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Cited by 65Psychosomatic Disorders and Their TreatmentsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPain Management and Placebo Effect

A randomized controlled trial of medication and cognitive-behavioral therapy for hypochondriasis

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Fallon, Brian A., Ahern, David K., Pavlicova, Martina, Slavov, Iordan, Skritskya, Natalia, Barsky, Arthur J.·2017·American Journal of Psychiatry
DOI 10.1176/appi.ajp.2017.16020189PMC PMC5957509
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Abstract

OBJECTIVE: Prior studies of hypochondriasis demonstrated benefits for pharmacotherapy and for cognitive-behavioral therapy (CBT). This study examined whether joint treatment offers additional benefit. METHOD: Patients with DSM-IV hypochondriasis (N=195) were randomly assigned to one of four treatments-placebo, CBT, fluoxetine, or joint treatment with both fluoxetine and CBT. Evaluations assessed hypochondriasis, other psychopathology, adverse events, functional status, and quality of life. The primary analysis assessed outcome at week 24 among the intent-to-treat sample, with responders defined as having a 25% or greater improvement over baseline on both the Whiteley Index and a modified version of the Yale-Brown Obsessive Compulsive Scale for hypochondriasis (H-YBOCS-M). The Cochran-Armitage trend test assessed the hypothesized pattern of response: joint treatment > CBT or fluoxetine treatment > placebo treatment. RESULTS: The predicted pattern of response was statistically significant, as shown by the following responder rates: joint treatment group, 47.2%; single active treatment group, 41.8%; and placebo group, 29.6%. Responder rates for each active treatment were not significantly different from the rate for placebo. Secondary analyses of the Whiteley Index as a continuous measure revealed that, compared with placebo, fluoxetine (but not CBT) was significantly more effective at week 24 in reducing hypochondriasis and had a significantly faster rate of improvement over 24 weeks. Fluoxetine also resulted in significantly less anxiety and better quality of life than placebo. Dropout rates did not differ between groups, and treatment-emergent adverse events were evenly distributed. CONCLUSIONS: This study supports the safety, tolerance, and efficacy of fluoxetine for hypochondriasis. Joint treatment provided a small incremental benefit. Because approximately 50% of patients did not respond to the study treatments, new or more intensive approaches are needed.

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Crossref · 10.1176/appi.ajp.2017.16020189

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  • Systematic reviews and meta-analyses have established the effectiveness of different psychological interventions for health anxiety.

    “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 [12]

    The treatment-background passage (labelled Abstract > Conclusions; page not provided) says CBT reduces hypochondriacal symptoms and lists other beneficial psychotherapies. The References include a psychotherapy systematic review and a CBT meta-analysis, but the paper cites individual studies—not reviews or meta-analyses—for several of the other interventions. It therefore supports their reported benefit, but not the claim that reviews and meta-analyses established the effectiveness of the different interventions. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • A double improvement of ≥25% over baseline scores on the WI-7 and the SHAI has been proposed as a reliable measure of clinically significant improvement.

    “The primary outcome for the analysis was clinically significant improvements calculated as the proportion of patients with a double improvement of ≥ 25% over baseline scores on two measures of health anxiety, i.e., the WI-7 and the SHAI, which has been proposed as a reliable measure of a clinically significant improvement [12].”

    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 [12]

    The Method > Data Analysis section defines treatment response as at least 25% improvement on two measures, but they are the Whiteley Index and H-YBOCS-M, not the WI-7 and SHAI. The paper does not establish that this threshold is a reliable measure of clinically significant improvement; its Discussion suggests considering higher thresholds in future trials. Page numbers are unavailable in our copy. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • There is support for treatment of health anxiety with selective serotonin reuptake inhibitors, but trials have generally shown fairly high levels of drop-out.

    “There is also support for treatment with selective serotonin reuptake inhibitors but trials have generally shown fairly high levels of drop-out.13,14”

    From Why health anxiety needs to be recognised in hospital practice (2020) · cites this paper as [13]

    The Discussion reports that fluoxetine improved hypochondriasis measures compared with placebo and says this trial’s attrition rates were relatively high (page not provided). It does not establish that SSRI trials generally have high dropout; it also notes that dropout rates did not differ significantly between treatment groups. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • There is support for treatment of health anxiety with selective serotonin reuptake inhibitors, but trials have generally shown fairly high levels of drop-out.

    “There is also support for treatment with selective serotonin reuptake inhibitors but trials have generally shown fairly high levels of drop-out.13,14”

    From Why health anxiety needs to be recognised in hospital practice (2020) · cites this paper as [14]

    The Discussion reports that fluoxetine improved hypochondriasis symptoms compared with placebo and explicitly describes this trial’s attrition rates as relatively high. The paper therefore supports both points for its own trial, but does not establish that trials generally had high drop-out rates. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Pharmacotherapy studies are lacking, but two studies into treatments for Hypochondriasis support the use of Fluoxetine in combination with CBT, or alone, and another earlier study found Paroxetine yielded similar effectiveness to CBT for hypochondriasis.

    “Pharmacotherapy studies are lacking, but two studies into treatments for Hypochondriasis support the use of Fluoxetine in combination with CBT, or alone [86, 87], and another earlier study found Paroxetine yielded similar effectiveness to CBT for hypochondriasis [88].”

    From Illness Anxiety Disorder: A Review of the Current Research and Future Directions (2024) · cites this paper as [86]

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Authors
Fallon, B. A., Ahern, D. K., Pavlicova, M., Slavov, I., Skritskya, N., & Barsky, A. J.
Affiliations
  • Brigham and Women's Hospital (US)
  • From the New York State Psychiatric Institute, New York; and Brigham and Women’s Hospital, Boston.
ORCID
Venue
American Journal of Psychiatry
Publisher
American Psychiatric Association Publishing
Published
2017-08-01
Volume
174
Issue
8
Pages
756-764
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
DOI
10.1176/appi.ajp.2017.16020189
PMC
PMC5957509
OpenAlex
W2731875168
Cited by
65
References
44
Citations by year
2026: 1 · 2025: 2 · 2024: 8 · 2023: 7 · 2022: 8 · 2021: 8 · 2020: 11 · 2019: 10 · 2018: 9 · 2017: 1
FWCI
6.95
Type
journal article
Language
en
Open access
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (R01MH071456, R01MH071688)
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
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
Keywords
health anxiety, fluoxetine, cognitive behavioral therapy, combined psychotherapy and pharmacotherapy, treatment response, Whiteley Index, anxiety, quality of life, treatment-emergent adverse events
MeSH terms
Adult, Aged, Combined Modality Therapy, Female, Fluoxetine, Humans, Hypochondriasis, Male, Middle Aged, Quality of Life, Cognitive Behavioral Therapy, Young Adult

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