Cognitive-Behavioral Therapy Effective in Treating Hypochondria
People with ]]>hypochondria]]> carry a persistent fear that real or imagined physical symptoms point to a serious illness, even when medical evidence suggests the contrary. It is believed that approximately one in 20 people who visit physicians on an outpatient basis suffer from hypochondria, which can significantly impair a person’s quality of life.
People with hypochondria benefit most when they have a close relationship with a healthcare provider, who can provide reassurance that a medical condition does not exist, and treat symptoms if necessary.
In the past, psychological treatment and medications have had disappointing results in hypochondriacal patients. But a new study in the March 24/31 issue of the Journal of the American Medical Association found that a series of behavioral therapy sessions significantly reduced anxieties in people with hypochondria.
About the Study
This study included 187 people who screened positive for hypochondria or borderline hypochondria according to well accepted, standardized criteria. The participants were either recruited through their primary care practices (80) or responded to public announcements (107).
The participants were randomly assigned to one of two groups:
- Treatment group – 102 participants underwent a Cognitive Behavior Therapy (CBT) intervention, which consisted of six weekly 90-minute therapy sessions that targeted behaviors and beliefs associated with hypochondria
- Control group – 85 participants received medical care as usual
Before the study began, and six and 12 months into the study, the participants filled out questionnaires that assessed their beliefs, fears, attitudes, and physical symptoms related to hypochondria. In addition, they completed questionnaires that evaluated their level of impairment in social functioning and day-to-day activities.
The researchers compared the effects of the therapy versus medical care in improving hypochondria. They used an “intent-to-treat” analysis, which means participants were included in the final analyses whether they participated in all of the therapy sessions or not. The analyses were adjusted for the participants’ education level, level of psychiatric distress, and recruitment group (patient vs. volunteer).
The participants, who were predominantly middle-aged women, reported having hypochondria for approximately 11 years. When the study began, public announcement respondents had significantly more symptoms of hypochondria and were significantly more disabled than the participants recruited at their primary care practices.
After 12 months, the participants in the treatment group had significantly altered their hypochondriacal beliefs and lowered their anxiety levels compared to participants in the control group. In addition, CBT was associated with significantly less impairment of social functioning and day-to-day activities than medical care as usual. Physical symptoms, on the other hand, were not significantly improved with CBT.
While these results of this study are intriguing, they’re significance is limited by the fact that only 30% of those deemed eligible chose to participate, and 25% of the participants attended less than four of the six treatment sessions. These limitations, however, probably represent what would actually happen if CBT were applied in the general population.
How Does This Affect You?
These results suggest that CBT may be a viable treatment for people with hypochondria. This is extremely promising, considering that there has not yet been a validated treatment for hypochondria. Though the effects of CBT were modest in this study, future research may determine that longer-term CBT with follow-up “boosters” are even more beneficial.
This study also showed that while CBT mitigated maladaptive beliefs and improved anxiety related to hypochondria, it did not significantly alleviate physical symptoms. The researchers assert that in a variety of conditions, learning to compensate for—rather than eliminate—physical distress is all that can be expected and may actually lead to better long-term outcomes. This method of treatment might also benefit people who suffer from a variety of chronic conditions for which there is no known treatment.
If you suffer from hypochondria, this study strongly suggests that cognitive-behavioral therapy may help. Since many psychologists offer CBT therapy, your doctor may be able to make a convenient referral. Don’t hesitate to ask—finding “nothing” to treat does not mean nothing can be done.
National Institutes of Health
Barsky AJ, Ahern DK. Cognitive behavior therapy for hypochondriasis: a randomized controlled trial. Journal of the American Medical Association . 2004;291:1464-1470.
Hypochondria. National Library of Medicine website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/001236.htm . Accessed March 23, 2004.
Last reviewed Mar 24, 2004 by ]]>Richard Glickman-Simon, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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