Cognitive behavioral therapy versus paroxetine in the treatment of hypochondriasis: An 18-month naturalistic follow-up

Greeven, Anja; Balkom, A.J.L.M. van; Leeden, Rien van der; Merkelbach, J.; Heuvel, Odile A. van den; Spinhoven, Philip

doi:10.1016/j.jbtep.2009.06.005

Cited by 51 publications

(20 citation statements)

References 21 publications

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“…Inconsistent findings have been produced by studies that investigated whether such comorbidity did indeed predict poor outcome [7-21]. Some studies showed that poor treatment outcome for UPS was predicted by concurrent depressive symptoms [9], anxiety symptoms [10], personality-disorder characteristics [11], a psychiatric history [12,21] or poor health-related quality of life [12].…”

Section: Introductionmentioning

confidence: 99%

“…Thus, for concurrent depressive symptoms, one study found that depressive symptoms predicted a better outcome [13], while others showed no influence [7,8,10,11,14-20]. For concurrent anxiety symptoms, another study found that anxiety, too, predicted a better outcome [14], while others showed no influence [7,8,11,15-19]. For concurrent personality disorders, two further studies found that a personality disorder did not predict outcome – though they also implied that a personality disorder might increase the drop-out rate [8,16].…”

Section: Introductionmentioning

confidence: 99%

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Predicting the outcome of a cognitive-behavioral group training for patients with unexplained physical symptoms: a one-year follow-up study

Zonneveld

Rood

Kooiman³

et al. 2012

BMC Public Health

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BackgroundAlthough Cognitive-Behavioral Therapy (CBT) is effective for Unexplained Physical Symptoms (UPS), some therapists in clinical practice seem to believe that CBT outcome will diminish if psychiatric comorbidity is present. The result is that patients with a psychiatric comorbidity are redirected from treatment for UPS into treatment for mental health problems. To explore whether this selection and allocation are appropriate, we explored whether CBT outcomes in UPS could be predicted by variables assessed at baseline and used in routine-practice assessments.MethodsPatients (n=162) with UPS classified as undifferentiated somatoform disorder or chronic pain disorder were followed up until one year after they had attended a CBT group training. The time-points of the follow-up were at the end of CBT (immediate outcome), three months after CBT (short-term outcome), and one year after CBT (long-term outcome).CBT outcome was measured using the Physical Component Summary of the SF-36, which was the primary outcome measure in the randomized controlled trial that studied effectiveness of the CBT group training. Predictors were: 1.) psychological symptoms (global severity score of SCL-90), 2.) personality-disorder characteristics (sum of DSM-IV axis II criteria confirmed), 3.) psychiatric history (past presence of DSM-IV axis I disorders), and 4.) health-related quality of life in the mental domain (mental component summary of SF-36). The effect of this predictor set was explored using hierarchical multiple regression analyses into which these predictors had been entered simultaneously, after control for: a.) pretreatment primary outcome scores, b.) age, c.) gender, d.) marital status, and e.) employment.ResultsThe predictor set was significant only for short-term CBT outcome, where it explained 15% of the variance. A better outcome was predicted by more psychological symptoms, fewer personality-disorder characteristics, the presence of a psychiatric history, and a better quality of life in the mental domain.ConclusionsAs the predictors do not seem to predict CBT outcome consistently over time, the need for selection and allocation of patients for CBT is doubtful. It seems that this would unnecessarily deprive patients of effective treatment.Trial registrationNederlands Trial Register, NTR1609

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predicting the outcome of a cognitive-behavioral group training for patients with unexplained physical symptoms: a one-year follow-up study

Zonneveld

Rood

Kooiman³

et al. 2012

BMC Public Health

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“…Greeven et al (2007) found response rates of 45% for CBT. Those response rates were relatively stable in the 18-month follow-up (Greeven et al, 2009). However, the rates of Greeven et al (2007) can also be considered as overestimated because the authors considered changes of one standard deviation, rather than 2 standard deviations, as Jacobson and Truax (1991) suggested, as treatment response.…”

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confidence: 99%

Response and Remission After Cognitive and Exposure Therapy for Hypochondriasis

Weck¹,

Neng²

2015

Journal of Nervous &Amp; Mental Disease

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Cognitive behavioral therapy has demonstrated large effect sizes for the treatment of hypochondriasis. However, response and remission rates, which provide important additional information about clinically significant improvements, have seldom been reported. In the current study, rates of response and remission after cognitive therapy and exposure therapy were evaluated. The study was based on a randomized controlled trial that treated patients with hypochondriasis (N = 75). The primary outcome measure was a clinician-administered structured interview for hypochondriasis. At posttreatment, response was found for 72.0% and remission for 45.3% of the patients. At 12-month follow-up, the response rate was 68.0%, and the remission rate was 54.7%. No significant differences in the frequency of response/remission were found between the cognitive therapy and the exposure therapy groups. Patients' and therapists' perspectives of clinical improvement corresponded with remission rather than response rates. Improvement rates were compared with those of other mental disorders, and implications for the treatment of hypochondriasis were discussed.

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“…Considering the fact that body dysmorphic disorder and hypochondriasis were both included as part of the ICD-10 diagnosis of hypochondriacal disorder, the most conservative approach would be to keep both disorders in the same grouping; the OCRD, which, in turn, are closely related to the anxiety disorders. Since hypochondriasis shares symptoms with OCD 33 and responds to the same treatments (cognitive-behavioral therapy and serotonergic antidepressants), 34,35 classification within the OCRD category could add to the clinical utility of the classification system. Although the same arguments hold for the overlap with other anxiety disorders, justifying an additional cross-linkage of hypochondriasis with the anxiety disorders, this is not the case for the somatoform disorders.…”

Section: Classificationmentioning

confidence: 99%

Hypochondriasis: considerations for ICD-11

Heuvel

Veale

Stein

2014

Rev. Bras. Psiquiatr.

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The World Health Organization (WHO) is currently revisiting the ICD. In the 10th version of the ICD, approved in 1990, hypochondriacal symptoms are described in the context of both the primary condition hypochondriacal disorder and as secondary symptoms within a range of other mental disorders. Expansion of the research base since 1990 makes a critical evaluation and revision of both the definition and classification of hypochondriacal disorder timely. This article addresses the considerations reviewed by members of the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders in their proposal for the description and classification of hypochondriasis. The proposed revision emphasizes the phenomenological overlap with both anxiety disorders (e.g., fear, hypervigilance to bodily symptoms, and avoidance) and obsessive-compulsive and related disorders (e.g., preoccupation and repetitive behaviors) and the distinction from the somatoform disorders (presence of somatic symptom is not a critical characteristic). This revision aims to improve clinical utility by enabling better recognition and treatment of patients with hypochondriasis within the broad range of global health care settings.

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Cognitive behavioral therapy versus paroxetine in the treatment of hypochondriasis: An 18-month naturalistic follow-up

Cited by 51 publications

References 21 publications

Predicting the outcome of a cognitive-behavioral group training for patients with unexplained physical symptoms: a one-year follow-up study

Predicting the outcome of a cognitive-behavioral group training for patients with unexplained physical symptoms: a one-year follow-up study

Response and Remission After Cognitive and Exposure Therapy for Hypochondriasis

Hypochondriasis: considerations for ICD-11

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