Cognitive therapy and depression

Cognitive behavioural therapy is more effective than standard care for people with hypochondria or health anxiety, say researchers writing in The Lancet.

As the BBC reported today, “In their study, 14% of patients given CBT regained normal anxiety levels against 7% given the usual care.


“The researchers say nurses could easily be trained to offer the psychological therapy.  Between 10% and 20% of hospital patients are thought to worry obsessively about their health. Previous studies have shown that CBT, which aims to change thought patterns and behaviour, is an effective treatment for other anxiety disorders. But there is a shortage of specialists trained to deliver CBT, and as a result waiting lists can be long.

“In this study, 219 people with health anxiety received an average of six sessions of cognitive behavioural therapy while 225 received reassurance and support, which is standard. After periods of six months and 12 months, patients in the CBT group showed “significantly greater improvement in self-rated anxiety and depression symptoms” compared with standard care, the study showed. There was also a particularly noticeable reduction in health anxiety in the CBT group straight after treatment began.

“The therapy was delivered by non-CBT experts who had been trained in only two workshops.Study author Prof Peter Tyrer, head of the Centre for Mental Health at Imperial College London, said the results showed that hypochondria could be successfully treated, in a “relatively cheap” way, by general nurses with minimal training in a hospital setting. Reducing the anxiety levels of 14% of the CBT group might not seem a high figure, he said, but these were often people with serious problems who had sometimes spent thousands of pounds on private health assessments because of fears about their health. “Health anxiety is costly for healthcare providers and an effective treatment could potentially save money by reducing the need for unnecessary tests and emergency hospital admissions,” Prof Tyrer said. Writing about the study in The Lancet, Chris Williams from the University of Glasgow and Allan House from the University of Leeds, said the findings were “intriguing” but translating them into services was “problematic”.

“They also questioned the cost-effectiveness of screening patients for health anxiety and CBT. They wrote: “Health anxiety is only one of the problems noted in medical outpatients – depression, hazardous alcohol use, poor treatment adherence, and other forms of medically unexplained presentation all press for recognition and intervention. “To develop multiple parallel services makes no sense, especially since the common emotional disorders overlap substantially.” But Prof Tyrer said health anxiety was a hidden epidemic that required the correct treatment, not just reassurance.”


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