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Acceptance and commitment group therapy (ACT-G) for health anxiety: a randomized controlled trial

  • T. Eilenberg (a1), P. Fink (a1), J. S. Jensen (a1), W. Rief (a2) and L. Frostholm (a1)...



Severe health anxiety is frequent and costly, yet rarely diagnosed or treated. Earlier treatment studies show problems with recruitment, dropout and recovery. In the current study, the authors aimed to test the effect of acceptance and commitment group therapy (ACT-G) compared to waitlist in patients with severe health anxiety.


During March 2010 to April 2012, 126 consecutively referred patients meeting research criteria for severe health anxiety were block-randomized (1:1) to ACT-G or a 10 months’ waitlist (, no. NCT01158430). Patients allocated to ACT-G were treated in seven groups of nine patients between December 2010 and October 2012 and received nine weekly 3-h group sessions and a booster session consisting of ACT techniques. The primary outcome was decided a priori as the mean change in self-reported illness worry on the Whiteley-7 Index (WI) from baseline to 10 months’ follow-up. Secondary outcomes were improvement in emotional distress and health-related quality of life at 10 months’ follow-up.


Intention-to-treat analysis showed a statistically significant mean difference of 20.5 points [95% confidence interval (CI) 11.7–29·4, p < 0.001] on the WI between the groups at 10 months, and the between-group effect sizes were large (Cohen's d = 0.89, 95% CI 0.50–1.29). The number needed to treat was 2.4 (95% CI 1.4–3.4, p < 0.001). Diagnosis and treatment were well accepted by the patients.


ACT-G seems feasible, acceptable and effective in treating severe health anxiety.


Corresponding author

* Address for correspondence: T. Eilenberg, Ph.D., The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark. (Email:


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Arch, JJ, Eifert, GH, Davies, C, Vilardaga, JC, Rose, RD, Craske, MG (2012). Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders. Journal of Consuling and Clinical Psychology 80, 750765.
Barsky, AJ, Ahern, DK (2004). Cognitive behavior therapy for hypochondriasis: a randomized controlled trial. Journal of the American Medical Association 291, 14641470.
Barsky, AJ, Wyshak, G, Klerman, LG (1990 a). Transient hypochondriasis. Archives of General Psychiatry 47, 746752.
Barsky, AJ, Wyshak, G, Klerman, LG, Latham, KS (1990 b). The prevalence of hypochondriasis in medical outpatients. Social Psychiatry and Psychiatric Epidemiology 25, 8994.
Bjørner, JB, Damsgaard, MT, Watt, T, Bech, P, Rasmussen, NK, Kristensen, TS, Modvig, J, Thunedborg, K (2003). Dansk manual til SF-36 - et spørgeskema om helbredsstatus. LIF Lægemiddelindustriforeningen, København.
Derogatis, LR (2007). Dokument for den danske udgave af SCL-90-R. In SCL-90-R: Symptom checklist-90-R. Vejledning til administration og scoring, Psykologisk Forlag.
Derogatis, LR, Cleary, PA (1977). Confirmation of the dimensional structure of the SCL-90: a study in construct validation. Journal of Clinical Psychology 33, 981989.
Eilenberg, T, Kronstrand, L, Fink, P, Frostholm, L (2013). Acceptance and commitment group therapy for health anxiety - Results from a pilot study. Journal of Anxiety Disorders 27, 461468.
Fink, P, Ewald, H, Jensen, J, Sorensen, L, Engberg, M, Holm, M, Munk-Jørgensen, P (1999). Screening for somatization and hypochondriasis in primary care and neurological in-patients: a seven-item scale for hypochondriasis and somatization. Journal of Psychosomatic Research 46, 261273.
Fink, P, Ørnbøl, E, Christensen, KS (2010). The outcome of health anxiety in primary care. A two-year follow-up study on health care costs and self-rated health. PLoS ONE 5, e9873.
Fink, P, Ørnbøl, E, Huyse, FJ, de Jonge, P, Lobo, A, Herzog, T, Slaets, JPJ, Cardoso, G, Arolt, V, Rigatelli, M, Hansen, MS (2004 a). A brief diagnostic screening instrument for mental disturbances in general medical wards. Journal of Psychosomatic Research 57, 1724.
Fink, P, Ørnbøl, E, Toft, T, Sparle, KC, Frostholm, L, Olesen, F (2004 b). A new, empirically established hypochondriasis diagnosis. American Journal of Psychiatry 161, 16801691.
Furukawa, TA, Noma, H, Caldwell, DM, Honyashiki, M, Shinohara, K, Imai, H, Chen, P, Hunot, V, Churchill, R (2014). Waiting list may be a nocebo condition in psychotherapy trials: a contribution from network meta-analysis. Acta Psychiatry Scandinavia 130, 181192.
Greeven, A, van Balkom, AJ, Spinhoven, P (2014). Personality predicts time to remission and clinical status in hypochondriasis during a 6-year follow-up. Journal of Nervous and Mental Disease 202, 402407.
Greeven, A, van Balkom, AJ, Visser, S, Merkelbach, JW, van Rood, YR, Van Dyck, R, van der Does, AJ, Zitman, FG, Spinhoven, P (2007). Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a randomized controlled trial. American Journal of Psychiatry 164, 9199.
Gureje, O, Ustun, TB, Simon, GE (1997). The syndrome of hypochondriasis: a cross-national study in primary care. Psychological Medicine 27, 10011010.
Hedman, E, Andersson, G, Andersson, E, Ljotsson, B, Ruck, C, Asmundson, GJ, Lindefors, N (2011). Internet-based cognitive-behavioural therapy for severe health anxiety: randomised controlled trial. British Journal of Psychiatry 198, 230236.
Hofmann, SG, Asmundson, GJ (2008). Acceptance and mindfulness-based therapy: new wave or old hat? Clinical Psychology Review 28, 116.
Jacobson, NS, Truax, P (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology 59, 1219.
Kellner, R, Schneider-Braus, K (1988). Distress and attitudes in patients perceived as hypochondriacal by medical staff. General.Hospital.Psychiatry 10, 157162.
McManus, F, Surawy, C, Muse, K, Vazquez-Montes, M, Williams, JM (2012). A randomized clinical trial of mindfulness-based cognitive therapy versus unrestricted services for health anxiety (Hypochondriasis). Journal of Consulting and Clinical Psychology 80, 817828.
Norman, GR, Sloan, JA, Wyrwich, KW (2003). Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Medical Care 41, 582592.
Olatunji, BO, Kauffman, BY, Meltzer, S, Davis, ML, Smits, JA, Powers, MB (2014). Cognitive-behavioral therapy for hypochondriasis/health anxiety: a meta-analysis of treatment outcome and moderators. Behavior.Research and.Therapy 58, 6574.
Olde Hartman, TC, Borghuis, MS, Lucassen, PL, van de Laar, FA, Speckens, AE, van, WC (2009). Medically unexplained symptoms, somatisation disorder and hypochondriasis: course and prognosis. A systematic review. Journal of Psychosomatic Research 66, 363377.
Perera, R, Heneghan, C, Yudkin, P (2007). Graphical method for depicting randomised trials of complex interventions. British Medical Journal 334, 127129.
Rosendal, M, Bro, F, Sokolowski, I, Fink, P, Toft, T, Olesen, F (2005). A randomised controlled trial of brief training in assessment and treatment of somatisation: effects on GPs’ attitudes. Family Practice 22, 419427.
Schroder, A, Fink, P, Fjorback, LO, Frostholm, L, Rosendal, M (2010). Towards a unified treatment approach for functional somatic syndromes and somatization. Ugeskr.laeger 172, 18391842.
Swain, J, Hancock, K, Hainsworth, C, Bowman, J (2013). Acceptance and Commitment Therapy in the treatment of anxiety: A systematic review. Clinical Psychology Review 33, 965978.
Thomson, AB, Page, LA (2007). Psychotherapies for hypochondriasis. Cochrane. Database of Systematic Reviews 4, CD006520.
Tyrer, P, Cooper, S, Salkovskis, P, Tyrer, H, Crawford, M, Byford, S, Dupont, S, Finnis, S, Green, J, McLaren, E, Murphy, D, Reid, S, Smith, G, Wang, D, Warwick, H, Petkova, H, Barrett, B (2014). Clinical and cost-effectiveness of cognitive behaviour therapy for health anxiety in medical patients: a multicentre randomised controlled trial. Lancet 383, 219225.
Ware, JE, Kosinski, M (2001). SF-36 Physical and Mental Health Summary Scales: A Manual for Users of Version 1, 2nd edn. Quality Metric Inc.: Lincoln, RI.
Weck, F, Neng, JM, Richtberg, S, Jakob, M, Stangier, U (2015). Cognitive therapy versus exposure therapy for hypochondriasis (Health Anxiety): a randomized controlled trial. Journal of Anxiety Disorders 34, 17.
Wetherell, JL, Afari, N, Rutledge, T, Sorrell, JT, Stoddard, JA, Petkus, AJ, Solomon, BC, Lehman, DH, Liu, L, Lang, AJ, Atkinson, JH (2011). A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain. Pain 152, 20982107.
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Psychological Medicine
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