CBT is effective for treating patients with health anxiety, study showsBMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j4177 (Published 07 September 2017) Cite this as: BMJ 2017;358:j4177
All rapid responses
"Tension is who you think you should be. Relaxation is who you are." - Indo-Chinese Proverb
Thank you for highlighting the effectiveness of CBT in Health Anxiety. Greater awareness of simple and cost-effective interventions is required for all health care professionals as the condition of Health Anxiety is pretty common. Health Anxiety is very common not only in Primary Care but also in Secondary and even Tertiary Care. It appears to be presenting on a spectrum, like several other psychosomatic conditions, from simple concern about having a medical condition to a severe form of Hypochondriasis which may turn morbid. Tyrer et al 2014 elegantly demonstrated the sustained effectiveness of CBT in Health Anxiety and so its need for wider application in medical practice.
Unfortunately, in the modern ‘instant gratification’ society the patient and the practitioner parry patience for the pill. Besides therapeutic-effectiveness and cost-effectiveness, time-effectiveness is also equally, if not more, important in present day medicine. CBT does require some investment of time both on the part of the patient and the practitioner.
Health Anxiety is related to unreasonable fear. Biologically the stress response is in operation. So, activating the relaxation response, by whatever means can counter the state anxiety. The trait anxiety is the harder part to crack where habit patterns are conditioned into the soma and the psyche. CBT is an established intervention with sustained benefits in several habit disorders. The intervention requires some training and support by a trained therapist who is usually a psychologist or a psychiatrist. In some societies, as my own, this has the burden of stigma.
In recent times Yoga has become a popular lifestyle and fitness activity. Yoga has both physical and psychological aspects. Yoga has been demonstrated in several studies to have inhibitory effects on the stress response and which are sustained over time. Clinically I have used components of Yoga including simple forms of asana or postural exercises, pranayama or breathing exercises and dhyana or meditation in mostly mild to moderate Health Anxiety and a few severe and chronic Hypochondriasis. Mild and moderate conditions have shown good response with as little as a single session with good long term benefits. But even here the initial investment of time is inevitable as it involves skills teaching. As Yoga is a popular lifestyle and fitness activity, patients are willing to invest their time and energy in a daily practice. Besides there is no stigma in learning and doing Yoga. In fact it is fashionable to say that you are going for yoga sessions than therapy sessions with a shrink! It is something that Primary Care and non-psychologists/-psychiatrists can easily learn and practice for their own benefit and for their patients'. Certainly worth an RCT?
“Undisturbed calmness of mind is attained by cultivating friendliness toward the happy, compassion for the unhappy, delight in the virtuous, and indifference toward the wicked.” - The Yoga Sutras of Patanjali
1. Tyrer, P., Cooper, S., Salkovskis, P., Tyrer, H., Crawford, M., Byford, S., ... & Murphy, D. (2014). Clinical and cost-effectiveness of cognitive behaviour therapy for health anxiety in medical patients: a multicentre randomised controlled trial. The Lancet, 383(9913), 219-225.
2. Singh, A. N. (2006, April). Role of yoga therapies in psychosomatic disorders. In International congress series (Vol. 1287, pp. 91-96). Elsevier.
Competing interests: No competing interests