Effect of Internet vs Face-to-Face Cognitive Behavior Therapy for Health Anxiety

Abstract

Health anxiety is a common and often chronic mental health problem associated with distress, substantial costs, and frequent attendance throughout the health care system. Face-to-face cognitive behavior therapy (CBT) is the criterion standard treatment, but access is limited.OBJECTIVE To test the hypothesis that internet-delivered CBT, which requires relatively little resources, is noninferior to face-to-face CBT in the treatment of health anxiety. DESIGN, SETTING, AND PARTICIPANTSThis randomized noninferiority clinical trial with health economic analysis was based at a primary care clinic and included patients with a principal diagnosis of health anxiety who were self-referred or referred from routine care. Recruitment began in December 10, 2014, and the last treatment ended on July 23, 2017. Follow-up data were collected up to 12 months after treatment. Analysis began October 2017 and ended March 2020. INTERVENTIONS Patients were randomized (1:1) to 12 weeks of internet-delivered CBT or to individual face-to-face CBT.MAIN OUTCOMES AND MEASURES Change in health anxiety symptoms from baseline to week 12. Analyses were conducted from intention-to-treat and per-protocol (completers only) perspectives, using the noninferiority margin of 2.25 points on the Health Anxiety Inventory, which has a theoretical range of 0 to 54. RESULTS Overall, 204 patients (mean [SD] age, 39 [12] years; 143 women [70%]) contributed with 2386 data points on the Health Anxiety Inventory over the treatment period. Of 204 patients, 102 (50%) were randomized to internet-delivered CBT, and 102 (50%) were randomized to face-to-face CBT. The 1-sided 95% CI upper limits for the internet-delivered CBT vs face-to-face CBT difference in change were within the noninferiority margin in the intention-to-treat analysis (B = 0.00; upper limit: 1.98; Cohen d = 0.00; upper limit: 0.23) and per-protocol analysis (B = 0.01; upper limit: 2.17; Cohen d = 0.00; upper limit: 0.25). The between-group effect was not moderated by initial symptom level, recruitment path, or patient treatment preference. Therapists spent 10.0 minutes per patient per week in the online treatment vs 45.6 minutes for face-to-face CBT. The net societal cost was lower in the online treatment (treatment period point difference: $3854). There was no significant group difference in the number of adverse events, and no serious adverse event was reported.

Sources of Health Anxiety for Hospital Staff Working during the Covid-19 Pandemic

“…Given the discussion there of health anxiety as a health belief model, it follows that merely changing the environment or increasing safety and security conditions in the hospital must by definition fail. Online cognitive–behavioral therapy interventions (CBT) have been shown to be no less effective than conventional face-to-face CBT for individuals with health anxiety [ 24 ]. Our view is that only CBT interventions have proven to offer efficacy, precision, economy, reliability, and success in treating health anxiety.…”

“…Second, health belief models, and in this case health anxiety, influence the degree to which a person believes she/he is more or less susceptible to infection by the COVID-19 virus. Third, health belief models share a common basis with the cognitive–emotional stress model of Lazarus and Folkman [ 23 ] and research on placebo effects [ 24 , 25 , 26 ]. It is not the COVID-19 virus per se [ 27 ], or stress per se [ 23 ], or a placebo per se [ 25 , 26 , 28 ] that produces an emotional, cognitive, and behavioral effect, but the subjective and cognitive–emotional meaning projected onto the virus, to a work environment, or to a placebo.…”

Emotional, Behavioral, and Psychological Impact of the COVID-19 Pandemic

“…Concerning its efficacy, Internet-delivered therapy, such as cognitive behavior therapy (CBT), was not less effective than face-to-face CBT in health anxiety disorders, while resulting in lower treatment costs in previous studies (Axelsson et al, 2020). Therefore, even though the evidence base is still limited, these therapeutic modalities may have an important role for facing mental health issues during COVID-19 pandemic (Bilder et al, 2020;Fegert et al, 2020).…”

When smartwatches contribute to health anxiety in patients with atrial fibrillation

“…The patient was referred to our cardiac psychologist (LR) for further psychological evaluation, and she ultimately was diagnosed with illness anxiety disorder (formerly known as hypochondriasis). The patient subsequently completed 6 sessions of cognitive behavioral therapy to target health anxiety 8 associated with AF, which resulted in complete symptom remission.…”