Examining Change in Health Anxiety Symptoms Resulting From Transdiagnostic, Internet-Delivered Cognitive Behaviour Theapy: The Impact of Therapist Support

Abstract

Internet-delivered Cognitive Behaviour Therapy (ICBT) is a relatively new method to improve access to psychological services and is based on the principles of cognitive behaviour therapy (CBT), a well-established and efficacious treatment option for various mental health concerns. The presence of therapist support is regarded as an important element in ICBT, yet less is known about how much therapist contact is needed; namely, whether optional therapist contact is as effective as weekly communication with a therapist. ICBT programs have historically been disorder-specific in nature, wherein specific information relevant to one disorder is presented; disorder-specific ICBT is efficacious in the treatment of generalized anxiety, panic, social phobia, depression, and health anxiety. Alternatively, transdiagnostic ICBT does not target one specific disorder, rather broad areas observable across different mental health disorders, which results in administering the same treatment protocol to individuals regardless of their primary diagnosis. Transdiagnostic ICBT has effectively reduced symptoms of depression, generalized anxiety, social phobia, and panic. The current study examined whether transdiagnostic ICBT can effectively reduce symptoms of health anxiety, characterized by excessive worry about one’s health and fear that one will acquire an illness, often resulting in frequent medical consultations at a significant economic cost. Further, the impact of level of therapist support (therapist-initiated vs. client-initiated) was investigated. Ninety-six clients participating in the Wellbeing Course, an 8-week transdiagnostic ICBT program, with elevated health anxiety symptomatology (≥15 on the Short Health Anxiety Inventory [SHAI]) were randomly assigned to a therapist-initiated (n = 52; consistent, weekly messages from therapist) or client-initiated (n = 44; message received from therapist only when client initiates communication) contact condition. Health anxiety symptoms decreased significantly from pre-treatment to post-treatment (χ2 = 25.05, p < 0.001), lending support to the efficacy of transdiagnostic ICBT in the treatment of health anxiety. Pertinently, the level of therapist support (therapist-initiated vs. client-initiated) did not appear to impact symptom reduction. Client-initiated contact requires less therapist time, which allows for higher levels of efficiency, as support is provided on an as-needed level. The level of therapist support did not directly impact symptom reduction, yet consistent and weekly messages from a therapist did promote more favourable treatment engagement when compared to optional therapist communication (4.48 vs. 3.86 lessons completed; 4.21 vs. 1.77 messages sent) and was associated with higher treatment completion rates (76.9% vs. 54.5%). Future research is warranted to disentangle the role of therapist contact on symptom reduction and treatment engagement. The current study did not identify significant predictors of health anxiety reduction; future research should further investigate whether ICBT is better suited for certain individuals. The results from the current study lend support for the use of transdiagnostic ICBT in the treatment of health anxiety; thus improving individual wellbeing and lessening the burden placed on the healthcare system.