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Barsky AJ, Ahern DK. Cognitive Behavior Therapy for Hypochondriasis: A Randomized Controlled Trial. JAMA. 2004;291(12):1464–1470. doi:10.1001/jama.291.12.1464
Author Affiliations: Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
Context Hypochondriasis is a chronic, distressing, and disabling condition that
is prevalent in ambulatory medical practice. Until recently, no specific treatment
has been clearly demonstrated to be effective.
Objective To assess the efficacy of a cognitive behavior therapy (CBT) for hypochondriasis.
Design A randomized, usual care control group design, conducted between September
1997 and November 2001. The individual primary care physician was the unit
of randomization, and all patients clustered within each physician's practice
were assigned to the experimental treatment (individual CBT and a consultation
letter to the primary care physician) or to the control condition. Subjects
were assessed immediately before and 6 and 12 months after the completion
Setting and Participants Participants were 80 patients from primary care practices and 107 volunteers
responding to public announcements, all of whom exceeded a predetermined cutoff
score on a hypochondriasis self-report questionnaire on 2 successive occasions.
Intervention A scripted, 6-session, individual CBT intervention was compared with
medical care as usual. The CBT was accompanied by a consultation letter sent
to the patient's primary care physician.
Main Outcome Measures Hypochondriacal beliefs, fears, attitudes, and somatic symptoms; role
function and impairment.
Results A total of 102 individuals were assigned to CBT and 85 were assigned
to medical care as usual. The sociodemographic and clinical characteristics
of the 2 groups were similar at baseline. 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). At 12-month follow-up,
CBT patients had significantly lower levels of hypochondriacal symptoms, beliefs,
and attitudes (P<.001) and health-related anxiety
(P = .009). They also had significantly less impairment
of social role functioning (P = .05) and intermediate
activities of daily living (P<.001). Hypochondriacal
somatic symptoms were not improved significantly by treatment.
Conclusion This brief, individual CBT intervention, developed specifically to alter
hypochondriacal thinking and restructure hypochondriacal beliefs, appears
to have significant beneficial long-term effects on the symptoms of hypochondriasis.
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