Peter Tyrer1, Sylvia Cooper2, Paul Salkovskis3, Helen Tyrer2, Michael Crawford2, Sarah Byford4, Simon Dupont5, Sarah Finnis5, John Green6, Elenor McLaren7, David Murphy7, Steven Reid6, Georgina Smith6, Duolao Wang8, Hilary Warwick2, Hristina Petkova4, Barbara Barrett4. 1. Centre for Mental Health, Imperial College, Claybrook Road London, UK. Electronic address: p.tyrer@imperial.ac.uk. 2. Centre for Mental Health, Imperial College, Claybrook Road London, UK. 3. Department of Psychology, University of Bath, Bath, UK. 4. Centre for the Economics of Mental and Physical Health, King's College London, De Crespigny Park, London, UK. 5. Greenacres Centre, Hillingdon Hospital, Pield Heath Road, Uxbridge, UK. 6. Central and North West London NHS Foundation Trust, Hampstead Road, London, UK. 7. Department of Clinical Psychology, Charing Cross Hospital, Fulham Palace Road, London, UK. 8. Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
Abstract
BACKGROUND: Health anxiety has been treated by therapists expert in cognitive behaviour therapy with some specific benefit in some patients referred to psychological services. Those in hospital care have been less often investigated. Following a pilot trial suggesting efficacy we carried out a randomised study in hospital medical clinics. METHODS: We undertook a multicentre, randomised trial on health anxious patients attending cardiac, endocrine, gastroenterological, neurological, and respiratory medicine clinics in secondary care. We included those aged 16-75 years, who satisfied the criteria for excessive health anxiety, and were resident in the area covered by the hospital, were not under investigation for new pathology or too medically unwell to take part. We used a computer-generated random scheme to allocate eligible medical patients to an active treatment group of five-to-ten sessions of adapted cognitive behaviour therapy (CBT-HA group) delivered by hospital-based therapists or to standard care in the clinics. The primary outcome was change in health anxiety symptoms measured by the Health Anxiety Inventory at 1 year and the main secondary hypothesis was equivalence of total health and social care costs over 2 years, with an equivalence margin of £150. Analysis was by intention to treat. The study is registered with controlled-trials.com, ISRCTN14565822. FINDINGS: Of 28,991 patients screened, 444 were randomly assigned to receive either adapted cognitive behaviour therapy (CBT-HA group, 219 participants) or standard care (standard care group, 225), with 205 participants in the CBT-HA group and 212 in the standard care group included in the analyses of the primary endpoints. At 1 year, improvement in health anxiety in the patients in the CBT-HA group was 2·98 points greater than in those in the standard care group (95% CI 1·64-4·33, p<0·0001), and twice as many patients receiving cognitive behaviour therapy achieved normal levels of health anxiety compared with those in the control group (13·9% vs 7·3%; odds ratio 2·15, 95% CI 1·09-4·23, p=0·0273). Similar differences were observed at 6 months and 2 years, and there were concomitant reductions in generalised anxiety and, to a lesser extent, depression. Of nine deaths, six were in the control group; all were due to pre-existing illness. Social functioning or health-related quality of life did not differ significantly between groups. Equivalence in total 2-year costs was not achieved, but the difference was not significant (adjusted mean difference £156, 95% CI -1446 to 1758, p=0·848). INTERPRETATION: This form of adapted cognitive behaviour therapy for health anxiety led to sustained symptomatic benefit over 2 years, with no significant effect on total costs. It deserves wider application in medical care. FUNDING: National Institute for Health Research Health Technology Assessment Programme.
BACKGROUND: Health anxiety has been treated by therapists expert in cognitive behaviour therapy with some specific benefit in some patients referred to psychological services. Those in hospital care have been less often investigated. Following a pilot trial suggesting efficacy we carried out a randomised study in hospital medical clinics. METHODS: We undertook a multicentre, randomised trial on health anxious patients attending cardiac, endocrine, gastroenterological, neurological, and respiratory medicine clinics in secondary care. We included those aged 16-75 years, who satisfied the criteria for excessive health anxiety, and were resident in the area covered by the hospital, were not under investigation for new pathology or too medically unwell to take part. We used a computer-generated random scheme to allocate eligible medical patients to an active treatment group of five-to-ten sessions of adapted cognitive behaviour therapy (CBT-HA group) delivered by hospital-based therapists or to standard care in the clinics. The primary outcome was change in health anxiety symptoms measured by the Health Anxiety Inventory at 1 year and the main secondary hypothesis was equivalence of total health and social care costs over 2 years, with an equivalence margin of £150. Analysis was by intention to treat. The study is registered with controlled-trials.com, ISRCTN14565822. FINDINGS: Of 28,991 patients screened, 444 were randomly assigned to receive either adapted cognitive behaviour therapy (CBT-HA group, 219 participants) or standard care (standard care group, 225), with 205 participants in the CBT-HA group and 212 in the standard care group included in the analyses of the primary endpoints. At 1 year, improvement in health anxiety in the patients in the CBT-HA group was 2·98 points greater than in those in the standard care group (95% CI 1·64-4·33, p<0·0001), and twice as many patients receiving cognitive behaviour therapy achieved normal levels of health anxiety compared with those in the control group (13·9% vs 7·3%; odds ratio 2·15, 95% CI 1·09-4·23, p=0·0273). Similar differences were observed at 6 months and 2 years, and there were concomitant reductions in generalised anxiety and, to a lesser extent, depression. Of nine deaths, six were in the control group; all were due to pre-existing illness. Social functioning or health-related quality of life did not differ significantly between groups. Equivalence in total 2-year costs was not achieved, but the difference was not significant (adjusted mean difference £156, 95% CI -1446 to 1758, p=0·848). INTERPRETATION: This form of adapted cognitive behaviour therapy for health anxiety led to sustained symptomatic benefit over 2 years, with no significant effect on total costs. It deserves wider application in medical care. FUNDING: National Institute for Health Research Health Technology Assessment Programme.
Authors: Danielle Petricone-Westwood; Georden Jones; Brittany Mutsaers; Caroline Séguin Leclair; Christina Tomei; Geneviève Trudel; Andreas Dinkel; Sophie Lebel Journal: Int J Behav Med Date: 2019-02
Authors: Dorothy M Wade; Paul R Mouncey; Alvin Richards-Belle; Jerome Wulff; David A Harrison; M Zia Sadique; Richard D Grieve; Lydia M Emerson; Alexina J Mason; David Aaronovitch; Nicole Als; Chris R Brewin; Sheila E Harvey; David C J Howell; Nicholas Hudson; Monty G Mythen; Deborah Smyth; John Weinman; John Welch; Chris Whitman; Kathryn M Rowan Journal: JAMA Date: 2019-02-19 Impact factor: 56.272
Authors: Suzanne H Richards; Lindsey Anderson; Caroline E Jenkinson; Ben Whalley; Karen Rees; Philippa Davies; Paul Bennett; Zulian Liu; Robert West; David R Thompson; Rod S Taylor Journal: Cochrane Database Syst Rev Date: 2017-04-28