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Sustained benefit of cognitive behaviour therapy for health anxiety in medical patients (CHAMP) over 8 years: a randomised-controlled trial

  • P. Tyrer (a1), D. Wang (a2), M. Crawford (a1), S. Dupont (a3), S. Cooper (a1), S. Nourmand (a1), V. Lazarevic (a1), A. Philip (a4) and H. Tyrer (a1)...
  • Please note a correction has been issued for this article.



Health anxiety is an under-recognised but a frequent cause of distress. It is particularly common in general hospitals.


We carried out an 8-year follow-up of medical out-patients with health anxiety (hypochondriasis) enrolled in a randomised-controlled trial in five general hospitals in London, Middlesex and Nottinghamshire. Randomisation was to a mean of six sessions of cognitive behaviour therapy adapted for health anxiety (CBT-HA) or to standard care in the clinics. The primary outcome was a change in score on the Short Health Anxiety Inventory, with generalised anxiety and depression as secondary outcomes. Of 444 patients aged 16–75 years seen in cardiology, endocrinology, gastroenterology, neurology and respiratory medicine clinics, 306 (68.9%) were followed-up 8 years after randomisation, including 36 who had died. The study is registered with, ISRCTN14565822.


There was a significant difference in the HAI score in favour of CBT-HA over standard care after 8 years [1.83, 95% confidence interval (CI) 0.25–3.40, p = 0.023], between group differences in generalised anxiety were less (0.54, 95% CI −0.29 to 1.36), p = 0.20, ns), but those for depression were greater at 8 years (1.22, 95% CI 0.42–2.01, p < 0.003) in CBT-HA than in standard care, most in standard care satisfying the criteria for clinical depression. Those seen by nurse therapists and in cardiology and gastrointestinal clinics achieved the greatest gains with CBT-HA, with greater improvement in both symptoms and social function.


CBT-HA is a highly long-term effective treatment for pathological health anxiety with long-term benefits. Standard care for health anxiety in medical clinics promotes depression. Nurse therapists are effective practitioners.


Corresponding author

Author for correspondence: P. Tyrer, E-mail:


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Cameron, I. M., Cardy, A., Crawford, J. R., du Toit, S. W., Hay, S., Lawton, K., Mitchell, K., … Reid, I. C. (2011). Measuring depression severity in general practice: Discriminatory performance of the PHQ-9, HADS-D, and BDI-II. British Journal of General Practice, 61, e419e426.
Clark, D. M., Salkovskis, P. M., Hackmann, A., Wells, A., Fennell, M., Ludgate, J., Ahmad, S., … Gelder, M. (1998). Two psychological treatments for hypochondriasis: A randomized controlled trial. British Journal of Psychiatry, 173, 218225.
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. (1996). Structured clinical interview for the DSM-IV axis I disorders. Washington, DC, USA: American Psychiatric Publishing Inc.
Gasteiger, C., Sherriff, R., Fraser, A., Shedden-Mora, M. C., Petrie, K. J., & Serlachius, A. S. (2018). Predicting patient reassurance after colonoscopy: The role of illness beliefs. Journal of Psychosomatic Research, 114, 5866.
Hedman, E., Andersson, G., Andersson, E., Ljotsson, B., Ruck, C., Asmundson, G. J., & Lindefors, N. (2011). Internet-based cognitive-behavioural therapy for severe health anxiety: Randomised controlled trial. British Journal of Psychiatry, 198, 230236.
Hedman, E., Axelsson, E., Andersson, E., Lekander, M., & Ljótsson, B. (2016). Exposure-based cognitive-behavioural therapy via the internet and as bibliotherapy for somatic symptom disorder and illness anxiety disorder: Randomised controlled trial. British Journal of Psychiatry, 209, 407413.
Hedman, E., Axelsson, E., Görling, A., Ritzman, C., Ronnheden, M., El Alaoui, S., Andersson, E., … Ljótsson, B. (2014). Internet-delivered cognitive-behavioural therapy and behavioural stress management for severe health anxiety: Randomised controlled trial. British Journal of Psychiatry, 205, 307314.
Hedman, E., Lekander, M., Ljótsson, B., Lindefors, N., Rück, C., Andersson, G., & Andersson, E. (2015). Optimal cut-off points on the Health Anxiety Inventory, Illness Attitude Scales and Whiteley Index to identify severe health anxiety. PLoS One, 10, e0123412.
Kanwar, A., Malik, S., Prokop, L. J., Sim, L. A., Feldstein, D., & Wang, Z. (2010). The association between anxiety disorders and suicidal behaviour: A systematic review. Depression and Anxiety, 30, 917929.
Mathes, B. M., Norr, A. M., Allan, N. P., Albanese, B. J., & Schmidt, N. B. (2018). Cyberchondria: Overlap with health anxiety and unique relations with impairment, quality of life, and service utilization. Psychiatry Research, 261, 204211.
McManus, F., Surawy, C., Muse, K., Vazquez-Montes, M., & Williams, J. M. (2012). A randomized trial of mindfulness-based cognitive therapy versus unrestricted services for health anxiety (hypochondriasis). Journal of Consulting and Clinical Psychology, 80, 817828.
Morriss, R., Patel, S., Malins, S., Guo, B., Higton, F., James, M., Wu, M., … Tyrer, H. (2019). Clinical and economic outcomes of remotely delivered cognitive behaviour therapy versus treatment as usual for repeat unscheduled care users with severe health anxiety: A multi-centre randomised controlled trial. BMC Medicine, 17, 16.
Salkovskis, P. M., Rimes, K. A., Warwick, H. M. C., & Clark, D. M. (2002). The Health Anxiety Inventory: Development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine, 32, 843853.
Scarella, T. M., Laferton, J. A., Ahern, D. K., Fallon, B. A., & Barsky, A. (2016). The relationship of hypochondriasis to anxiety, depressive and somatoform disorders. Psychosomatics, 57, 200207.
Seivewright, H., Green, J., Salkovskis, P., Barrett, B., Nur, U., & Tyrer, P. (2008). Randomised controlled trial of cognitive behaviour therapy in the treatment of health anxiety in a genitourinary medicine clinic. British Journal of Psychiatry, 192, 332337.
Sørensen, P., Birket-Smith, M., Wattar, U., Buemann, I., & Salkovskis, P. A. (2011). Randomized clinical trial of cognitive behavioural therapy versus short-term psychodynamic psychotherapy versus no intervention for patients with hypochondriasis. Psychological Medicine, 41, 431441.
Stein, D. J., Kogan, C. S., Atmaca, M., Fineberg, N. A., Fontenelle, L. E., Grant, J. E., Matsunaga, H., … Reed, G. M. (2016). The classification of obsessive-compulsive and related disorders in the ICD-11. Journal of Affective Disorders, 190, 663674.
Te Poel, F., Baumgartner, S. E., Hartmann, T., & Tanis, M. (2016). The curious case of cyberchondria: A longitudinal study on the reciprocal relationship between health anxiety and online health information seeking. Journal of Anxiety Disorders, 43, 3240.
Tyrer, P., Cooper, S., Salkovskis, P., Tyrer, H., Crawford, M., Byford, S., Dupont, S., … Barrett, B. (2014). Clinical and cost-effectiveness of cognitive behaviour therapy for health anxiety in medical patients: Randomized controlled trial. Lancet (London, England), 383, 219225.
Tyrer, P., Cooper, S., Tyrer, H., Wang, D., & Bassett, P. (2019). Increase in the prevalence of health anxiety in medical clinics: Possible cyberchondria. International Journal of Social Psychiatry, 65, 566569.
Tyrer, P., Nur, U., Crawford, M., Karlsen, S., McLean, C., Rao, B., & Johnson, T. (2005). The Social Functioning Questionnaire: A rapid and robust measure of perceived functioning. International Journal of Social Psychiatry, 51, 265275.
Tyrer, P., Salkovskis, P., Tyrer, H., Wang, D., Crawford, M. J., Dupont, S., Cooper, S., … Barrett, B. (2017). Cognitive behaviour therapy for health anxiety in medical patients (CHAMP): Randomised controlled trial with outcomes to five years. Health Technology Assessment, 21, 50.
Tyrer, H., Tyrer, P., Lisseman-Stones, Y., McAllister, S., Cooper, S., Salkovskis, P., Crawford, M. J., … Wang, D. (2015). Therapist differences in a randomised trial of the outcome of cognitive behaviour therapy for health anxiety in medical patients. International Journal of Nursing Studies, 52, 686694.
Van Beek, M. H., Zuidersma, M., Lappenschaar, M., Pop, G., Roest, A. M., Van Balkom, A. J., Speckens, A. E., … Voshaar, R. C. (2016). Prognostic association of cardiac anxiety with new cardiac events and mortality following myocardial infarction. British Journal of Psychiatry, 209, 400406.
Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 57, 361370.


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Sustained benefit of cognitive behaviour therapy for health anxiety in medical patients (CHAMP) over 8 years: a randomised-controlled trial

  • P. Tyrer (a1), D. Wang (a2), M. Crawford (a1), S. Dupont (a3), S. Cooper (a1), S. Nourmand (a1), V. Lazarevic (a1), A. Philip (a4) and H. Tyrer (a1)...
  • Please note a correction has been issued for this article.


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