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A Randomized Controlled Trial

Arthur J. Barsky, MD; David K. Ahern, PhD

JAMA. 2004;291:1464-1470.

Context  Hypochondriasis is a chronic, distressing, and disabling condition that is prevalent in ambulatory medical practice. Until recently, no specific treatment has been clearly demonstrated to be effective.

Objective  To assess the efficacy of a cognitive behavior therapy (CBT) for hypochondriasis.

Design  A randomized, usual care control group design, conducted between September 1997 and November 2001. The individual primary care physician was the unit of randomization, and all patients clustered within each physician's practice were assigned to the experimental treatment (individual CBT and a consultation letter to the primary care physician) or to the control condition. Subjects were assessed immediately before and 6 and 12 months after the completion of treatment.

Setting and Participants  Participants were 80 patients from primary care practices and 107 volunteers responding to public announcements, all of whom exceeded a predetermined cutoff score on a hypochondriasis self-report questionnaire on 2 successive occasions.

Intervention  A scripted, 6-session, individual CBT intervention was compared with medical care as usual. The CBT was accompanied by a consultation letter sent to the patient's primary care physician.

Main Outcome Measures  Hypochondriacal beliefs, fears, attitudes, and somatic symptoms; role function and impairment.

Results  A total of 102 individuals were assigned to CBT and 85 were assigned to medical care as usual. The sociodemographic and clinical characteristics of the 2 groups were similar at baseline. Using an intent-to-treat analytic strategy, a consistent pattern of statistically and clinically significant treatment effects was found at both 6- and 12-month follow-up, adjusting for baseline covariates that included educational level, generalized psychiatric distress, and participant status (patient vs volunteer). At 12-month follow-up, CBT patients had significantly lower levels of hypochondriacal symptoms, beliefs, and attitudes (P<.001) and health-related anxiety (P = .009). They also had significantly less impairment of social role functioning (P = .05) and intermediate activities of daily living (P<.001). Hypochondriacal somatic symptoms were not improved significantly by treatment.

Conclusion  This brief, individual CBT intervention, developed specifically to alter hypochondriacal thinking and restructure hypochondriacal beliefs, appears to have significant beneficial long-term effects on the symptoms of hypochondriasis.

Author Affiliations: Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.

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