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Cited by 119Digital Mental Health InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychosomatic Disorders and Their Treatments

Exposure-based cognitive–behavioural therapy via the internet and as bibliotherapy for somatic symptom disorder and illness anxiety disorder: randomised controlled trial

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Hedman, Erik, Axelsson, Erland, Andersson, Erik, Lekander, Mats, Ljótsson, Brjánn·2016·British Journal of Psychiatry
DOI 10.1192/bjp.bp.116.181396
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Abstract

Background: In DSM-5 two new diagnoses, somatic symptom disorder (SSD) and illness anxiety disorder (IAD), have replaced DSM-IV hypochondriasis. There are no previous treatment studies for these disorders. Cognitive–behavioural therapy (CBT) delivered as therapist-guided or unguided internet treatment or as unguided bibliotherapy could be used to increase treatment accessibility. Aims: To investigate the effect of CBT delivered as guided internet treatment (ICBT), unguided internet treatment (U-ICBT) and as unguided bibliotherapy. Method: A randomised controlled trial (RCT) where participants (n= 132) with a diagnosis of SSD or IAD were randomised to ICBT, U-ICBT, bibliotherapy or to a control condition on a waiting list (trial registration: Clinicaltrials.gov identifier NCT01966705). Results: Compared with the control condition, all three treatment groups made large and significant improvements on the primary outcome Health Anxiety Inventory (between-group d at post-treatment was 0.80–1.27). Conclusions: ICBT, U-ICBT and bibliotherapy can be highly effective in the treatment of SSD and IAD. This is the first study showing that these new DSM-5 disorders can be effectively treated.

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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 [13]

    The Secondary outcome measures section reports greater reductions in health anxiety across the trial’s three treatment groups than in the control group. But this paper is a randomised trial of one exposure-based CBT model delivered in different ways, not a systematic review or meta-analysis establishing the effectiveness of different psychological interventions. Page numbers were not supplied for the deciding passages. (LLM, conf=0.87)

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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., 2016

    The Primary outcome measure section reports that iCBT improved health anxiety more than this trial’s control condition, with improvements maintained at 6 months. The treatment-model section says earlier studies found effects lasting at least 1 year. Our copy does not identify online forums or internet-delivered behavioural stress management as the control groups for these findings, so the specific comparator claim is not supported by this source. (LLM, conf=0.88)

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  • Previous studies have evaluated iCBT delivered either with intensive, weekly therapist guidance or without any support.

    “Finally, previous studies have evaluated iCBT delivered either with intensive, weekly therapist guidance or without any support ( Hedman et al., 2016 )”

    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., 2016

    The treatment description says participants in guided ICBT reported to a therapist at least weekly, while the U-ICBT section says no therapist support was provided. It does not establish that the therapist guidance was intensive: the General description of the treatment model reports an average of 63.6 minutes of therapist time per patient across treatment. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Evidence supports the delivery of CBT for health anxiety and IAD online, with large effect sizes when delivered in routine care.

    “Evidence also supports the delivery of CBT for health anxiety and IAD online [26, 58, 77], with large effect sizes when delivered in routine care [78, 79].”

    From Illness Anxiety Disorder: A Review of the Current Research and Future Directions (2024) · cites this paper as [77]

  • This is the first RCT to independently replicate the findings of Hedman and colleagues' studies, and demonstrate that the efficacy of iCBT for health anxiety generalises to an Australian sample with DSM-5 IAD and SSD.

    “This is the first RCT to independently replicate the findings of Hedman and colleagues' studies, and demonstrate that the efficacy of iCBT for health anxiety generalises to an Australian sample with DSM-5 IAD and SSD (replicating Hedman et al., 2016).”

    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., 2016

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Authors
Hedman, E., Axelsson, E., Andersson, E., Lekander, M., & Ljótsson, B.
Affiliations
Stockholm University (SE)
ORCID
Venue
British Journal of Psychiatry
Publisher
Royal College of Psychiatrists
Published
2016-11
Volume
209
Issue
5
Pages
407-413
ISSN
  • 0007-1250 (ISSN-L)
  • 1472-1465
DOI
10.1192/bjp.bp.116.181396
OpenAlex
W2494313366
Cited by
119
References
43
Citations by year
2026: 12 · 2025: 7 · 2024: 13 · 2023: 10 · 2022: 13 · 2021: 6 · 2020: 14 · 2019: 17 · 2018: 14 · 2017: 11 · 2016: 2
FWCI
22.68
Type
journal article
Language
en
Open access
Licence
www.cambridge.org/core/terms (unspecified, 427 d)
Locations
  • The British Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Karolinska Institutet
  • Stockholms Läns Landsting
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
somatic symptom disorder, health anxiety, internet-based cognitive behavioral therapy, bibliotherapy, exposure therapy, treatment accessibility, DSM-5
MeSH terms
Adult, Aged, Bibliotherapy, Female, Follow-Up Studies, Humans, Hypochondriasis, Implosive Therapy, Male, Middle Aged, Psychophysiologic Disorders, Somatoform Disorders, Cognitive Behavioral Therapy, Outcome Assessment, Health Care, Internet, Young Adult

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