis, Male, Middle Aged, Outpatient Clinics, Hospital, Psychometrics, Quality of Life, Cognitive Behavioral Therapy, Single-Blind Method, Treatment Outcome, Health Care Costs, Diagnostic and Statistical Manual of Mental Disorders, Young Adult
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