Psychological Interventions for Health Anxiety and Somatic Symptoms
A Systematic Review and Meta-Analysis
Abstract
Abstract. This study examined the effectiveness of psychological interventions for severe health anxiety (SHA) regarding somatic symptoms (SS) and health anxiety (HA). The databases Web of Science, EBSCO, and CENTRAL were searched on May 15, 2019, May 16, 2019, and August 5, 2019, respectively. Eighteen randomized controlled trials (N = 2,050) met the inclusion criteria (i.e., hypochondriasis, illness anxiety disorder or somatic symptom disorder with elevated HA being assessed with validated interviews; use of standardized outcome measures). Two reviewers independently evaluated the studies’ risk of bias using the Revised Cochrane Risk-of-Bias Tool for randomized trials (RoB-2) tool. Overall, psychological interventions were significantly more effective than waitlist, treatment-as-usual, or placebo post-treatment (gSS = 0.70, gHA = 1.11) and at follow-up (gSS = 0.33, gHA = 0.70). CBT outperformed other psychological interventions or pharmacotherapy for HA post-treatment (Hedge’s gHA = 0.81). The number of sessions did not significantly predict the effect sizes. In sum, psychological interventions were effective for SHA, but the generalizability of the results for SS is limited, because only two high-quality trials contributed to the comparisons.
References
2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: American Psychiatric Association.
. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.
. (2019).
(The concept of health anxiety . In E. Hedman-LagerlöfEd., The clinician’s guide to treating health anxiety (pp. 1–18). London, UK: Academic Press. https://doi.org/10.1016/B978-0-12-811806-1.00001-92004). Cognitive behavior therapy for hypochondriasis: A randomized controlled trial. The Journal of the American Medical Association, 291, 1464–1470. https://doi.org/10.1001/jama.291.12.1464
(1995). Accurate awareness of heartbeat in hypochondriacal and non-hypochondriacal patients. Journal of Psychosomatic Research, 39, 489–497. https://doi.org/10.1016/0022-3999(94)00166-3
(1993). Hypochondriacal patients’ beliefs about good health. American Journal of Psychiatry, 150, 1085–1089. https://doi.org/10.1176/ajp.150.7.1085
(2007). Hypochondriasis and health anxiety in the German population. British Journal of Health Psychology, 12, 511–523. https://doi.org/10.1348/135910706X146034
(Borenstein, M. (Ed.). (2009). Introduction to meta-analysis. Chichester, UK: Wiley.
Cadima (Version 2.1.1). (2019). Retrieved from https://www.cadima.info/index.php
1998). Two psychological treatments for hypochondriasis: A randomised controlled trial. The British Journal of Psychiatry, 173, 218–225. https://doi.org/10.1192/bjp.173.3.218
(1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum. https://doi.org/10.4324/9780203771587
(2013). Inducing symptoms in high symptom reporters via emotional pictures: The interactive effects of valence and arousal. Journal of Psychosomatic Research, 74, 191–196. https://doi.org/10.1016/j.jpsychores.2012.12.015
(2017). Cognitive behaviour therapy for health anxiety: A systematic review and meta-analysis. Behavioural and Cognitive Psychotherapy, 45, 110–123. https://doi.org/10.1017/S1352465816000527
(2009). What is meta-analysis? Retrieved from http://www.bandolier.org.uk/painres/download/whatis/Meta-An.pdf
(2000). Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56, 455–463. https://doi.org/10.1111/j.0006-341X.2000.00455.x
(1997). Bias in meta-analysis detected by a simple, graphical test. British Medical Journal, 315, 629–634. https://doi.org/10.1136/bmj.315.7109.629
(2016). Acceptance and commitment group therapy (ACT-G) for health anxiety: A randomized controlled trial. Psychological Medicine, 46, 103–115. https://doi.org/10.1017/S0033291715001579
(2017). Intervening variables in group-based acceptance & commitment therapy for severe health anxiety. Behaviour Research and Therapy, 92, 24–31. https://doi.org/10.1016/j.brat.2017.01.009
(2000). Explanatory therapy in hypochondriasis. Journal of Clinical Psychiatry, 61, 317–322. https://doi.org/10.4088/JCP.v61n0414
(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. https://doi.org/10.1371/journal.pone.0009873
(2004). A new, empirically established hypochondriasis diagnosis. American Journal of Psychiatry, 161, 1680–1691. https://doi.org/10.1176/appi.ajp.161.9.1680
(1996). Structured clinical interview for the DSM-IV Axis I Disorders. Washington, DC: American Psychiatric Press.
(2000). SCL-90-R, Symptom Checkliste von L. R. Derogatis – Deutsche Version
([SCL-90-R, symptom checklist by L. R. Derogatis – German version] (2nd ed.). Göttingen, Germany: Beltz Test GmbH.2009). Hypochondriasis Y-BOCS: A study of the psychometric properties of a clinician-administered semi-structured interview to assess hypochondriacal thoughts and behaviours. Clinical Psychology & Psychotherapy, 16, 431–443. https://doi.org/10.1002/cpp.634
(2007). Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: A randomized controlled trial. American Journal of Psychiatry, 164, 91–99. https://doi.org/10.1176/ajp.2007.164.1.91
(2018). Optimierung von Expositionstherapie bei pathologischen Krankheitsängsten: Theoretische Grundlagen und praktische Implikationen
([Optimization of exposure therapy for pathological health anxiety: Theoretical principles and practical implications] . Psychotherapeut, 63, 188–193. https://doi.org/10.1007/s00278-018-0285-11996). Hypochondriasis and symptom reporting – The effect of attention versus distraction. Psychotherapy and Psychosomatics, 65, 43–48. https://doi.org/10.1159/000289030
(2016). Exposure-based cognitive–behavioural therapy via the Internet and as bibliotherapy for somatic symptom disorder and illness anxiety disorder: Randomised controlled trial. British Journal of Psychiatry, 209, 407–413. https://doi.org/10.1192/bjp.bp.116.181396
(Higgins, J.Green, S. (Eds.). (2011). Cochrane handbook for systematic reviews of interventions. (Version 5.1.0). Retrieved from https://www.handbook.cochrane.org
2019). Revised Cochrane risk-of-bias tool for randomized trials (RoB 2). Retrieved from https://sites.google.com/site/riskofbiastool/welcome/rob-2-0-tool/current-version-of-rob-2
(2006). Somatization in the population: From mild bodily misperceptions to disabling symptoms. Social Psychiatry and Psychiatric Epidemiology, 41, 704–712. https://doi.org/10.1007/s00127-006-0082-y
(1988). A rating scale of somatic symptoms. Psychiatric Medicine, 6, 49–63.
(2015). A diary-based modification of symptom attributions in pathological health anxiety: Effects on symptom report and cognitive biases. Journal of Consulting and Clinical Psychology, 83, 578–589. https://doi.org/10.1037/a0039056
(2011). Efficacy of short-term psychotherapy for multiple medically unexplained physical symptoms: A meta-analysis. Clinical Psychology Review, 31, 146–160. https://doi.org/10.1016/j.cpr.2010.09.001
(2002). The PHQ-15: Validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic Medicine, 64, 258–266. https://doi.org/10.1097/00006842-200203000-00008
(2016). A meta-analytic review of brief guided self-help education for chronic pain. European Journal of Pain, 20, 1551–1562. https://doi.org/10.1002/ejp.881
(2014). Estimation of the predictive power of the model in mixed-effects meta-regression: A simulation study. British Journal of Mathematical and Statistical Psychology, 67, 30–48. https://doi.org/10.1111/bmsp.12002
(2007). A one-session treatment for patients suffering from medically unexplained symptoms in primary care: A randomized clinical trial. Psychosomatics, 48, 294–303. https://doi.org/10.1176/appi.psy.48.4.294
(2012). A randomized clinical trial of mindfulness-based cognitive therapy versus unrestricted services for health anxiety (hypochondriasis). Journal of Consulting and Clinical Psychology, 80, 817–828. https://doi.org/10.1037/a0028782
(2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. British Medical Journal, 339, b2535. https://doi.org/10.1136/bmj.b2535
. (2008). Estimating effect sizes from pretest-posttest-control group designs. Organizational Research Methods, 11, 364–386. https://doi.org/10.1177/1094428106291059
(2019). Clinical and economic outcomes of remotely delivered cognitive behaviour therapy versus treatment as usual for repeat unscheduled care users with severe health anxiety: A multicentre randomised controlled trial. BMC Medicine, 17, 16. https://doi.org/10.1186/s12916-019-1253-5
(2017). DSM-5 illness anxiety disorder and somatic symptom disorder: Comorbidity, correlates, and overlap with DSM-IV hypochondriasis. Journal of Psychosomatic Research, 101, 31–37. https://doi.org/10.1016/j.jpsychores.2017.07.010
(2018). Internet-based cognitive behavioral therapy versus psychoeducation control for illness anxiety disorder and somatic symptom disorder: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 86, 89–98. https://doi.org/10.1037/ccp0000248
(2014). Cognitive-behavioral therapy for hypochondriasis/health anxiety: A meta-analysis of treatment outcome and moderators. Behaviour Research and Therapy, 58, 65–74. https://doi.org/10.1016/j.brat.2014.05.002
(2009). Medically unexplained symptoms, somatisation disorder and hypochondriasis: Course and prognosis. A systematic review. Journal of Psychosomatic Research, 66, 363–377. https://doi.org/10.1016/j.jpsychores.2008.09.018
(1994).
(Evaluating coding decisions . In H. CooperL. V. HedgesEds., The handbook of research synthesis (pp. 139–162). New York, NY: Russell Sage Foundation.1967). Dimensions of hypochondriasis. British Journal of Psychiatry, 113(494), 89–93. https://doi.org/10.1192/bjp.113.494.89
(2017). Patient characteristics and patient behavior as predictors of outcome in cognitive therapy and exposure therapy for hypochondriasis: Predictors of outcome for hypochondriasis. Journal of Clinical Psychology, 73, 612–625. https://doi.org/10.1002/jclp.22356
(2017). Core outcome domains for clinical trials on somatic symptom disorder, bodily distress disorder, and functional somatic syndromes: European network on somatic symptom disorders recommendations. Psychosomatic Medicine, 79, 1008–1015. https://doi.org/10.1097/PSY.0000000000000502
(2014). How to use the new DSM-5 somatic symptom disorder diagnosis in research and practice: A critical evaluation and a proposal for modifications. Annual Review of Clinical Psychology, 10, 339–367. https://doi.org/10.1146/annurev-clinpsy-032813-153745
(2007). A randomized controlled trial of brief training in the assessment and treatment of somatization in primary care: Effects on patient outcome. General Hospital Psychiatry, 29, 364–373. https://doi.org/10.1016/j.genhosppsych.2007.03.005
(2015). RStudio: Integrated development for R. Retrieved from http://www.rstudio.com/
. (2002). The Health Anxiety Inventory: Development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine, 32, 843–853. https://doi.org/10.1017/S0033291702005822
(2012). Brief psychodynamic interpersonal psychotherapy for patients with multisomatoform disorder: Randomised controlled trial. British Journal of Psychiatry, 200, 60–67. https://doi.org/10.1192/bjp.bp.111.093526
(2017). Emotionserleben und somatische Beschwerden: Der Effekt einer Induktion von Ärger und Traurigkeit auf den körperlichen Symptombericht
([Experience of emotions and somatic symptoms: The effects of inducing anger and sadness on somatic symptom reports] . Zeitschrift für Klinische Psychologie und Psychotherapie, 46, 147–156. https://doi.org/10.1026/1616-3443/a0004272013). Specific collaborative group intervention for patients with medically unexplained symptoms in general practice: A cluster randomized controlled trial. Psychotherapy and Psychosomatics, 82, 106–119. https://doi.org/10.1159/000343652
(2011). A randomized clinical trial of cognitive behavioural therapy versus short-term psychodynamic psychotherapy versus no intervention for patients with hypochondriasis. Psychological Medicine, 41, 431–441. https://doi.org/10.1017/S0033291710000292
(2007). Psychotherapies for hypochondriasis. Cochrane Database of Systematic Reviews, 4, CD006520. https://doi.org/10.1002/14651858.CD006520.pub2
(2018). Recent advances in the understanding and treatment of health anxiety. Current Psychiatry Reports, 20, 49. https://doi.org/10.1007/s11920-018-0912-0
(2019).
(Etiology and epidemiology of health anxiety . In E. Hedman-LagerlöfEd., The clinician’s guide to treating health anxiety (pp. 35–42). London, UK: Academic Press. https://doi.org/10.1016/B978-0-12-811806-1.00003-22014). Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults. Cochrane Database of Systematic Reviews, 11, CD011142. https://doi.org/10.1002/14651858.CD011142.pub2
(2013). Mindfulness-based cognitive therapy for patients with medically unexplained symptoms: A randomized controlled trial. Psychotherapy and Psychosomatics, 82, 299–310. https://doi.org/10.1159/000348588
(2010). Conducting Meta-Analyses in R with the metafor Package. Journal of Statistical Software, 36, 1–48. https://doi.org/10.18637/jss.v036.i03
(2001). The treatment of hypochondriasis: Exposure plus response prevention vs cognitive therapy. Behaviour Research and Therapy, 39, 423–442. https://doi.org/10.1016/S0005-7967(00)00022-X
(1996). A controlled trial of cognitive–behavioural treatment of hypochondriasis. The British Journal of Psychiatry, 169, 189–195. https://doi.org/10.1192/bjp.169.2.189
(2017). Cognitive therapy and exposure therapy for hypochondriasis (health anxiety): A 3-year naturalistic follow-up. Journal of Consulting and Clinical Psychology, 85, 1012–1017. https://doi.org/10.1037/ccp0000239
(2015). Cognitive therapy versus exposure therapy for hypochondriasis (health anxiety): A randomized controlled trial. Journal of Consulting and Clinical Psychology, 83, 665–676. https://doi.org/10.1037/ccp0000013
(2012). Dysfunctional beliefs about symptoms and illness in patients with hypochondriasis. Psychosomatics, 53, 148–154. https://doi.org/10.1016/j.psym.2011.11.007
(