Review: psychotherapy may be beneficial for people with hypochondriasis.

Question: Is psychotherapy effective for people suffering from hypochondriasis? Outcomes: Hypochondrial cognition or behaviour rated by a validated hypochondriasis or health anxiety scale (Health Anxiety Inventory, Health Anxiety Questionnaire, Whitley Index, Somatic Symptom Index or Illness Attitudes Scale), or appropriate visual analogue scale. METHODS Design: Systematic review with meta-analysis. Data sources: MEDLINE, EMBASE, PsycINFO, AMED, CINAHL, CENTRAL, Cochrane Trials register, ISI Web of Knowledge and WorldCat Dissertations were searched in August 2007. Reference lists of retrieved articles were also searched to identify additional studies and experts in the field contacted to identify unpublished trials. Study selection and analysis: Randomised controlled trials (RCTs) comparing individual or group psychotherapy with placebo, waiting list, treatment as usual or no treatment in adults (aged 18DS75 years) diagnosed with hypochondriasis (ICD-10, DSM-IV or abridged criteria) were included. Psychotherapy interventions included cognitive behavioural therapy (CBT), interpersonal therapy, psychoeducation, brief psychodynamic therapy, counselling, hypnotherapy and relaxation training. Trials comparing different types of psychotherapy were also included. Exclusions: trials where hypochondriasis was not the primary diagnosis; participants with comorbid psychosis or body dysmorphic disorder; >30 psychotherapy sessions; trials of psychotherapy in combination with drug treatment. MAIN RESULTS Six RCTs assessed individual psychotherapy: three assessed CBT, one cognitive therapy and behavioural therapy, one cognitive therapy and behavioural stress management, and one explanatory therapy (patient education and reassurance). In four RCTs psychotherapy was compared to waiting list control, one to placebo tablets, and one to treatment as usual from a general practitioner. Number of participants in the trials ranged from 20 to 187, and total duration of therapy ranged from 4 to 19 hours. Assessment was immediately post treatment in all but one RCT, which assessed outcomes at 12 months. The primary behavioural outcome in two trials was the Whitley Index, one used the health anxiety subscale of the Illness Attitudes Scale, and three did not specify a primary outcome scale (two used visual analogue scales and one included the Illness Attitudes Scale in assessment). Other psychiatric symptoms, physical distress and functional disability were variably assessed by trials. Overall, psychotherapy improved hypochondriasis and other outcomes comparedto no treatment (see online table for a breakdown of results). CONCLUSIONS Psychotherapy reduces symptoms of hypochondriasis compared with control conditions (waiting lists, placebo, or treatment as usual) in the short term. However, the evidence was not sufficient to assess the magnitude of change and whether it results in clinically significant outcomes, or to compare different types of psychotherapy to each other. Long-term outcomes of psychotherapy have not been assessed. NOTES Trials were small, of variable quality, assessed variable outcomes, and only half used intention-to-treat analysis. Two studies were conducted in the UK, two in The Netherlands, one in Italy and one in the USA. ABSTRACTED FROM Thomson AB, Page LA. Psychotherapies for hypochondriasis. Cochrane Database Syst Rev 2007;4:CD006520.