Predictors of Course and Outcome in Hypochondriasis after Cognitive-Behavioral Treatment

Abstract

Background: Predictors of treatment outcome were evaluated in a clinical sample suffering from hypochondriasis. Methods: The sample consisted of 96 patients with hypochondriacal disorder according to DSM-IV or high syndrome scores on the Illness Attitude Scales (IAS) or Whiteley Index (WI). After intense inpatient cognitive-behavioral treatment (CBT), 60% of the patients were classified as responders because of substantial improvements or recovery from hypochondriacal symptomatology. Results: Non-responders were characterized by a higher degree of pre-treatment hypochondriasis, more somatization symptoms and general psychopathology (SCL-90R), more dysfunctional cognitions related to bodily functioning, higher levels of psychosocial impairments, and more utilization of the health care system as indicated by the number of hospital days and costs for inpatient treatments and medication. No predictive value was found for sociodemographic variables, comorbidity with other mental disorders and chronicity. Multiple linear regression showed that pre-treatment variables significantly predicted IAS scores at post-treatment (R² = 0.59), changes during treatment (0.10), IAS scores at follow-up two years later (0.41) and changes between baseline and follow-up (0.25). Conclusions: The results demonstrate the relevance of various psychopathological variables and health care utilization as important indicators for outcome and further course of clinical hypochondriasis.

Predictors of treatment outcome in headache patients with the Millon Clinical Multiaxial Inventory III (MCMI-III)

“…These findings corresponds with earlier studies of outcome for headache patients [25][26][27] and a study of hypochondriasis, which showed more somatisation among non-responders [28]. In the present study most patients were offered 8 group sessions focused on different relaxation techniques and behavioural and cognitive stress management.…”

“…The corresponding numbers for the different headache diagnoses were TTH 26 , , and Other 29 (21)(22)(23)(24)(25)(26)(27)(28)(29)(30).…”

The Illness Attitude Scales

“…In a study [38] on intense inpatient cognitive-behavioural therapy for hypochondriasis, the pretreatment IAS total score significantly predicted the clinical outcome, as identified by the IAS total score measured at discharge and at a 2-year follow-up, and the degree of change in this score between pretreatment and follow-up. Unlike the WI, which failed to discriminate between responders and non-responders, the pretreatment IAS total score was significantly higher in the latter.…”

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

“…Only a few studies have investigated which predictors are associated with a favorable treatment outcome in hypochondriasis, and to our knowledge only on the short term. These studies showed that good treatment outcome seems to be negatively associated with illness duration, comorbidity, severity of pre-treatment hypochondriasis, extent of somatization symptoms, general psychopathology, dysfunctional cognitions related to bodily functioning, psychosocial impairments, utilization of the health care system and benzodiazepine use (Greeven et al, 2007;Hiller, Leibbrand, Rief, & Fichter, 2002;Kellner, 1983). The counterproductive effect of benzodiazepine use can be explained by its relation to anxiety sensitivity.…”