Cognitive-behavioural bibliotherapy for hypochondriasis: A pilot study
Open accessAbstract
Aims: The present study aims to determine whether cognitive-behavioural minimal contact bibliotherapy is acceptable to participants suffering from DSM-IV-TR hypochondriasis, and whether this intervention is able to reduce hypochondriacal complaints, as well as comorbid depressive complaints and trait anxiety. Method: Participants were assigned to either an immediate treatment condition, or subsequently to a waiting list condition. Participants were sent a book, Doctor, I Hope it's Nothing Serious?, containing cognitive behavioural theory and exercises. Measures were taken pre, post and at follow-up (after 3 months). Those in the waiting list group received a second pre-assessment, and were then enrolled in the bibliotherapy. Results: Results showed that participants were accepting of the cognitive-behavioural theory. Furthermore, results showed beneficial effects of the intervention: all effect measures decreased significantly over time, with the largest effect at post-assessment. However, a large amount of questionnaires were not returned. Conclusion: It is concluded that bibliotherapy may be an efficient aid in reducing hypochondriacal and comorbid complaints, but due to data attrition and methodological flaws should first be studied further. © 2009 British Association for Behavioural and Cognitive Psychotherapies.
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Claims the paper makes
0 of 10 cited sources checked · 0 supported · 0 flagged
- Findingown data
About half of the participants had done the exercises once.
“About half of the participants had done the exercises once, and about a third had done them partly.”
Quote in the paperNot a substantial claim - Findingown data
Participants rated the theoretical parts of the book as significantly more useful (M = 5.6, SD = 1.0) than the exercises (M = 4.7, SD = 1.5; t = 2.6, p = 0.02).
“The answers regarding specific usefulness of the theoretical parts of the different chapters ranged from 5.4 to 6.1 (M = 5.6, SD = 1.0), and the answers regarding usefulness of the exercises ranged from 4.3 to 5.6 (M = 4.7, SD = 1.5), indicating that the theory was regarded as significantly (t = 2.6, p = 0.02) more useful.”
Quote in the paperNot a substantial claim - Findingown data
During the waiting list period, hypochondriacal complaint scores did not decrease significantly (t = 0.2).
“With regard to the waiting list period, the scores did not decrease significantly (t = 0.2).”
Quote in the paperSubstantial claim - Findingown data
Between pre- and post-assessment, the mean Beck Depression Inventory score decreased significantly (t = -2.3, p < .02).
“Between pre-and post-assessment, the mean score of the BDI did decrease significantly (t = -2.3,p < .02).”
Quote in the paperNot a substantial claim - Findingown data
Trait anxiety scores did not show a significant decrease after the waiting list period (t = 0.3).
“Scores did not show a significant decrease after the waiting list period (t = 0.3) but did so, with the groups taken together, at post-test (t = -2.4,p < .02)for trait anxiety.”
Quote in the paperNot a substantial claim
- Findingown data
The effect size (Cohen's d) for the decrease in hypochondriacal complaints (GIAS) from pre- to post-assessment was large (0.75).
“The effect size was large for the GIAS: 0.75.”
Quote in the paperSubstantial claim - Findingown data
At 3-month follow-up, Beck Depression Inventory scores remained stable.
“At 3-month follow-up the scores remained stable.”
Quote in the paperNot a substantial claim - Findingown data
With the groups taken together, trait anxiety decreased significantly at post-test (t = -2.4, p < .02).
“Scores did not show a significant decrease after the waiting list period (t = 0.3) but did so, with the groups taken together, at post-test (t = -2.4,p < .02)for trait anxiety.”
Quote in the paperNot a substantial claim - Findingown data
Participants rated the overall usefulness of the book with a mean score of 6.1 (SD = 0.7, range = 1-7).
“Participants rated the overall usefulness of the book with a mean score of 6.1 (SD = 0.7, range = 1-7).”
Quote in the paperNot a substantial claim - Findingnone given
Almost all participants indicated they had read all chapters very attentively.
“Almost all participants indicated they had read all chapters very attentively.”
Quote in the paperNot a substantial claim - Findingown data
About a third of the participants had done the exercises partly.
“About half of the participants had done the exercises once, and about a third had done them partly.”
Quote in the paperNot a substantial claim - Findingown data
With the groups taken together, at post-assessment, a decrease in hypochondriacal complaints was apparent (t = -4.3, p < 0.00).
“With the groups taken together, at post-assessment, a decrease in hypochondriacal complaints was apparent (t = -4.3,p < 0.00).”
Quote in the paperSubstantial claim - Findingown data
The Beck Depression Inventory scores did not decrease during the waiting list period (t = 0.0).
“The scores on the BDI did not decrease during the waiting list period (t = 0.0).”
Quote in the paperNot a substantial claim - Findingown data
The effect size (Cohen's d) for the decrease in trait anxiety (STAI) from pre- to post-assessment was medium (0.42).
“The effect sizes found for both the BDI (0.34), and the STAI (0.42) were medium.”
Quote in the paperNot a substantial claim - Findingown data
The effect size (Cohen's d) for the decrease in depressive complaints (BDI) from pre- to post-assessment was medium (0.34).
“The effect sizes found for both the BDI (0.34), and the STAI (0.42) were medium.”
Quote in the paperNot a substantial claim - Premisecitation
Recent studies suggest that short-term psychoeducational courses are effective for hypochondriasis.
“Recent studies suggest the effectiveness of individual cognitive-behavioural interventions for hypochondriasis and also of short-term psychoeducational courses (Abramowitz and Braddock, 2008).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Abramowitz and Braddock, 2008
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Study design and conductown data
There were no significant differences between the conditions in gender (χ2 = 2.9; df = 1; p = .09).
“T-tests and chi-square tests showed that there were no significant differences between the conditions regarding the demographic variables age (t = 1.1; df = 38; p = .29),gender (χ 2 = 2.9; df = 1; p = .09),duration of hypochondriacal complaints (t = .91;df = 37; p = .37),or level of education (χ 2 = 5.8; df = 6; p = .48).”
Quote in the paperNot a substantial claim - Study design and conductown data
There were no significant differences between the conditions in age (t = 1.1; df = 38; p = .29).
“T-tests and chi-square tests showed that there were no significant differences between the conditions regarding the demographic variables age (t = 1.1; df = 38; p = .29),gender (χ 2 = 2.9; df = 1; p = .09),duration of hypochondriacal complaints (t = .91;df = 37; p = .37),or level of education (χ 2 = 5.8; df = 6; p = .48).”
Quote in the paperNot a substantial claim - Study design and conductown data
There were no significant differences between the immediate treatment and waiting list conditions at pre-assessment in depressive complaints (t = .48; df = 37; p = .63).
“Chi-square tests and t-tests showed that there were no significant differences between the two conditions at pre-assessment with regard to hypochondriacal complaints (t = -.28;df = 38; p = .79),trait anxiety (t = .90;df = 37; p = .38),and depressive complaints (t = .48;df = 37; p = .63).”
Quote in the paperSubstantial claim - Study design and conductown data
There were no significant differences between the immediate treatment and waiting list conditions at pre-assessment in trait anxiety (t = .90; df = 37; p = .38).
“Chi-square tests and t-tests showed that there were no significant differences between the two conditions at pre-assessment with regard to hypochondriacal complaints (t = -.28;df = 38; p = .79),trait anxiety (t = .90;df = 37; p = .38),and depressive complaints (t = .48;df = 37; p = .63).”
Quote in the paperSubstantial claim - Premisecitation
One study to date has investigated bibliotherapy for health anxiety.
“One study to date has investigated bibliotherapy for health anxiety (Jones, 2002).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Jones, 2002 source
- Premisecitation
Jones (2002) found a reduction in health anxiety after receiving bibliotherapy (Cohen's d = 1.12).
“Results of this study showed a reduction in health anxiety after receiving bibliotherapy (Cohen's d = 1.12).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Jones, 2002 source
- Study design and conductown data
There were no significant differences between the immediate treatment and waiting list conditions at pre-assessment in hypochondriacal complaints (t = -.28; df = 38; p = .79).
“Chi-square tests and t-tests showed that there were no significant differences between the two conditions at pre-assessment with regard to hypochondriacal complaints (t = -.28;df = 38; p = .79),trait anxiety (t = .90;df = 37; p = .38),and depressive complaints (t = .48;df = 37; p = .63).”
Quote in the paperSubstantial claim - Interpretationown data
Hypochondriasis can be tackled by an unintrusive type of intervention in which no contact with a therapist is involved.
“However, these beneficial results indicate that hypochondriasis can be tackled by an unintrusive type of intervention in which no contact with a therapist is involved.”
Quote in the paperSubstantial claim- Rests on an assumption: The completers who returned questionnaires are representative of the full sample.
- Study design and conductown data
There were no significant differences between the conditions in level of education (χ2 = 5.8; df = 6; p = .48).
“T-tests and chi-square tests showed that there were no significant differences between the conditions regarding the demographic variables age (t = 1.1; df = 38; p = .29),gender (χ 2 = 2.9; df = 1; p = .09),duration of hypochondriacal complaints (t = .91;df = 37; p = .37),or level of education (χ 2 = 5.8; df = 6; p = .48).”
Quote in the paperNot a substantial claim - Study design and conductreasoning
There was a lack of extensive diagnostic information due to the use of the ADIS as a short telephone interview.
“Furthermore, this was not a randomized clinical trial, and there was a lack of extensive diagnostic information due to the use of the ADIS as a short telephone interview.”
Quote in the paperNot a substantial claim - Interpretationown data
Cognitive-behavioural bibliotherapy is effective in reducing depressive complaints.
“bibliotherapy proved to be effective in reducing hypochondriacal complaints, depressive complaints, and trait anxiety.”
Quote in the paperSubstantial claim- Rests on an assumption: The completers who returned questionnaires are representative of the full sample.
- Interpretationreasoning
Generalizing the beneficial effects found in this study is difficult because the self-referred patients could be a subgroup of hypochondriacal patients.
“Second, generalizing the beneficial effects found in this study is difficult, because the patients participating in this study, who were self-referred, could be a subgroup of hypochondriacal patients.”
Quote in the paperSubstantial claim- Rests on an assumption: The completers who returned questionnaires are representative of the full sample.
- Study design and conductown data
There were no significant differences between the conditions in duration of hypochondriacal complaints (t = .91; df = 37; p = .37).
“T-tests and chi-square tests showed that there were no significant differences between the conditions regarding the demographic variables age (t = 1.1; df = 38; p = .29),gender (χ 2 = 2.9; df = 1; p = .09),duration of hypochondriacal complaints (t = .91;df = 37; p = .37),or level of education (χ 2 = 5.8; df = 6; p = .48).”
Quote in the paperNot a substantial claim - Interpretationown data
Cognitive-behavioural bibliotherapy is effective in reducing trait anxiety.
“bibliotherapy proved to be effective in reducing hypochondriacal complaints, depressive complaints, and trait anxiety.”
Quote in the paperSubstantial claim- Rests on an assumption: The completers who returned questionnaires are representative of the full sample.
- Interpretationown data
Cognitive-behavioural bibliotherapy is effective in reducing hypochondriacal complaints.
“bibliotherapy proved to be effective in reducing hypochondriacal complaints, depressive complaints, and trait anxiety.”
Quote in the paperSubstantial claim- Rests on an assumption: The completers who returned questionnaires are representative of the full sample.
- May combine two claims. 7
- Classified as probably not a substantial claim. 8
May combine two claims.
Findingown dataTrait anxiety scores showed slightly different patterns for the two groups, with the immediate treatment group showing a slighter decrease over time and the waiting list group showing a larger decrease at post-assessment and a non-significant increase at follow-up.
“Scores show slightly different patterns for both groups, with the immediate treatment group showing a slighter decrease over time, and the waiting list group showing a larger decrease at post-assessment and a non-significant increase in scores at follow-up.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataAt the 3-month follow-up, hypochondriacal complaint scores in the immediate treatment group decreased somewhat further, while scores in the waiting list group increased.
“At the 3-month follow-up, scores in the immediate treatment group decreased somewhat further, while scores in the waiting list group increased, as can be seen in Table 1.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingnone givenNone of the participants made use of the possibility to contact the researchers and ask questions about the book's theory or exercises.
“Interestingly, none of the participants made use of the possibility to contact the researchers and ask questions about the book's theory or exercises.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThe ADIS-IV lifetime version has good to excellent reliability (kappas .58-.81).
“The instrument has been reported to have good to excellent reliability (kappas.58-.81;Brown, DiNardo, Lehman and Campbell, 2001).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Brown, DiNardo, Lehman and Campbell, 2001 source
Probably not a substantial claim: may not pass S1 (asserted).
PremisecitationThe didactic and self-directed treatment strategies used in psychoeducation could be imparted by bibliotherapy.
“It has been hypothesized (Gould, Clum and Shapiro, 1993) that the didactic and self-directed treatment strategies used in psychoeducation could also very well be imparted by bibliotherapy, an intervention in which patients are supplied with written self-help material that they can work through with or without therapist contact.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Gould, Clum and Shapiro, 1993 source
May combine two claims.
PremisecitationIn Jones (2002), 40 participants with health anxiety identified by their GPs were randomized into two conditions: one receiving cognitive bibliotherapy and the other not.
“A total of 40 participants, suffering from health anxiety, as identified by their GPs, was randomized into two conditions: one receiving cognitive bibliotherapy and the other not.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Jones, 2002 source
Classified as probably not a substantial claim.
PremisecitationRecent studies suggest that individual cognitive-behavioural interventions are effective for hypochondriasis.
“Recent studies suggest the effectiveness of individual cognitive-behavioural interventions for hypochondriasis and also of short-term psychoeducational courses (Abramowitz and Braddock, 2008).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Abramowitz and Braddock, 2008
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThe Beck Depression Inventory has Cronbach's α's ranging from .73 to .92 within patient groups.
“Cronbach's α's of this measure ranged from .73 to .92 within patient groups (Bouman, Luteijn, Albersnagel and Van der Ploeg, 1985).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Bouman, Luteijn, Albersnagel and Van der Ploeg, 1985
May combine two claims.
Study design and conductown dataMany participants did not return their questionnaires, so nothing conclusive can be said about them.
“First, there were many participants who did not return their questionnaires, so that nothing conclusive can be said about them.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThis study was not a randomized clinical trial.
“Furthermore, this was not a randomized clinical trial, and there was a lack of extensive diagnostic information due to the use of the ADIS as a short telephone interview.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataTwo immediate treatment participants dropped out of treatment, as did five waiting list participants.
“Two of the IT participants dropped out of the treatment, as did 5 WL participants.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductown dataOf the 33 completers, 16 in the immediate treatment group and 10 in the waiting list group returned post-assessments, and 11 immediate treatment and 8 waiting list completers returned 3-month follow-up assessments.
“Of the 33 completers, 16 in the IT group and 10 in the WL group returned the post-assessments, and 11 completers of the IT group and 8 completers of the WL group returned their 3-month follow-up assessments.”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductcitationThe Groningen Illness Attitude Scale has satisfactory discriminative validity and strong convergent validity.
“The questionnaire has satisfactory discriminative validity, and strong convergent validity (Visser, 2000).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Visser, 2000
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThe STAI trait scale has Cronbach's α ranging between .91 and .93.
“The trait-scale has a Cronbach's α ranging between .91 (for college students) and .93(for a patient norm group) (Van der Ploeget al., 1980).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Van der Ploeg, Defares and Spielberger, 1980
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
The paper relies on this without support.
Bibliotherapy has not yet been studied for DSM-IV-TR hypochondriasis.
“Bibliotherapy has not yet been studied for DSM-IV-TR hypochondriasis.”
The paper relies on this without support.
The completers who returned questionnaires are representative of the full sample.
“Data of completers were used in the analysis.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Low-education percentage does not match the count
MinorSeven of the 40 participants represent 17.5%, not 17.9%.
Reported 17.9 · recomputed 17.5
“7 (17.9%)had a low educational level.”
Table 1 labels its variability measures inconsistently
MinorThe table title calls the accompanying measures standard errors, while the results text says the table shows standard deviations.
“Table 1 . Mean scores and standard errors on the GIAS, the BDI, and the STAI over time”
“Means and standard deviations of the scores over time are shown in Table 1.”
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Cited by
Sorted by citations
Health anxiety disorders in older adults: Conceptualizing complex conditions in late life
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“Several studies have highlighted psycho-education as an effective means of reducing health anxiety (Buwalda & Bouman, 2008, 2009; Buwalda, Bouman, & van Duijn, 2007).”
BackgroundMonroy‐Fraustro, D., Maldonado-Castellanos, I., Aboites-Molina, M., Rodríguez, S., Sueiras, P., Altamirano-Bustamante, N. F., de Hoyos, A., & Altamirano‐Bustamante, M. M. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.629872 · Cited by 60 · see citing works
“…is thought of as a more economical therapy alternative Cognitive–Behavioral Bibliotherapy for Hypochondriasis: A Pilot Study Femke M. Buwalda, 2009 Participants were given a book with cognitive–behavioral activities The results were positive, given the active participation.”
BackgroundGuided self-help for the management of worry in parkinson's disease: A pilot study
Lawson, R. A., Millar, D., Brown, R. G., & Burn, D. J. (2013) · Journal of Parkinson's Disease · doi:10.3233/jpd-120156 · Cited by 29 · see citing works
“This problem has also been found in previous bibliotherapy studies [16–18] and may be due to the nature of the contact between research participant and researcher, rather than face-toface contact.”
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The effect of group bibliotherapy on the self-esteem of female students living in dormitory
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“This finding was consistent with Balouch Zera’at kar,[15] Jokar, Baghban and Ahmadi,[16] Riahinia,[35] Parirokh and Naseri,[36] Nokarizi and Alam zade,[37] Navvabi nezhad and Riahinia,[38] Banki, Amiri and As’adi,[39] Buwalda,[40] Nordin,[41] Karacan and Yerin Gunery,[19] Moto,[20] Jernelov[42] which they proved that…”
ResultPsychological Treatments for Hypochondriasis: A Narrative Review
Bouman, T. K. (2014) · Current Psychiatry Reviews · doi:10.2174/1573400509666131119010612 · Cited by 11 · see citing works
“Buwalda and Bouman [16] screened 40 self-referred people for hypochondriasis using a telephone diagnostic”
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Kapfhammer, H. (2017) · Springer eBooks · doi:10.1007/978-3-662-49295-6_74 · Cited by 8 · see citing works
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Kapfhammer, H. (2011) · Springer eBooks · doi:10.1007/978-3-642-03637-8_61 · Cited by 3 · see citing works
Somatoforme Störungen – somatoforme Belastungsstörung und verwandte Störungen
Kapfhammer, H. (2016) · Springer eBooks · doi:10.1007/978-3-642-45028-0_74-1 · Cited by 1 · see citing works
Self‐Help: Bibliotherapy and Internet Resources
Deane, F. P., & Kavanagh, D. J. (2012) · Wiley eBooks · doi:10.1002/9781118702703.ch16
Bibliotherapy for Chinese Patients with Depression in Rehabilitation
Wang, Y. (2012) · InTech eBooks · doi:10.5772/30387
“[13] revealed that bibliotherapy ameliorated the symptoms and physical distress of hypochondriacs effectively.”
BackgroundStabolidis, A. (2018) · Minerva Access (University of Melbourne)
Asmundson, G. J. G., Peluso, D. L., Thibodeau, M. A., & Taylor, S. J. (2013) · Wiley eBooks · doi:10.1002/9781118528563.wbcbt21 · Cited by 1 · see citing works
- Authors
- Buwalda, F. M., & Bouman, T. K.
- Affiliations
- University of Groningen (NL)
- Corresponding author
- Bouman, Theo K.
- ORCID
- Bouman, Theo K.
- Venue
- Behavioural and Cognitive Psychotherapy
- Publisher
- Cambridge University Press (CUP)
- Published
- 2009-05
- Volume
- 37
- Issue
- 3
- Pages
- 335-340
- ISSN
- 1352-4658 (ISSN-L)
- 1469-1833
- OpenAlex
- W2155745096
- Cited by
- 15
- References
- 12
- Citations by year
- 2021: 1 · 2018: 2 · 2017: 1 · 2016: 2 · 2014: 2 · 2013: 4 · 2012: 2
- FWCI
- 1.27
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Behavioural and Cognitive Psychotherapy (publishedVersion, other-oa)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- 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
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- health anxiety, bibliotherapy, cognitive-behavioural intervention, depressive symptoms, trait anxiety, acceptability, self-help books
- MeSH terms
- Adaptation, Psychological, Adult, Bibliotherapy, Female, Follow-Up Studies, Humans, Hypochondriasis, Male, Middle Aged, Patient Acceptance of Health Care, Patient Education as Topic, Surveys and Questionnaires, Cognitive Behavioral Therapy, Patient Satisfaction
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