Treatment Acceptability and Preference Among Primary Care Patients Experiencing Severe Health Anxiety: The Role of Internet-Delivered Cognitive Behaviour Therapy

Abstract

Severe health anxiety is characterized by persistent and excessive anxiety about one’s health and is prevalent in primary care settings. While cognitive behaviour therapy (CBT) is an established treatment for health anxiety, barriers to service access limit the number of individuals who receive this treatment. Internet-delivered cognitive behaviour therapy (ICBT) has the potential to improve patient access to treatment and has been shown to be an effective intervention for health anxiety. Nevertheless, because ICBT is a novel treatment, it remains unclear whether the service would be perceived by primary care patients as acceptable. The goal of the present study was to investigate how patients perceive ICBT relative to other interventions for health anxiety. Primary care patients (N = 116) who exhibited severe health anxiety completed a battery of online questionnaires and then were presented with in counterbalanced order, three treatment vignettes that each described a different treatment protocol for health anxiety (i.e., medication, CBT, ICBT). Perceptions of the treatments were assessed following the presentation of each vignette. Participants then ranked the three treatments based on the likelihood of agreeing to receive that intervention for health anxiety. The treatments were perceived as yielding similar reductions on symptoms of health anxiety and were similarly rated as marginally acceptable. Relative to medication and ICBT, CBT was perceived as the most credible treatment for health anxiety. The highest preference ranks were for CBT and medication. Lack of accountability and familiarity, lower therapeutic support, and limited availability in Canada were described as reasons why ICBT was ranked low in preference. Among participants who ranked ICBT as the preferred treatment (n = 23), convenience, acceptability, and anonymity were described as reasons that influenced preference ranking. Regression analyses indicated that lower computer anxiety, previous medication use, and lower ratings of negative cognitions about difficulty coping with an illness significantly predicted greater ICBT acceptability. Demographic and clinical variables had no significant predictive value. The findings suggest that ICBT is perceived by primary care patients as a potentially acceptable and effective treatment for health anxiety; however, face-to-face interventions appear to be the treatments of choice relative to ICBT. Keywords: Health Anxiety; Internet-Delivered Cognitive Behaviour Therapy; Treatment Acceptability; Treatment Preference