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Internet-based CBT for severe health anxiety

Published online by Cambridge University Press:  02 January 2018

Itoro I. Udo
Affiliation:
Lanchester Road Hospital, Tees, Esk, Wear Valleys NHS Foundation Trust, Email: itoroime.udo@tewv.nhs.uk
Jagannatha Reddy
Affiliation:
Lanchester Road Hospital, Tees, Esk, Wear Valleys NHS Foundation Trust, Email: itoroime.udo@tewv.nhs.uk
Mark Appleton
Affiliation:
Lanchester Road Hospital, Tees, Esk, Wear Valleys NHS Foundation Trust, Email: itoroime.udo@tewv.nhs.uk
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Abstract

Type
Columns
Copyright
Copyright © Royal College of Psychiatrists, 2011 

Having appraised the evidence regarding the article by Hedman et al, Reference Hedman, Andersson, Andersson, Ljótsson, Rück and Asmundson1 we write to comment as follows.

First, it is not possible, from the article, Reference Hedman, Andersson, Andersson, Ljótsson, Rück and Asmundson1 to tell whether the comparison group was similar to the experimental group, as no statistical tests were done.

Second, the treatment described by the authors as internet-based cognitive–behavioural therapy (CBT) involved components of mindfulness and may have been more appropriately described as internet-based modified CBT.

Third, given that defined psychological approaches, including CBT are accepted as treatment for health anxiety, Reference Warwick2Reference Looper and Kirmayer5 CBT delivered as usual may have been a more appropriate control treatment than the online discussion forum. An online discussion forum is not recognisable or recommended treatment for health anxiety.

Fourth, the description of participant recruitment is contradictory: ‘There were no advertisements in newspapers or in other media. However, an article about the study was published in a major nationwide newspaper’.

Fifth, we note that the power in per cent is not stated explicitly in the study such as to inform respective clinician’s appraisal of this study as regards applicability of results to various clinical settings.

In light of the above, there is a need for cautious interpretation of the evidence presented, which we feel has limited therapeutic value in the acute psychiatry settings, such as crisis resolution and home treatment teams and in-patient wards, in which we work. However, we value this paper as adding to the limited body of knowledge available about treatments for health anxiety and expanding the notion that this disorder is treatable.

References

1 Hedman, E, Andersson, G, Andersson, E, Ljótsson, B, Rück, C, Asmundson, GJG, et al. Internet-based cognitive–behavioural therapy for severe health anxiety: randomised controlled trial. Br J Psychiatry 2011; 198: 230–6.CrossRefGoogle ScholarPubMed
2 Warwick, HMC. Cognitive therapy in the treatment of hypochondriasis. Adv Psychiatr Treat 1998; 4: 285–91.CrossRefGoogle Scholar
3 Kroenke, K, Swindle, R. Cognitive-behavioral therapy for somatization and symptom syndromes a critical review of controlled clinical trials. Psychother Psychosom 2000; 69: 205–15.CrossRefGoogle ScholarPubMed
4 Visser, S, Bouman, TK. The treatment of hypochondriasis: exposure plus response prevention vs cognitive therapy. Behav Res Ther 2001; 39: 423–42.CrossRefGoogle ScholarPubMed
5 Looper, KJ, Kirmayer, LJ. Behavioral medicine approaches to somatoform disorders. J Consult Clin Psychol 2002; 70: 810–27.CrossRefGoogle ScholarPubMed
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