Hypochondriasis occurs in as many as 5 percent of medical outpatients, and can be a disabling and chronic condition. Hypochondriasis generally has not been responsive to psychological and pharmacological treatment and is costly for the health care system, according to background information in the article. Until recently, no specific treatment has been clearly demonstrated to be effective.
Arthur J. Barsky, M.D., and David K. Ahern, Ph.D., of Brigham and Women's Hospital and Harvard Medical School, Boston, examined whether cognitive behavior therapy (CBT) would alleviate the symptoms of hypochondriasis more effectively than medical care as usual.
The CBT consisted of six individually administered 90-minute sessions at weekly intervals. Each session was tightly scripted and devoted to 1 of 5 factors that cause patients to amplify symptoms and misattribute them to serious disease: attention and bodily hypervigilance, beliefs about symptom etiology, circumstances and context, illness and sick role behaviors, and mood. Each session consisted of educational information about the symptom amplifiers, an illustrative exercise, and a discussion to personalize the material presented. The CBT was accompanied by a consultation letter sent to the patient's primary care physician. Participants were recruited from primary care practices and from volunteers responding to public announcements.
The study, conducted between September 1997 and November 2001, included 102 individuals who were assigned to CBT and 85 who were assigned to medical care as usual. Participants were assessed immediately before and 6 and 12 months after the completion of treatment.
"Using an intent-to-treat analytic strategy, a consistent pattern of statistically and clinically significant treatment effects was found at both 6-and 12-month follow-up, adjusting for baseline covariates that included educational level, generalized psychiatric distress, and participant status (patient vs. volunteer)," the authors write. "At 12-month follow-up, CBT patients had significantly lower levels of hypochondriacal symptoms, beliefs, and attitudes and health-related anxiety. They also had significantly less impairment of social role functioning and intermediate activities of daily living."
(JAMA. 2004;291:1464-1470. Available post-embargo at JAMA.com)
Editor's Note: This investigation was supported by a research grant from the National Institute of Mental Health.