BMJ 2013;347:f6308 doi: 10.1136/bmj.f6308 (Published 18 October 2013)
Page 1 of 1
Research News
RESEARCH NEWS Short course of cognitive behavioural therapy may reduce health anxiety, say researchers Jacqui Wise London
A short course of cognitive behavioural therapy delivered by nurses with minimal training would be an effective and relatively cheap way to reduce health anxiety in general medical clinics, researchers claim. Health anxiety or hypochondriasis places a substantial burden on health services because it leads to multiple consultations and investigations. Cognitive behavioural therapy is known to be an effective treatment for other anxiety disorders, but there are shortages of specialist therapists and long waiting lists for treatment.
The Cognitive Behaviour Therapy for Health Anxiety in Medical Patients (CHAMP) study randomised 445 people with abnormal health anxiety who were attending gastroenterological, neurological, and respiratory medicine clinics in six UK general hospitals to receive either five to 10 sessions of modified cognitive behaviour treatment or to standard care. The cognitive behavioural therapy was delivered at outpatient clinics by non-specialists who had been trained in two workshops and were then supervised by more experienced therapists. The results, reported in the Lancet, show that after one year twice as many patients given cognitive behavioural therapy achieved normal levels of health anxiety as those receiving standard care (13.9% vs 7.3%; odds ratio 2.15 (95% confidence interval 1.09 to 4.23; P=0.0273)).1 Treatment also significantly improved generalised anxiety and depression. These improvements were sustained at two years. The study also found no significant difference in overall costs between the two groups. Peter Tyrer, of the centre for mental health at Imperial College London and the study’s leader, said, “Until now we had no evidence that health anxiety in medical settings could be successfully treated. Our results indicate that cognitive behaviour therapy is relatively cheap, can be delivered by general nurses with minimal training, and could be easily rolled out in hospital settings.”
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However, one weakness of the study is that most of the patients who were potentially eligible for the study declined to take part, and so the population treated may not have been representative. The researchers initially screened 28 991 people. Of these, 5769 scored over 20 on the health inventory anxiety index, but 1389 were removed because of exclusion criteria. Of the 4380 remaining, 3935 people declined to participate. That left a total of 445 who were randomised into the study.
In a linked comment, Chris Williams, from the Institute of Health and Wellbeing at the University of Glasgow, questioned the cost effectiveness of treatment as the study had not included the cost of the initial screening and also had not included any measurement of quality of life. He pointed out that screening of more than 28 000 people led to the recovery of only 14 people who would not have got better with routine care.
But he added, “Health anxiety is only one of the problems noted in medical outpatients—depression, hazardous alcohol use, poor treatment adherence, and other forms of medically unexplained presentation all press for recognition and intervention. For the treatment of these disorders, cognitive behaviour therapy offers a generic treatment framework, which is not fundamentally different across disorders.” He added, “Such treatment should be available in general hospital settings, in multidisciplinary liaison psychiatry, or clinical health psychology clinics that can deal with the full range of problems that present.” 1
Tyrer P, Cooper S, Salkovskis P, Tyrer H, Crawford M, Byford S, et al. Clinical and cost-effectiveness of cognitive behaviour therapy for health anxiety in medical patients: a multicentre randomised controlled trial. Lancet 18 Oct 2013, doi:10.1016/S0140-6736( 13)61905-4.
Cite this as: BMJ 2013;347:f6308 © BMJ Publishing Group Ltd 2013
Subscribe: http://www.bmj.com/subscribe
Page 1 of 1
Research News
RESEARCH NEWS Short course of cognitive behavioural therapy may reduce health anxiety, say researchers Jacqui Wise London
A short course of cognitive behavioural therapy delivered by nurses with minimal training would be an effective and relatively cheap way to reduce health anxiety in general medical clinics, researchers claim. Health anxiety or hypochondriasis places a substantial burden on health services because it leads to multiple consultations and investigations. Cognitive behavioural therapy is known to be an effective treatment for other anxiety disorders, but there are shortages of specialist therapists and long waiting lists for treatment.
The Cognitive Behaviour Therapy for Health Anxiety in Medical Patients (CHAMP) study randomised 445 people with abnormal health anxiety who were attending gastroenterological, neurological, and respiratory medicine clinics in six UK general hospitals to receive either five to 10 sessions of modified cognitive behaviour treatment or to standard care. The cognitive behavioural therapy was delivered at outpatient clinics by non-specialists who had been trained in two workshops and were then supervised by more experienced therapists. The results, reported in the Lancet, show that after one year twice as many patients given cognitive behavioural therapy achieved normal levels of health anxiety as those receiving standard care (13.9% vs 7.3%; odds ratio 2.15 (95% confidence interval 1.09 to 4.23; P=0.0273)).1 Treatment also significantly improved generalised anxiety and depression. These improvements were sustained at two years. The study also found no significant difference in overall costs between the two groups. Peter Tyrer, of the centre for mental health at Imperial College London and the study’s leader, said, “Until now we had no evidence that health anxiety in medical settings could be successfully treated. Our results indicate that cognitive behaviour therapy is relatively cheap, can be delivered by general nurses with minimal training, and could be easily rolled out in hospital settings.”
For personal use only: See rights and reprints http://www.bmj.com/permissions
However, one weakness of the study is that most of the patients who were potentially eligible for the study declined to take part, and so the population treated may not have been representative. The researchers initially screened 28 991 people. Of these, 5769 scored over 20 on the health inventory anxiety index, but 1389 were removed because of exclusion criteria. Of the 4380 remaining, 3935 people declined to participate. That left a total of 445 who were randomised into the study.
In a linked comment, Chris Williams, from the Institute of Health and Wellbeing at the University of Glasgow, questioned the cost effectiveness of treatment as the study had not included the cost of the initial screening and also had not included any measurement of quality of life. He pointed out that screening of more than 28 000 people led to the recovery of only 14 people who would not have got better with routine care.
But he added, “Health anxiety is only one of the problems noted in medical outpatients—depression, hazardous alcohol use, poor treatment adherence, and other forms of medically unexplained presentation all press for recognition and intervention. For the treatment of these disorders, cognitive behaviour therapy offers a generic treatment framework, which is not fundamentally different across disorders.” He added, “Such treatment should be available in general hospital settings, in multidisciplinary liaison psychiatry, or clinical health psychology clinics that can deal with the full range of problems that present.” 1
Tyrer P, Cooper S, Salkovskis P, Tyrer H, Crawford M, Byford S, et al. Clinical and cost-effectiveness of cognitive behaviour therapy for health anxiety in medical patients: a multicentre randomised controlled trial. Lancet 18 Oct 2013, doi:10.1016/S0140-6736( 13)61905-4.
Cite this as: BMJ 2013;347:f6308 © BMJ Publishing Group Ltd 2013
Subscribe: http://www.bmj.com/subscribe
