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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 the citing paper
“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]
Experimental — accuracy not yet measuredIn the citing paper
“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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Hybelius, J., Gustavsson, A., af Winklerfelt Hammarberg, S., Toth-Pal, E., Johansson, R., Ljótsson, B., & Axelsson, E. (2022) · Figshare · doi:10.6084/m9.figshare.20342406
Self-citationAxelsson, E., Österman, S., & Hedman-Lagerlöf, E. (2023) · Figshare · doi:10.6084/m9.figshare.24098307
Sasseville, M., LeBlanc, A., Tchuente, J., Boucher, M., Dugas, M., Mbemba, G. I. C., Barony, R., Chouinard, M., Beaulieu, M., Beaudet, N., et al. (2023) · Figshare · doi:10.6084/m9.figshare.22767524
Sasseville, M., LeBlanc, A., Tchuente, J., Boucher, M., Dugas, M., Mbemba, G. I. C., Barony, R., Chouinard, M., Beaulieu, M., Beaudet, N., et al. (2023) · Figshare · doi:10.6084/m9.figshare.22767512
Xu, J., Shen, J., Wang, J., & Huang, G. (2026) · doi:10.2196/preprints.91108
Jalali, A., Ghasemianrad, M., Khazaie, H., Jalali, R., Chavoshani, F., Khalili, M., & Kazeminia, M. (2026) · SN Comprehensive Clinical Medicine · doi:10.1007/s42399-025-02235-1 · Cited by 2
Zhu, M., Li, M., Li, J., Wu, P., Qiang, W., & Wang, Y. (2026) · Holistic Integrative Oncology · doi:10.1007/s44178-026-00231-6
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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