Hypochondriasis Responds To Brief CBT Treatment

People who think they are ill when they really aren’t may be the butt of jokes, but the truth is, hypochondriasis is a chronic, distressing, and disabling condition for which there has been no effective treatment. It is also a disorder that can lead to tensions between primary care physicians and patients and run up health care costs.

Thus, even a treatment that reaches only a limited number of hypochondriasis patients and helps them only modestly would be of value.

Such a treatment may have been found by Arthur Barsky, M.D., a professor of psychiatry at Harvard Medical School, and his Harvard colleague David Ahern, Ph.D. They reported their findings in the March 24/31 Journal of the American Medical Association.

Barsky and Ahern designed a brief, individual, cognitive-behavioral therapy to restructure hypochondriasis patients’ faulty beliefs and to help them deal with their symptoms. They tested the therapy on 187 persons who met DSM-IV criteria for hypochondriasis and whom they had recruited for their study through primary care practices and public announcements.

Of the 187 subjects, 102 were assigned to cognitive-behavioral therapy, and 85 were assigned to medical care as usual. The two groups were similar on sociodemographic and clinical characteristics. The clinical status of the two groups was then assessed at six months and again at one year, and results from each group were compared.

At the six-month follow-up, the cognitive-behavioral therapy group had made significantly greater progress than the control group with regard to improved hypochondriacal beliefs and attitudes. At the 12-month follow-up, the cognitive-behavioral therapy group had not only significantly lower levels of hypochondriacal beliefs and attitudes, but also significantly improved social functioning.

In contrast, the cognitive-behavioral therapy did not lessen subjects’ hypochondriacal somatic symptoms appreciably. This finding might seem surprising in view of the subjects’ improved attitudes and concerns, but it “was actually expected,” Barsky and Ahern said in their study report. “The treatment was intended to improve coping with symptoms rather than curing them outright.”

In other words, Barsky and Ahern explained, “Conceptually, hypochondriacal somatic symptoms cannot simply be stripped away with symptomatic treatment, because they exist for underlying psychological and interpersonal reasons. This suggests that a realistic goal in treating hypochondriasis is amelioration of distressing fears and beliefs and improved coping, rather than the elimination of somatic symptoms per se.”

Thus, “this brief, individual CBT intervention, developed specifically to alter hypochondriacal thinking and restructure hypochondriacal beliefs, appears to have beneficial long-term effects on the symptoms of hypochondriasis,” Barsky and Ahern concluded.

If the therapy included some booster sessions after the six basic sessions, it might be even more effective, they believe.

An abstract of the study, “Cognitive Behavior Therapy for Hypochondriasis—A Randomized Controlled Trial,” is posted online at www.jama.ama-assn.org/cgi/content/abstract/291/12/1464. ▪

JAMA 2004 291 1464