Randomized Controlled Feasibility Trial of a Self-Help Book for Health Anxiety

Abstract

The purpose of this feasibility study was to determine the efficacy of a cognitive-behaviour therapy (CBT) self-help book for health anxiety titled, It’s Not All in Your Head (Asmundson & Taylor, 2005) relative to a wait-list control. It was hypothesized that using a CBT self-help book would be a more efficacious treatment than wait-list control. Health anxiety is marked by anxious preoccupation about having a physical disease, based on the catastrophic misinterpretation of innocuous bodily sensations. It is associated with unpleasant physiological, behavioural, cognitive, and affective symptoms. When elevated, health anxiety affects an individual‘s interpersonal relationships, especially with his or her doctor, and increases health utilization of primary care, diagnostic tests, and secondary care resources (Conradt, Cavanagh, Franklin, & Rief, 2006). Although once regarded as a chronic disorder resistant to treatment and often associated with a poor prognosis (Avia, Ruiz, Olivares, & Crespo, 1996; Barsky, Bailey, Fama, & Ahern), there are now several empirically-supported treatment options (Taylor, Asmundson, & Coons, 2005). In particular, CBT treatments that aim to identify maladaptive thoughts and behaviours and replace them with healthy and adaptive ones, have been proven effective, and are the treatment of choice for many (Furer, Walker, & Freeston, 2001). The development of CBT programs for treating elevated health anxiety has progressed to the point where widely accessible self-help options are available. In this trial, 14 volunteers experiencing health anxiety were recruited. Participants were randomly assigned to either an 8-week self-help book treatment (SHB; n = 10) during which they read the self-help book and received therapist guidance sessions or an 8-week wait-list control group (WLC; n = 4). Health anxiety, depression, and general health symptoms were assessed at pre-, mid-, and post-treatment. T tests were used for statistical analyses and intention-to-treat analyses were employed. Relative to WLC, SHB participants reported minor reductions in health anxiety symptoms after 3 weeks of treatment and significant reductions in health anxiety and depression symptoms post-treatment. Unfortunately, due to the small sample size and lack of statistical power, some analyses could not be performed. These findings provide preliminary support the trial hypothesis and can be used to inform a future, large-scale, randomized controlled trial. Participants had mostly positive feedback about the treatment, but reported difficulty completing treatment in 8 weeks and a poor therapeutic alliance. Procedural difficulties were encountered during the trial that limit the generalizability of the results. A clinically supported, CBT-based, self-help treatment for health anxiety will potentially improve the psychological and social lives of many individuals and reduce the financial and time expenditures of mental health care providers.