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Exposure-based cognitive–behavioural therapy via the internet and as bibliotherapy for somatic symptom disorder and illness anxiety disorder: randomised controlled trial

  • Erik Hedman (a1), Erland Axelsson (a2), Erik Andersson (a2), Mats Lekander (a3) and Brjánn Ljótsson (a2)...
Abstract
Background

In DSM-5 two new diagnoses, somatic symptom disorder (SSD) and illness anxiety disorder (IAD), have replaced DSM-IV hypochondriasis. There are no previous treatment studies for these disorders. Cognitive–behavioural therapy (CBT) delivered as therapist-guided or unguided internet treatment or as unguided bibliotherapy could be used to increase treatment accessibility.

Aims

To investigate the effect of CBT delivered as guided internet treatment (ICBT), unguided internet treatment (U-ICBT) and as unguided bibliotherapy.

Method

A randomised controlled trial (RCT) where participants (n = 132) with a diagnosis of SSD or IAD were randomised to ICBT, U-ICBT, bibliotherapy or to a control condition on a waiting list (trial registration: Clinicaltrials.gov identifier NCT01966705).

Results

Compared with the control condition, all three treatment groups made large and significant improvements on the primary outcome Health Anxiety Inventory (between-group d at post-treatment was 0.80–1.27).

Conclusions

ICBT, U-ICBT and bibliotherapy can be highly effective in the treatment of SSD and IAD. This is the first study showing that these new DSM-5 disorders can be effectively treated.

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Copyright
Corresponding author
Erik Hedman, PhD, Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, SE-171 77 Stockholm, Sweden. Email: kire.hedman@ki.se
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder (5th edn) (DSM-5). APA, 2013.
2 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder (4th edn) (DSM-IV). APA, 1994.
3 Barsky, AJ, Fama, JM, Bailey, ED, Ahern, DK. A prospective 4- to 5-year study of DSM-III-R hypochondriasis. Arch Gen Psychiatry 1998; 55: 737–44.
4 Tyrer, P, Cooper, S, Crawford, M, Dupont, S, Green, J, Murphy, D, et al. Prevalence of health anxiety problems in medical clinics. J Psychosom Res 2011; 71: 392–4.
5 Sunderland, M, Newby, JM, Andrews, G. Health anxiety in Australia: prevalence, comorbidity, disability and service use. Br J Psychiatry 2013; 202: 5661.
6 Seivewright, H, Salkovskis, P, Green, J, Mullan, N, Behr, G, Carlin, E, et al. Prevalence and service implications of health anxiety in genitourinary medicine clinics. Int J STD AIDS 2004; 15: 519–22.
7 Hedman, E, Andersson, G, Andersson, E, Ljotsson, B, Ruck, C, Asmundson, GJG, et al. Internet-based cognitive–behavioural therapy for severe health anxiety: randomised controlled trial. Br J Psychiatry 2011; 198: 230–6.
8 Hedman, E, Axelsson, E, Gorling, A, Ritzman, C, Ronnheden, M, El Alaoui, S, et al. Internet-delivered exposure-based cognitive–behavioural therapy and behavioural stress management for severe health anxiety: randomised controlled trial. Br J Psychiatry 2014; 205: 307–14.
9 Rohde, P, Lewinsohn, PM, Seeley, JR. Comparability of telephone and face-to-face interviews in assessing Axis I and II disorders. Am J Psychiatry 1997; 154: 1593–8.
10 Axelsson, E, Andersson, E, Ljótsson, B, Wallhed Finn, D, Hedman, E. The Health Preoccupation Diagnostic Interview: inter-rater reliability of a structured interview for diagnostic assessment of DSM-5 somatic symptom disorder and illness anxiety disorder. Cogn Behav Ther 2016; 45: 259–69.
11 Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998; 59 (suppl 20): 2233.
12 Di Nardo, PA, O'Brien, GT, Barlow, DH, Waddell, MT, Blanchard, EB. Reliability of DSM-III anxiety disorder categories using a new structured interview. Arch Gen Psychiatry 1983; 40: 1070–4.
13 Salkovskis, PM, Rimes, KA, Warwick, HM, Clark, DM. The health anxiety inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychol Med 2002; 32: 843–53.
14 Hedman, E, Ljotsson, B, Andersson, E, Andersson, G, Lindefors, N, Ruck, C, et al Psychometric properties of internet-administered measures of health anxiety: an investigation of the Health Anxiety Inventory, the Illness Attitude Scales, and the Whiteley Index. J Anxiety Disord 2015; 31C: 32–7.
15 Speckens, AEM, Spinhoven, P, Sloekers, PP, Bolk, JH, van Hemert, AM. A validation study of the Whitely Index, the Illness Attitude Scales, and the Somatosensory Amplification Scale in general medical and general practice patients. J Psychosom Res 1996; 40: 95104.
16 Pilowsky, I. Dimensions of hypochondriasis. Br J Psychiatry 1967; 113: 8993.
17 Reiss, S, Peterson, RA, Gursky, DM, McNally, RJ. Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behav Res Ther 1986; 24: 18.
18 Beck, AT, Epstein, N, Brown, G, Steer, RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988; 56: 893–7.
19 Svanborg, P, Åsberg, M. A new self-rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale. Acta Psychiatr Scand 1994; 89: 21–8.
20 Sheehan, DV. The Anxiety Disease. Scribner, 1983.
21 Borkovec, TD, Nau, SD. Credibility of analogue therapy rationales. J Behav Ther Exp Psychiatry 1972; 3: 257–60.
22 Attkisson, CC, Zwick, R. The Client Satisfaction Questionnaire. Psychometric properties and correlations with service utilization and psychotherapy outcome. Eval Program Plann 1982; 5: 233–7.
23 Hedman, E, Ljótsson, B, Rück, C, Furmark, T, Carlbring, P, Lindefors, N, et al. Internet administration of self-report measures commonly used in research on social anxiety disorder: a psychometric evaluation. Comput Hum Behav 2010; 26: 736–40.
24 Furer, P, Walker, JR. Treatment of hypochondriasis with exposure. J Contemp Psychother 2005; 35: 251–67.
25 Furer, P, Walker, JR, Stein, MB. Treating Health Anxiety and Fear of Death: A Practitioner's Guide. Springer, 2007.
26 McManus, F, Surawy, C, Muse, K, Vazquez-Montes, M, Williams, JM. A randomized clinical trial of mindfulness-based cognitive therapy versus unrestricted services for health anxiety (hypochondriasis). J Consult Clin Psychol 2012; 80: 817–28.
27 Hedman, E, Ljótsson, B, Andersson, E, Rück, C, Andersson, G, Lindefors, N. Effectiveness and cost offset analysis of group CBT for hypochondriasis delivered in a psychiatric setting: an open trial. Cogn Behav Ther 2010; 39: 239–50.
28 Hedman, E, Andersson, E, Lindefors, N, Andersson, G, Ruck, C, Ljotsson, B. Cost-effectiveness and long-term effectiveness of internet-based cognitive behaviour therapy for severe health anxiety. Psychol Med 2013; 43: 363–74.
29 Gueorguieva, R, Krystal, JH. Move over ANOVA: Progress in analyzing repeated-measures data and its reflection in papers published in the archives of general psychiatry. Arch Gen Psychiatry 2004; 61: 310–7.
30 Muthén, B, Curran, PJ. General longitudinal modeling of individual differences in experimental designs: a latent variable framework for analysis and power estimation. Psychol Methods 1997; 2: 371402.
31 Verbeke, G, Molenberghs, G. Linear Mixed Models for Longitudinal Data. Springer; 2000.
32 Heck, RH, Thomas, SL, Tabata, LN. Multilevel and Longitudinal Modeling with IBM SPSS. Routledge, 2010.
33 Jacobson, NS, Truax, P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 1991; 59: 12–9.
34 Spek, V, Cuijpers, P, Nyklicek, I, Riper, H, Keyzer, J, Pop, V. Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med 2007; 37: 319–28.
35 Furmark, T, Carlbring, P, Hedman, E, Sonnenstein, A, Clevberger, P, Bohman, B, et al. Guided and unguided self-help for social anxiety disorder: randomised controlled trial. Br J Psychiatry 2009; 195: 440–7.
36 Berger, T, Hammerli, K, Gubser, N, Andersson, G, Caspar, F. Internet-based treatment of depression: a randomized controlled trial comparing guided with unguided self-help. Cogn Behav Ther 2011; 40: 251–66.
37 Rief, W, Martin, A. How to use the new DSM-5 somatic symptom disorder diagnosis in research and practice: A critical evaluation and a proposal for modifications. Ann Rev Clin Psychol 2014; 10: 339–67.
38 Mohr, DC, Spring, B, Freedland, KE, Beckner, V, Arean, P, Hollon, SD, et al. The selection and design of control conditions for randomized controlled trials of psychological interventions. Psyhother Psychosom 2009; 78: 275–84.
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Exposure-based cognitive–behavioural therapy via the internet and as bibliotherapy for somatic symptom disorder and illness anxiety disorder: randomised controlled trial

  • Erik Hedman (a1), Erland Axelsson (a2), Erik Andersson (a2), Mats Lekander (a3) and Brjánn Ljótsson (a2)...
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