Helen Tyrer1, Peter Tyrer2, Yvonne Lisseman-Stones3, Sharon McAllister4, Sylvia Cooper1, Paul Salkovskis5, Michael J Crawford1, Simon Dupont6, John Green7, David Murphy8, Duolao Wang9. 1. Centre for Mental Health, Imperial College, Claybrook Road, London W6 8LN, UK. 2. Centre for Mental Health, Imperial College, Claybrook Road, London W6 8LN, UK. Electronic address: p.tyrer@imperial.ac.uk. 3. Department of Nursing, King's Mill Hospital, Sutton-in-Ashfield, Nottinghamshire NG17 4JL, UK. 4. Medical Services, King Faisal Specialist Hospital, Riyadh, Saudi Arabia. 5. Department of Psychology, University of Bath, Bath BA2 7AY, UK. 6. Greenacres Centre, Hillingdon Hospital, Pield Heath Road, Uxbridge UB8 3NN, UK. 7. Central and North West London NHS Foundation Trust, Hampstead Road, London NW1 7QY, UK. 8. Department of Clinical Psychology, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK. 9. Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
Abstract
BACKGROUND: Health anxiety is common in medical settings and can be treated successfully by cognitive behaviour therapy. However it is not clear who might be best placed to deliver this therapy. OBJECTIVES: In a planned secondary analysis of data from a randomised trial of adapted cognitive behaviour therapy for health anxiety we compared outcomes of therapy delivered by nurses and other professional groups. DESIGN: A randomised controlled trial with two treatment arms, 5-10 sessions of cognitive behaviour therapy adapted health anxiety or standard care. SETTING: Cardiology, endocrine, gastroenterology, neurological and respiratory clinics in six general hospitals in the UK covering urban, suburban and rural areas. PARTICIPANTS: Medical patients attending the clinics who had pathological health anxiety and also scored for a diagnosis of hypochondriasis. METHODS: Patients were randomised to one of two treatment arms, 5-10 sessions of cognitive behaviour therapy adapted health anxiety or standard care delivered by naive therapists (not randomised) who were trained in advance before delivering the treatment. Independent assessment of outcomes by researchers masked to allocation status at 3m, 6m, 12m and 24m. RESULTS:444 patients were randomised in the trial, 219 to cognitive behaviour therapy adapted health anxiety and 225 to standard care. 373 (84%) completed assessments after two years. Those treated by nurses (n=66) had improvement in health anxiety, generalised anxiety and depression outcomes that were significantly better and twice as great as those of the professional groups of assistant psychologists (n=87) and graduate workers (n=66) (P<0.01 over all time points). The number needed to treat to show superiority of nurse-delivered treatment over other treatment delivery was 4 at 6 months and 6 at one year. CONCLUSION: General nurses, after suitable training, are very effective therapists for patients with health anxiety in medical clinics and should be the therapists of choice for patients in these settings.
RCT Entities:
BACKGROUND: Health anxiety is common in medical settings and can be treated successfully by cognitive behaviour therapy. However it is not clear who might be best placed to deliver this therapy. OBJECTIVES: In a planned secondary analysis of data from a randomised trial of adapted cognitive behaviour therapy for health anxiety we compared outcomes of therapy delivered by nurses and other professional groups. DESIGN: A randomised controlled trial with two treatment arms, 5-10 sessions of cognitive behaviour therapy adapted health anxiety or standard care. SETTING: Cardiology, endocrine, gastroenterology, neurological and respiratory clinics in six general hospitals in the UK covering urban, suburban and rural areas. PARTICIPANTS: Medical patients attending the clinics who had pathological health anxiety and also scored for a diagnosis of hypochondriasis. METHODS:Patients were randomised to one of two treatment arms, 5-10 sessions of cognitive behaviour therapy adapted health anxiety or standard care delivered by naive therapists (not randomised) who were trained in advance before delivering the treatment. Independent assessment of outcomes by researchers masked to allocation status at 3m, 6m, 12m and 24m. RESULTS: 444 patients were randomised in the trial, 219 to cognitive behaviour therapy adapted health anxiety and 225 to standard care. 373 (84%) completed assessments after two years. Those treated by nurses (n=66) had improvement in health anxiety, generalised anxiety and depression outcomes that were significantly better and twice as great as those of the professional groups of assistant psychologists (n=87) and graduate workers (n=66) (P<0.01 over all time points). The number needed to treat to show superiority of nurse-delivered treatment over other treatment delivery was 4 at 6 months and 6 at one year. CONCLUSION: General nurses, after suitable training, are very effective therapists for patients with health anxiety in medical clinics and should be the therapists of choice for patients in these settings.
Authors: Albert T Higgins-Chen; Sarah B Abdallah; Jennifer B Dwyer; Alfred P Kaye; Gustavo A Angarita; Michael H Bloch Journal: Front Psychiatry Date: 2019-03-22 Impact factor: 4.157
Authors: Peter Tyrer; Helen Tyrer; Sylvia Cooper; Barbara Barrett; Stephanie Kings; Valentina Lazarevic; Kate Bransby-Adams; Katherine Whittamore; Gemma Walker; Antoinette McNulty; Emma Donaldson; Luke Midgley; Shani McCoy; Rachel Evered; Min Yang; Boliang Guo; Yvonne Lisseman-Stones; Asmae Doukani; Roger Mulder; Richard Morriss; Mike Crawford Journal: BMC Psychol Date: 2015-11-24
Authors: Peter Tyrer; Helen Tyrer; Richard Morriss; Michael Crawford; Sylvia Cooper; Min Yang; Boliang Guo; Roger T Mulder; Samuel Kemp; Barbara Barrett Journal: Open Heart Date: 2017-05-16