Cognitive behavior therapy for health anxiety: systematic review and meta-analysis of clinical efficacy and health economic outcomes

ABSTRACT

Introduction: Health anxiety, also known as ‘hypochondriasis’, is a common, distressing and costly condition that responds to cognitive behavior therapy (CBT) but evidence pertaining to response and remission rates, treatment in routine care, therapist-guided Internet-delivered CBT (ICBT) and health economics has not been systematically reviewed.

Areas covered: In this systematic review and meta-analysis we searched PubMed, PsycINFO, and OATD (17/06/2019) for randomized controlled trials (RCTs) comparing CBT to non-CBT controls for health anxiety. Based on 19 RCTs, the pooled between-group effect on health anxiety was moderate to large (g = 0.79; 95% CI: 0.57–1.01; adjusted for publication bias: g = 0.62), with small to moderate effects on secondary symptoms and effects largely sustained 12–18 months after treatment. Moderators were control condition and recruitment path, but not treatment setting. The pooled CBT response rate was 66%, and the remission rate 48%. ICBT had effects comparable to face-to-face CBT. CBT for health anxiety is probably cost-effective, but with limited effect on the quality of life.

Expert opinion: CBT is a highly efficacious and probably cost-effective treatment for health anxiety. We recommend that ICBT is implemented more widely, and that health economic outcomes and ways of increasing response and remission rates are explored further.

KEYWORDS:

• Cognitive behavior therapy
• cost-effectiveness
• efficacy
• health anxiety
• hypochondriasis
• systematic review

Article highlights

• Cognitive behavior therapy (CBT) is an efficacious treatment for health anxiety.

• Evidence pertaining to responder and remission rates, effects in routine care, new CBT delivery formats, and health economic outcomes has not been systematically reviewed.

• About two-thirds of patients with health anxiety respond to CBT, and every other patient achieves remission.

• Between-group effects are smaller when CBT is compared with other active conditions such as other psychological treatments than when it is compared to waiting-list conditions.

• Therapist-guided Internet-delivered CBT appears to be an efficacious treatment format, and has been found to be superior to two active controls by independent research groups.

• CBT for health anxiety is probably a cost-effective treatment, but its effects on generic measures of health-related quality of life are small.

Declaration of interest

The authors have written books about CBT for health anxiety for which they have received royalties. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

A reviewer on this manuscript has disclosed that they were the senior author in one of the larger trials. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

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Additional information

Funding

This work was funded by Karolinska Institutet and Region Stockholm which are public institutions that did not take part in the design, conduct or publication of the study.