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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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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 [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]
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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., 2016
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“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
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“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]
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“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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“Second, with the exception of one study which showed iCBT was efficacious in patients who met criteria for DSM-5 IAD or SSD (Hedman et al. 2016), all past research has evaluated CBT (and iCBT) in patients with DSM-IV Hypochondriasis.”
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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“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 [17]
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Scarella, T. M. (2019) · Springer eBooks · doi:10.1007/978-3-030-04245-5_6 · Cited by 2
Somatic Symptom and Related Disorders
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von Cederwald, A. F., Salomonsson, S., Isacsson, N. H., & Kaldo, V. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-13232-4 · Cited by 1
Liu, S., Li, Y., He, Z., Sima, X., & Li, J. (2026) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2026.01.017 · Cited by 1
Kalon, L., Boß, L., Wiencke, C., Zarski, A., & Lehr, D. (2026) · Frontiers in Digital Health · doi:10.3389/fdgth.2026.1680033 · Cited by 1
Peters, L., Matysiak, A., Hübener, S., Lohse, A. W., Löwe, B., & Maehder, K. (2026) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2026.03.004 · Cited by 1
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Mills, A. (2018) · Springer eBooks · doi:10.1007/978-3-319-57111-9_9185 · Cited by 1
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Hedman‐Lagerlöf, E., & Axelsson, E. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-811806-1.00008-1
Self-citationMills, A. (2017) · Springer eBooks · doi:10.1007/978-3-319-56782-2_9185-1
Axelsson, E., & Hedman‐Lagerlöf, E. (2020) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1080/14737167.2020.1831240
Self-citationVivian, K., Strodl, E. S., Kitamura, H., & Johnson, L. R. (2022) · Clinical Psychologist · doi:10.1080/13284207.2022.2065913
حفني, ع. ث. إ., & صادق, ن. ت. ا. ج. (2022) · مجلة كلية التربية جامعة بنها · doi:10.21608/jfeb.2022.288585
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Hennemann, S., Böhme, K., & Witthöft, M. (2023) · Springer eBooks · doi:10.1007/978-3-662-65816-1_9
INTERNET-BASED COGNITIVE BEHAVIORAL THERAPY FOR SOMATIC SYMPTOM DISORDER
Ariyanti, N. T. (2024) · Journal of Psychiatry Psychology and Behavioral Research · doi:10.21776/ub.jppbr.2024.005.01.9
Metadata
- Authors
- Hedman, E., Axelsson, E., Andersson, E., Lekander, M., & Ljótsson, B.
- Affiliations
- Stockholm University (SE)
- 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
- 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
- bronze
- doi.org
- 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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