Internet-based cognitive-behavioural therapy for severe health anxiety: randomised controlled trial
Open accessAbstract
Background: Hypochondriasis, characterised by severe health anxiety, is a common condition associated with functional disability. Cognitive–behavioural therapy (CBT) is an effective but not widely disseminated treatment for hypochondriasis. Internet-based CBT, including guidance in the form of minimal therapist contact via email, could be a more accessible treatment, but no study has investigated internet-based CBT for hypochondriasis. Aims: To investigate the efficacy of internet-based CBT for hypochondriasis. Method: A randomised controlled superiority trial with masked assessment comparing internet-based CBT ( n = 40) over 12 weeks with an attention control condition ( n = 41) for people with hypochondriasis. The primary outcome measure was the Health Anxiety Inventory. This trial is registrated with ClinicalTrials.gov (NCT00828152). Results: Participants receiving internet-based CBT made large and superior improvements compared with the control group on measures of health anxiety (between-group Cohen's d range 1.52–1.62). Conclusions: Internet-based CBT is an efficacious treatment for hypochondriasis that has the potential to increase accessibility and availability of CBT for hypochodriasis.
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In a series of RCTs, Hedman and colleagues demonstrated efficacy of iCBT for health anxiety, showed it outperforms control groups, and leads to improvements maintained up to 1-year follow-up.
“In a series of randomised controlled trials (RCTs), Hedman and colleagues have demonstrated the efficacy of internet-delivered CBT (iCBT) for health anxiety, and showed that it outperforms control groups (online forums and internet-delivered behavioural stress management), and leads to improvements in health anxiety that are maintained up to 1-year follow-up ( Hedman et al., 2011 ; Hedman, AxelSSO”
From Internet-Based Cognitive Behavioral Therapy Versus Psychoeducation Control for Illness Anxiety Disorder and Somatic Symptom Disorder: A Randomized Controlled Trial (2018) · cites this paper as Hedman et al., 2011
The Results report that internet-based CBT produced greater improvements in health anxiety than the control condition, which the Control condition section identifies as an online discussion forum. This paper reports one trial, not a series; its Main findings report maintenance at 6 months, not 1 year, and it does not test behavioural stress management as a comparator. (LLM, conf=0.90)
Experimental — accuracy not yet measuredEffective psychological treatments for health anxiety exist in both face-to-face and internet-delivered formats.
“effective psychological treatments for HA also exist in both face-to-face and internet-delivered formats [12-14].”
From Internet-Delivered Therapy for Parents With Health Anxiety by Proxy: Protocol for a Single-Case Experimental Design Study (2023) · cites this paper as [13]
Internet-delivered CBT can produce large and enduring effects in the treatment of severe health anxiety.
“In a randomized controlled trial, our research group showed that CBT delivered via the Internet can produce large and enduring effects in the treatment of severe health anxiety [11,12].”
From Mediators in Internet-Based Cognitive Behavior Therapy for Severe Health Anxiety (2013) · cites this paper as [12]
The trial was registered at ClinicalTrials.gov, ID NCT00828152.
“The main findings of the RCT has been previously published and the trial was registered at ClinicalTrials.gov, ID NCT00828152 [12].”
From Mediators in Internet-Based Cognitive Behavior Therapy for Severe Health Anxiety (2013) · cites this paper as [12]
In 3 randomized controlled trials, iCBT can be highly effective for severe health anxiety.
“In 3 randomized controlled trials (RCTs), Hedman-Lagerlöf and colleagues showed that iCBT can be highly effective for severe health anxiety [15-17].”
From Development and Feasibility Testing of Internet-Delivered Acceptance and Commitment Therapy for Severe Health Anxiety: Pilot Study. (2018) · cites this paper as [15]
The completion rate in this study was comparable to iCBT for health anxiety, which has shown a similar completion rate of 85%.
“This was comparable to iCBT for health anxiety which has shown a similar completion rate of 85% [15].”
From Development and Feasibility Testing of Internet-Delivered Acceptance and Commitment Therapy for Severe Health Anxiety: Pilot Study. (2018) · cites this paper as [15]
Existing treatments do not specifically address health anxiety by proxy.
“Existing treatments do not specifically address HA by proxy.”
From Internet-Delivered Therapy for Parents With Health Anxiety by Proxy: Protocol for a Single-Case Experimental Design Study (2023) · cites this paper as [13]
The Internet-based CBT section describes treatment focused on participants’ own bodily sensations and hypochondriasis. Neither that section nor the other passages found when searching for ‘health anxiety by proxy’ and treatments for concern about another person’s health addresses whether existing treatments specifically target health anxiety by proxy. (LLM, conf=0.72)
Experimental — accuracy not yet measuredEighteen studies state that encouraging adherence is a task for the counselor.
“it is remarkable that 18 state that encouraging adherence is a task for the counselor [45-62]”
From Persuasive System Design Does Matter: a Systematic Review of Adherence to Web-based Interventions (2012) · cites this paper as [50]
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Personality Change following Internet-Based Cognitive Behavior Therapy for Severe Health Anxiety
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“In 3 randomized controlled trials (RCTs), Hedman-Lagerlöf and colleagues showed that iCBT can be highly effective for severe health anxiety [15-17].”
Self-citationMediators in Internet-Based Cognitive Behavior Therapy for Severe Health Anxiety
Hedman, E., Andersson, E., Andersson, G., Lindefors, N., Lekander, M., Rück, C., & Ljótsson, B. (2013) · PLoS ONE · doi:10.1371/journal.pone.0077752 · Cited by 43 · see citing works
“The aim of the present study was to investigate mediators of treatment effect in Internet-based CBT for severe health anxiety using data from a previously reported clinical trial where participants were randomized to either Internet-based CBT (n=40) or to a control condition that did not receive active treatment (n=41…”
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Exposure-based cognitive behavior therapy for atopic dermatitis: an open trial
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Can attention control conditions have detrimental effects on behavioral medicine randomized trials?
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Self-citationAssessing Bodily Preoccupations is sufficient: Clinically effective screening for hypochondriasis
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Health anxiety: Detection and treatment
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Internet-Based Extinction Therapy for Worry: A Randomized Controlled Trial
Andersson, E., Hedman, E., Wadström, O., Boberg, J., Andersson, E. Y., Axelsson, E., Bjureberg, J., Hursti, T., & Ljótsson, B. (2017) · Behavior Therapy · doi:10.1016/j.beth.2016.07.003 · Cited by 30 · see citing works
Self-citationSudden gains in internet-based cognitive behaviour therapy for severe health anxiety
Hedman, E., Lekander, M., Ljótsson, B., Lindefors, N., Rück, C., Hofmann, S. G., Andersson, E., Andersson, G., & Schulz, S. M. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2013.12.007 · Cited by 32 · see citing works
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Hedman, E., Lekander, M., Karshikoff, B., Ljótsson, B., Axelsson, E., & Axelsson, J. (2016) · Journal of Abnormal Psychology · doi:10.1037/abn0000195 · Cited by 30 · see citing works
Self-citationUnderstanding adherence to web-based interventions
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Metacognitive Therapy in the Treatment of Hypochondriasis: A Systematic Case Series
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Digitally Delivered Psychological Interventions for Anxiety Disorders: a Comprehensive Review
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All-Cause and Cause-Specific Mortality Among Individuals With Hypochondriasis
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Internet-Delivered Cognitive Behaviour Therapy
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Internet-Based Cognitive Behavior Therapy
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Self-citationA randomised controlled trial of computerised interpretation bias modification for health anxiety
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Individually tailored internet treatment in routine care: A feasibility study
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“Patients in the iFORUM discussion group, a format that was used in a previous study of iCBT [47] for health anxiety, did report minor improvements in health anxiety, which might largely be explained by the effect of the diagnostic interview.”
Method
- Authors
- Hedman, E., Andersson, G., Andersson, E., Ljótsson, B., Rück, C., Asmundson, G. J. G., & Lindefors, N.
- Affiliations
- Linköping University (SE)
- Karolinska Institutet (SE)
- University of Regina (CA)
- ORCID
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2011-03
- Volume
- 198
- Issue
- 3
- Pages
- 230-236
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2102870587
- Cited by
- 212
- References
- 39
- Citations by year
- 2026: 14 · 2025: 3 · 2024: 5 · 2023: 24 · 2022: 11 · 2021: 9 · 2020: 6 · 2019: 21 · 2018: 19 · 2017: 16 · 2016: 15 · 2015: 10 · 2014: 24 · 2013: 15 · 2012: 14
- FWCI
- 25.76
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- 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
- health anxiety, internet-based cognitive behavioral therapy, online therapy, treatment accessibility, Health Anxiety Inventory
- MeSH terms
- Adult, Aged, Attitude to Health, Female, Humans, Hypochondriasis, Male, Middle Aged, Patient Education as Topic, Psychiatric Status Rating Scales, Cognitive Behavioral Therapy, Outcome Assessment, Health Care, Internet
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