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

Published online by Cambridge University Press:  12 April 2010

P. Sørensen*
Affiliation:
Liaison Psychiatry Unit, Psykiatrisk Centre Copenhagen, Copenhagen University Hospital, Denmark Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Denmark
M. Birket-Smith
Affiliation:
Liaison Psychiatry Unit, Psykiatrisk Centre Copenhagen, Copenhagen University Hospital, Denmark
U. Wattar
Affiliation:
Kognitivt Psykolog Centre, Copenhagen, Denmark
I. Buemann
Affiliation:
Kognitivt Psykolog Centre, Copenhagen, Denmark
P. Salkovskis
Affiliation:
Department of Psychology, King's College Institute of Psychiatry and South London and Maudsley NHS Trust, London, UK
*
*Address for correspondence: Dr P. Sørensen, Psykiatrisk Centre Copenhagen, Copenhagen University Hospital, Bispebjerg Bakke 23, 2400-NVCopenhagen, Denmark. (Email: per.soerensen@dadlnet.dk)

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.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2010

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References

APA (1995). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, international version. American Psychiatric Association: Washington, DC.Google Scholar
Avia, MD, Ruiz, MA, Olivares, ME, Crespo, M, Guisado, AB, Sanchez, A, Varela, A (1996). The meaning of psychological symptoms: effectiveness of a group intervention with hypochondriacal patients. Behaviour Research and Therapy 34, 2331.CrossRefGoogle ScholarPubMed
Barsky, AJ (1996). Hypochondriasis. Medical management and psychiatric treatment. Psychosomatics 37, 4856.CrossRefGoogle ScholarPubMed
Barsky, AJ, Ahern, DK (2004). Cognitive behavior therapy for hypochondriasis: a randomized controlled trial. Journal of the American Medical Association 291, 14641470.CrossRefGoogle ScholarPubMed
Barsky, AJ, Ettner, SL, Horsky, J, Bates, DW (2001). Resource utilization of patients with hypochondriacal health anxiety and somatisation. Medical Care 39, 705715.Google Scholar
Barsky, AJ, Wyshak, G, Klerman, GL (1992). Psychiatric comorbidity in DSM-III-R hypochondriasis. Archives of General Psychiatry 49, 101108.Google Scholar
Baskin, TW, Tierney, SC, Minami, T, Wampold, BE (2003). Establishing specificity in psychotherapy: a meta-analysis of structural equivalence of placebo controls. Journal of Consulting and Clinical Psychology 71, 973979.CrossRefGoogle ScholarPubMed
Blagys, MD, Hilsenroth, MJ (2000). Distinctive features of short-term psychodynamic-interpersonal psychotherapy: a review of the comparative psychotherapy process literature. Clinical Psychology: Science and Practice 7, 167188.Google Scholar
Clark, DM, Salkovskis, PM, Hackmann, A, Wells, A, Fennell, M, Ludgate, J, Ahmad, S, Richards, HC, Gelder, M (1998). Two psychological treatments for hypochondriasis. A randomised controlled trial. British Journal of Psychiatry 173, 218225.CrossRefGoogle ScholarPubMed
Fava, GA, Grandi, S, Rafanelli, C, Fabbri, S, Cazzaro, M (2000). Explanatory therapy in hypochondriasis. Journal of Clinical Psychiatry 61, 317322.Google Scholar
Fergusson, D, Aaron, SD, Guyatt, G, Hebert, P (2002). Post-randomisation exclusions: the intention to treat principle and excluding patients from analysis. British Medical Journal 325, 652654.CrossRefGoogle ScholarPubMed
Greeven, A, van Balkom, AJ, Visser, S, Merkelbach, JW, van Rood, YR, van Dyck, R, Van der Does, AJW, Zitman, FG, Spinhoven, P (2007). Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a randomized controlled trial. American Journal of Psychiatry 164, 9199.Google Scholar
Gureje, O, Ustun, TB, Simon, GE (1997). The syndrome of hypochondriasis: a cross-national study in primary care. Psychological Medicine 27, 10011010.Google Scholar
Hamilton, M (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology 32, 5055.CrossRefGoogle ScholarPubMed
Jones, J, Hunter, D (1995). Consensus methods for medical and health services research. British Medical Journal 311, 376380.Google Scholar
Messer, SB (2001). What makes brief psychodynamic therapy time efficient. Clinical Psychology: Science and Practice 8, 5–22.Google Scholar
Salkovskis, PM (1989). Somatic problems. In Cognitive Behaviour Therapy for Psychiatric Problems: A Practical Guide (ed. Hawton, K., Salkovskis, P. M., Kirk, J. and Clark, D. M.), pp. 235276. Oxford University Press: Oxford.CrossRefGoogle Scholar
Salkovskis, PM, Rimes, KA, Warwick, HM, Clark, DM (2002). The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine 32, 843853.CrossRefGoogle ScholarPubMed
Salkovskis, PM, Warwick, HM (1986). Morbid preoccupations, health anxiety and reassurance: a cognitive-behavioural approach to hypochondriasis. Behaviour Research and Therapy 24, 597602.Google Scholar
Salkovskis, P, Warwick, HM, Deale, AC (2003). Cognitive-behavioural treatment for severe and persistent health anxiety (hypochondriasis). Brief Treatment and Crisis Intervention 3, 353367.CrossRefGoogle Scholar
Segal, Z, Williams, JMG, Teasdale, JD (2002). Mindfulness-based Cognitive Therapy for Depression. Guilford Press: New York.Google Scholar
Thomson, AB, Page, LA (2007). Psychotherapies for hypochondriasis. Cochrane Database of Systematic Reviews 4, CD006520.CrossRefGoogle Scholar
Visser, S, Bouman, TK (2001). The treatment of hypochondriasis: exposure plus response prevention vs cognitive therapy. Behaviour Research and Therapy 39, 423442.CrossRefGoogle ScholarPubMed
Warwick, HM (1989). A cognitive-behavioural approach to hypochondriasis and health anxiety. Journal of Psychosomatic Research 33, 705711.Google Scholar
Warwick, HM, Clark, DM, Cobb, AM, Salkovskis, PM (1996). A controlled trial of cognitive-behavioural treatment of hypochondriasis. British Journal of Psychiatry 169, 189195.CrossRefGoogle ScholarPubMed
Warwick, HM, Marks, IM (1988). Behavioural treatment of illness phobia and hypochondriasis. A pilot study of 17 cases. British Journal of Psychiatry 152, 239241.Google Scholar
Wattar, U, Sorensen, P, Bueman, I, Birket-Smith, M, Salkovskis, PM (2005). Outcome of cognitive-behavioural treatment for health anxiety (hypochondriasis) in a routine clinical setting. Behavioural and Cognitive Psychotherapy 33, 111.CrossRefGoogle Scholar
WHO (2000). Schedules for Clinical Assessment in Neuropsychiatry, Version 2.1. World Health Organization Collaborating Centre for Research and Training in Mental Health: Århus, Denmark.Google Scholar