The impact of exposure-based cognitive behavior therapy for severe health anxiety on self-rated health: Results from a randomized trial

Erik Hedman-Lagerlöf; Erland Axelsson; Erik Andersson; Brjánn Ljótsson; Anna Andreasson; Mats Lekander

doi:10.1016/j.jpsychores.2017.09.013

The impact of exposure-based cognitive behavior therapy for severe health anxiety on self-rated health: Results from a randomized trial

J Psychosom Res. 2017 Dec:103:9-14. doi: 10.1016/j.jpsychores.2017.09.013. Epub 2017 Sep 28.

Authors

Erik Hedman-Lagerlöf¹, Erland Axelsson², Erik Andersson², Brjánn Ljótsson², Anna Andreasson³, Mats Lekander⁴

Affiliations

¹ Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden. Electronic address: kire.hedman@ki.se.
² Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
³ Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden; Department of Psychology, Macquarie University, North Ryde, NSW, Australia.
⁴ Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden.

PMID: 29167052
DOI: 10.1016/j.jpsychores.2017.09.013

Abstract

Objective: Self-rated health (SRH) has been shown to be a stable predictor of illness and mortality. Improvement in SRH, even in the absence of change in objective health, predicts better health and reduced mortality. Severe health anxiety (SHA) is characterized by fear of illness and distorted health perception. The objective of the present study was to investigate if exposure-based cognitive behavior therapy (CBT) for SHA can lead to improvement in SRH and whether this improvement is mediated by reduced health anxiety.

Methods: Data were collected from a randomized controlled trial where participants with SHA were allocated to 12weeks of exposure-based CBT (n=99) for SHA or to a no treatment control condition (n=33). The mediation analysis was based on SRH- and health anxiety data collected weekly during the treatment phase.

Results: Linear mixed effects models analysis showed a significant interaction effect of group and time indicating superior improvements in SRH in exposure-based CBT compared to the control condition (Z=2.69, p=0.007). The controlled effect size was moderately large (d=0.64) and improvements were stable at 1-year follow-up. Reduced health anxiety was a significant mediator of improvement in SRH.

Conclusions: 12weeks of exposure-based CBT for SHA can lead to significant improvements in SRH. Considering the previously established importance of SRH as a predictor for disease and mortality, exposure-based CBT for severe health anxiety may lead to improvements on several important health parameters, possibly even increasing the likelihood of longevity.

Trial registration: ClinicalTrials.gov NCT01966705.

Keywords: Exposure-based cognitive behavior therapy; Mediation; Randomized controlled trial; Self-rated health; Severe health anxiety.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Anxiety Disorders / psychology*
Cognitive Behavioral Therapy / methods*
Female
Humans
Male
Negotiating / psychology*
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT01966705