Internet-delivered Acceptance and Commitment Therapy for Patients With Health Anxiety: a Randomized Controlled Trial

Brief Summary

Detailed Description

Severe health anxiety (illness anxiety disorder) or hypochondriasis, according to the psychiatric classification system ICD-10, is characterized by preoccupation with fear of having a serious illness, which interferes with daily functions and persists despite medical reassurance. Clinical significant health anxiety is prevalent in primary care with 0.8-9.5%, and has a lifetime prevalence of 5.7% in the general population. It is a disabling disorder, associated with extensive use of health care services and occupational disability. Earlier, health anxiety has been considered a chronic disease with poor treatment outcomes. A recent review found effect of both medicine and psychotherapy, but patients may prefer psychotherapeutic treatments. Despite the high prevalence, health anxiety is rarely diagnosed within primary care, and there is limited access to evidence-based treatment for health anxiety. An easily accessible, evidence-based treatment is needed for this debilitating condition. Internet-based treatment is a new approach where patients receive access to a guided self-help program. A meta-analysis has shown equal treatment effects of internet-based treatment compared to "face-to-face" treatment for depressive- and anxiety disorders. Internet-based cognitive behavioral therapy for health anxiety has shown to be cost-effective. ACT is a new effective generation of cognitive-behavioral therapy, with an emphasis on acceptance and value-based exposure that has shown good results for treating health anxiety in a group setting. Internet-based Cognitive behavioral therapy (CBT) for health anxiety has shown promising results but low treatment completion. This may be due to the comprehensive treatment modules and the text-based format. ACT is an experiential behavioral therapy, and aims to activate patients with exercises, videos, audio-files and less text material. Most persons with health anxiety have high health care expenditure. However, some patients with health anxiety avoid contact to the health care system, and may not receive proper treatment. Patient self-referral is a new approach that may facilitate access to treatment. Aim 1. To develop an internet-delivered treatment program for patients suffering from health anxiety based on ACT. 2. To test the feasibility and effectiveness of the treatment programme in a randomized, controlled trial, comparing treatment with an active control condition. Hypothesis Primary hypothesis Patients with health anxiety treated with iACT will at 6-month follow-up report a significant reduction in illness worry compared to the action control condition iFORUM. Secondary hypotheses Patients with health anxiety treated with iACT compared to the active control condition iFORUM will at 6-month follow-up report: 1. a reduction in physical symptoms and symptoms of anxiety and depression 2. increased health-related quality of life 3. more expedient illness perceptions and increased acceptance of symptoms Mediation analyses 4. changes in illness perception and acceptance mediate the effect of iACT

Primary Outcomes

Secondary Outcomes

• Health anxiety symptoms measured with the Short Health Anxiety Inventory (SHAI)(At baseline (i.e. at self-referral), and 3 and 9 months after randomisation)
• Quality of life measured with the visual analogue scale (VAS question) from Youth profile, National Institute of Public Health(At baseline (i.e. at self-referral), before randomisation (i.e. after clinical assessment and up to 6 weeks after baseline) and 1, 2, 3 and 9 months after randomisation)
• Somatisation measured with the Bodily Distress Syndrome Checklist (BDS Checklist)(At baseline (i.e. at self-referral))
• General health status and functioning measured with the Short Form 12 Health Survey (SF-12)(At baseline (i.e. at self-referral), before randomisation (i.e. after clinical assessment and up to 6 weeks after baseline), 3 and 9 months after randomisation)
• Diagnosed somatic illnesses measured with questions from the Danish study for Functional Disorders (DanFund)(At baseline (i.e. at self-referral))
• Demographic questions measured with questions from the Danish study for Functional Disorders (DanFund)(At baseline (i.e. at self-referral))
• Quality of life measured with the World Health Organisation Well-being Index-Five (WHO-5)(At baseline (i.e. at self-referral), before randomisation (i.e. after clinical assessment and up to 6 weeks after baseline) and 1, 2, 3 and 9 months after randomisation)
• Stress measured with questions from the survey Youth stress, Danish Health Authority(At baseline (i.e. at self-referral), before randomisation (i.e. after clinical assessment and up to 6 weeks after baseline) and 1, 2, 3 and 9 months after randomisation)
• Anxiety, depression, obsessive-compulsive and physical symptoms measured with subscales from the Symptom Checklist (SCL-92)(At baseline (i.e. at self-referral), and 3 and 9 months after randomisation)