Psychological Medicine

Original Articles

A randomized clinical trial of cognitive behavioural therapy versus short-term psychodynamic psychotherapy versus no intervention for patients with hypochondriasis

P. Sørensena1a2 c1, M. Birket-Smitha1, U. Wattara3, I. Buemanna3 and P. Salkovskisa4

a1 Liaison Psychiatry Unit, Psykiatrisk Centre Copenhagen, Copenhagen University Hospital, Denmark

a2 Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Denmark

a3 Kognitivt Psykolog Centre, Copenhagen, Denmark

a4 Department of Psychology, King's College Institute of Psychiatry and South London and Maudsley NHS Trust, London, UK

Abstract

Background Hypochondriasis is common in the clinic and in the community. Cognitive behavioural therapy (CBT) has been found to be effective in previous trials. Psychodynamic psychotherapy is a treatment routinely offered to patients with hypochondriasis in many countries, including Denmark. The aim of this study was to test CBT for hypochondriasis in a centre that was not involved in its development and compare both CBT and short-term psychodynamic psychotherapy (STPP) to a waiting-list control and to each other. CBT was modified by including mindfulness and group therapy sessions, reducing the therapist time required. STPP consisted of individual sessions.

Method Eighty patients randomized to CBT, STPP and the waiting list were assessed on measures of health anxiety and general psychopathology before and after a 6-month treatment period. Waiting-list patients were subsequently offered one of the two active treatments on the basis of re-randomization, and assessed on the same measures post-treatment. Patients were again assessed at 6- and 12-month follow-up points.

Results Patients who received CBT did significantly better on all measures relative to the waiting-list control group, and on a specific measure of health anxiety compared with STPP. The STPP group did not significantly differ from the waiting-list group on any outcome measures. Similar differences were observed between CBT and STPP during follow-up, although some of the significant differences between groups were lost.

Conclusions A modified and time-saving CBT programme is effective in the treatment of hypochondriasis, although the two psychotherapeutic interventions differed in structure.

(Received May 14 2009)

(Revised January 20 2010)

(Accepted January 26 2010)

(Online publication April 12 2010)

Correspondence

c1 Address for correspondence: Dr P. Sørensen, Psykiatrisk Centre Copenhagen, Copenhagen University Hospital, Bispebjerg Bakke 23, 2400-NV Copenhagen, Denmark. (Email: per.soerensen@dadlnet.dk)

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