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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 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
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
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“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]
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“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]
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“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]
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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].”
From Development and Feasibility Testing of Internet-Delivered Acceptance and Commitment Therapy for Severe Health Anxiety: Pilot Study. (2018) · cites this paper as [15]
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“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]
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“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]
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“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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“This is a standardized procedure in psychological treatment studies [24]”
MethodPredictors of outcome in Internet-based cognitive behavior therapy for severe health anxiety
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Self-citationMediators in Internet-Based Cognitive Behavior Therapy for Severe Health Anxiety
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“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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“with our previous studies investigating similar treatment protocols for other disorders marked by preoccupation of bodily symptoms, such as severe health anxiety, irritable bowel syndrome, and fibromyalgia (Hedman et al., 2011; Hedman-Lagerlof et al., 2017; Ljotsson et al., 2014).”
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Internet-Delivered Cognitive Behaviour Therapy
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Newby, J. M., Haskelberg, H., Hobbs, M. J., Mahoney, A. E. J., Mason, E., & Andrews, G. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.11.087 · Cited by 23
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Internet-Based Cognitive Behavior Therapy
Andersson, G., Carlbring, P., & Hadjistavropoulos, H. D. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-803457-6.00021-0 · Cited by 26
Self-citationMaj, A., Michalak, N., Graczykowska, A., & Andersson, G. (2023) · Internet Interventions · doi:10.1016/j.invent.2023.100654 · Cited by 22
Self-citationTherapist guided internet delivered cognitive behavioural therapy
Hedman‐Lagerlöf, E. (2014) · BMJ · doi:10.1136/bmj.g1977 · Cited by 21
Hedman, E., Ljótsson, B., Axelsson, E., Andersson, G., Rück, C., & Andersson, E. (2017) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.11.007 · Cited by 20
Self-citationChristopoulou, S., Kotsilieris, T., & Anagnostopoulos, I. (2018) · Healthcare · doi:10.3390/healthcare6030109 · Cited by 20
The impact of phone calls on follow-up rates in an online depression prevention study
Muñoz, R. F., Leykin, Y., Barrera, A. Z., Brown, C. H., & Bunge, E. L. (2017) · Internet Interventions · doi:10.1016/j.invent.2017.02.001 · Cited by 20
Axelsson, E., Andersson, E., Ljótsson, B., & Hedman-Lagerlöf, E. (2018) · Behaviour Research and Therapy · doi:10.1016/j.brat.2018.06.002 · Cited by 19
Self-citationA randomised controlled trial of computerised interpretation bias modification for health anxiety
Antognelli, S. L., Sharrock, M. J., & Newby, J. M. (2019) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2019.101518 · Cited by 22
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“While moderate to large effect sizes (ES) have been reported for CBT-based treatment for HA (Hedman et al., 2011; Newby et al., 2018; Thomson & Page, 2007; Weck, Neng, Schwind, & Hofling, Clinical Psychology in Europe 2019, Vol.1(1), Article e32217 https://doi.org/10.32872/cpe.v1i1.32217 2015),…”
BackgroundInfluentialNewby, 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
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Hedman, E., Hesser, H., Andersson, E., Axelsson, E., & Ljótsson, B. (2017) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2017.04.007 · Cited by 17
Self-citationVernmark, K., Buhrman, M., Carlbring, P., Hedman‐Lagerlöf, E., Kaldo, V., & Andersson, G. (2024) · Digital Health · doi:10.1177/20552076241287059 · Cited by 19
Self-citationSasseville, M., LeBlanc, A., Tchuente, J., Boucher, M., Dugas, M., Mbemba, G. I. C., Barony, R., Chouinard, M., Beaulieu, M., Beaudet, N., et al. (2023) · Systematic Reviews · doi:10.1186/s13643-023-02241-1 · Cited by 16
Gropalis, M., Witthöft, M., Bailer, J., & Weck, F. (2017) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2017.09.001 · Cited by 14
Tyrer, P. J., Wang, D., Tyrer, H., Crawford, M., & Cooper, S. (2016) · Personality and Mental Health · doi:10.1002/pmh.1339 · Cited by 13
Individually tailored internet treatment in routine care: A feasibility study
Kraepelien, M., Svanborg, C., Lallerstedt, L., Sennerstam, V., Lindefors, N., & Kaldo, V. (2019) · Internet Interventions · doi:10.1016/j.invent.2019.100263 · Cited by 14
Self-citationArjadi, R., Nauta, M. H., Suryani, A. O., & Bockting, C. (2018) · Makara Human Behavior Studies in Asia · doi:10.7454/hubs.asia.2050418 · Cited by 14
Axelsson, E., Hesser, H., Andersson, E., Ljótsson, B., & Hedman-Lagerlöf, E. (2020) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2019.102172 · Cited by 12
Self-citationRisør, B. W., Frydendal, D. H., Villemoes, M. K., Nielsen, C. P., Rask, C. U., & Frostholm, L. (2022) · PharmacoEconomics - Open · doi:10.1007/s41669-021-00319-x · Cited by 11
“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
Metadata
- 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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