Internet-delivered exposure-based cognitive–behavioural therapy and behavioural stress management for severe health anxiety: randomised controlled trial
Open accessAbstract
Background: Exposure-based cognitive–behavioural therapy (CBT) delivered via the internet has been shown to be effective for severe health anxiety (hypochondriasis) but has not been compared with an active, effective and credible psychological treatment, such as behavioural stress management (BSM). Aims: To investigate two internet-delivered treatments – exposure-based CBT v.BSM – for severe health anxiety in a randomised controlled trial (trial registration: NCT01673035). Method: Participants (n= 158) with a principal diagnosis of severe health anxiety were allocated to 12 weeks of exposure-based CBT (n= 79) or BSM (n= 79) delivered via the internet. The Health Anxiety Inventory (HAI) was the primary outcome. Results: Internet-delivered exposure-based CBT led to a significantly greater improvement on the HAI compared with BSM. However, both treatment groups made large improvements on the HAI (pre-to-post-treatment Cohen's d: exposure-based CBT, 1.78; BSM, 1.22). Conclusions: Exposure-based CBT delivered via the internet is an efficacious treatment for severe health anxiety. Declarations of interest: None.
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A patient was considered a completer according to the content criterion if 50% or more of the content was completed within the treatment period, as all of the six psychological flexibility processes then had been introduced.
“A patient was considered a completer according to the content criterion if 50% or more of the content was completed within the treatment period, as all of the six psychological flexibility processes then had been introduced (24,45).”
From Internet-delivered acceptance and commitment therapy (iACT) for chronic pain—feasibility and preliminary effects in clinical and self-referred patients (2020) · cites this paper as [45]
The ‘Attrition and adherence’ section defines completers as participants who finished at least 6 of 12 modules, matching the 50% threshold. The ‘Internet-delivered exposure-based CBT’ section says those first six modules covered the treatment’s main components, but it does not identify them as the six psychological flexibility processes. Page numbers are not provided in the copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredOne way to increase availability is to provide treatment via the Internet.
“One way to increase availability is to provide treatment via Internet (Hedman et al., 2014;Vigerland et al., 2016).”
From Internet-delivered acceptance and commitment therapy as microlearning for chronic pain: A randomized controlled trial with 1-year follow-up (2021) · cites this paper as Hedman et al., 2014
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., 2014
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 [16]
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- Authors
- Hedman, E., Axelsson, E., Görling, A., Ritzman, C., Ronnheden, M., Alaoui, S. E., Andersson, E., Lekander, M., & Ljótsson, B.
- Affiliations
- Stockholm University (SE)
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2014-10
- Volume
- 205
- Issue
- 4
- Pages
- 307-314
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2100297997
- Cited by
- 103
- References
- 43
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 6 · 2023: 7 · 2022: 10 · 2021: 8 · 2020: 9 · 2019: 15 · 2018: 9 · 2017: 13 · 2016: 9 · 2015: 7 · 2014: 2
- FWCI
- 16.00
- 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 › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- health anxiety, online therapy, treatment efficacy comparison
- MeSH terms
- Adaptation, Psychological, Adult, Aged, Counseling, Female, Humans, Hypochondriasis, Male, Middle Aged, Stress, Psychological, Cognitive Behavioral Therapy, Treatment Outcome, Internet, Young Adult
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