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Erik Hedman - One of the best experts on this subject based on the ideXlab platform.
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Health Anxiety in obsessive compulsive disorder and obsessive compulsive symptoms in severe Health Anxiety: An investigation of symptom profiles.
Journal of Anxiety Disorders, 2016Co-Authors: Erik Hedman, Erland Axelsson, Brjánn Ljótsson, Christian Rück, Gerhard Andersson, Erik AnderssonAbstract:Abstract Severe Health Anxiety (SHA) shares features with obsessive-compulsive disorder (OCD) and in recent years there has been a debate as to whether the two disorders may represent two facets of the same condition. Few studies have however investigated the overlap and differences in symptom profiles between the disorders. The primary aim of the present study was to investigate these aspects using one sample of participants with a principal diagnosis of SHA and one sample of participants with a principal OCD diagnosis. The second aim was to examine differences in improvement trajectories on measures of Health Anxiety and OCD symptoms in patients with SHA receiving treatment with exposure and response prevention. We compared persons participating in clinical trials with a principal diagnosis of SHA (N = 290) to persons with a principal diagnosis of OCD (n = 95) on measures of Health Anxiety, OCD symptoms, and depressive symptoms. A subsample of SHA participants (n = 99) received exposure and response prevention (ERP) for SHA over 12 weeks and was assessed at baseline and post-treatment. The results showed large and significant differences between SHA and OCD patients on measures of Health Anxiety (ds = 2.99–3.09) and OCD symptoms (ds = 1.64–2.14), while they had equivalent levels of depressive symptoms (d = 0.19, 95% CI [−0.04, 0.43]). In the SHA sample 7.6% had comorbid OCD, and in the OCD sample 9.5% had SHA. For participants with a principal diagnosis of SHA, ERP led to large reductions of Health Anxiety, but effects on OCD symptoms were small to moderate. Among participants with comorbid OCD, effect sizes were large on measures of Health Anxiety and moderate to large on OCD measures. We conclude that SHA and OCD are separate psychiatric disorders with limited overlap in symptom profiles.
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Is Health Anxiety related to disease avoidance
Brain Behavior and Immunity, 2015Co-Authors: John Axelsson, Mats Lekander, Bianka Karshikoff, Erik HedmanAbstract:Health Anxiety is characterized by a persistent and debilitating worry of somatic illness, as well as of avoidance behaviours. However, little is known of the cognitive mechanisms involved. We hypothesized that a higher degree of Health Anxiety would relate to an altered interpretation of other people’s Health status and that this would be driven by disgust and a fear for becoming sick. We recruited 225 participants with a varying degree of Health Anxiety (of which 132 were patients suffering from severe Health Anxiety). The participants rated facial photographs of other individuals with a varying degree of appeared sickness. A higher degree of Health Anxiety was related to perceiving other people as less Healthy, being more contagious, and that they had a higher risk of becoming infected if meeting these people (p’s .05), particularly if people looked more sick. Health Anxiety was also related to increased feelings of disgust and Anxiety of other people (p’s .05). Our data supports that disgust and cognitive biases of other peoples’ Health status are significant features of severe Health Anxiety. We propose that a heightened sensitivity to whether other people are contagious (pathogenic threats) or not, have been beneficial throughout evolution, allowing for “disease avoidance”, but that this can have debilitating effects in a society with many people and a high demand for social interactions.
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Optimal cut-off points on the Health Anxiety inventory, illness attitude scales and whiteley index to identify severe Health Anxiety.
PLOS ONE, 2015Co-Authors: Erik Hedman, Mats Lekander, Brjánn Ljótsson, Nils Lindefors, Christian Rück, Gerhard Andersson, Erik AnderssonAbstract:Background Health Anxiety can be viewed as a dimensional phenomenon where severe Health Anxiety in form of DSM-IV hypochondriasis represents a cut-off where the Health Anxiety becomes clinically significant. Three of the most reliable and used self-report measures of Health Anxiety are the Health Anxiety Inventory (HAI), the Illness Attitude Scales (IAS) and the Whiteley Index (WI). Identifying the optimal cut-offs for classification of presence of a diagnosis of severe Health Anxiety on these measures has several advantages in clinical and research settings. The aim of this study was therefore to investigate the HAI, IAS and WI as proximal diagnostic instruments for severe Health Anxiety defined as DSM-IV hypochondriasis. Methods We investigated sensitivity, specificity and predictive value on the HAI, IAS and WI using a total of 347 adult participants of whom 158 had a diagnosis of severe Health Anxiety, 97 had obsessive-compulsive disorder and 92 were Healthy non-clinical controls. Diagnostic assessments were conducted using the Anxiety Disorder Interview Schedule. Results Optimal cut-offs for identifying a diagnosis of severe Health Anxiety was 67 on the HAI, 47 on the IAS, and 5 on the WI. Sensitivity and specificity were high, ranging from 92.6 to 99.4%. Positive and negative predictive values ranged from 91.6 to 99.4% using unadjusted prevalence rates. Conclusions The HAI, IAS and WI have very good properties as diagnostic indicators of severe Health Anxiety and can be used as cost-efficient proximal estimates of the diagnosis.
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Psychometric properties of Internet-administered measures of Health Anxiety: an investigation of the Health Anxiety Inventory, the Illness Attitude Scales, and the Whiteley Index.
Journal of Anxiety Disorders, 2015Co-Authors: Erik Hedman, Erland Axelsson, Brjánn Ljótsson, Nils Lindefors, Christian Rück, Gerhard Andersson, Erik Andersson, Mats LekanderAbstract:Abstract Background The Health Anxiety Inventory (HAI), the Illness Attitude Scales (IAS), and the Whiteley Index (WI) are three of the most widely used Health Anxiety measures, but their psychometric properties have not been investigated when administered via the Internet. Methods We investigated the three instruments' test–retest reliability, internal consistency, convergent, and discriminant validity and sensitivity to change using one sample ( n = 111) of participants with severe Health Anxiety and one sample of Healthy controls ( n = 92). Results The HAI, IAS, and WI showed high test–retest reliability ( r s ≥ .80), good convergent, and discriminant validity and were sensitive to detect change. The HAI and IAS ( α s ≥ .85), but not the WI ( α s ≤ .60) demonstrated high internal consistency. Conclusions The HAI, IAS, and WI have good psychometric properties, except for the low internal consistency of WI, when used as Internet-administered measures of Health Anxiety. Using these measures over the Internet offers highly important advantages such as increased ease of administration, reduced attrition, and cost-efficient treatment evaluation.
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Mediators in Internet-Based Cognitive Behavior Therapy for Severe Health Anxiety
PLOS ONE, 2013Co-Authors: Erik Hedman, Mats Lekander, Nils Lindefors, Christian Rück, Gerhard Andersson, Erik Andersson, Brjánn LjótssonAbstract:According to the cognitive behavioral model of severe Health Anxiety (hypochondriasis) four central maintaining mechanisms are how the individual perceives the risk of disease and how negative its consequences would be, attention to bodily sensations, and intolerance of uncertainty. The aim of the present study was to investigate the mediating role of these putative mechanisms in Internet-delivered CBT for severe Health Anxiety. We analyzed data from an RCT where participants were randomized to Internet-delivered CBT (n=40) or to a control condition (n=41). Mediators and outcome, i.e. Health Anxiety, were assessed weekly throughout the treatment, enabling fulfillment of the criterion of temporal precedence of changes occurring in the mediator in relation to the outcome to be met. The results showed that reduced perceived risk of disease, less attention to bodily symptoms, and reduced intolerance of uncertainty significantly mediated improvement in Health Anxiety. The study supports the validity of the cognitive behavioral model of Health Anxiety. The findings have theoretical and clinical implications as they indicate processes that may be causally related to the improvements observed after CBT for Health Anxiety.
Nils Lindefors - One of the best experts on this subject based on the ideXlab platform.
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Optimal cut-off points on the Health Anxiety inventory, illness attitude scales and whiteley index to identify severe Health Anxiety.
PLOS ONE, 2015Co-Authors: Erik Hedman, Mats Lekander, Brjánn Ljótsson, Nils Lindefors, Christian Rück, Gerhard Andersson, Erik AnderssonAbstract:Background Health Anxiety can be viewed as a dimensional phenomenon where severe Health Anxiety in form of DSM-IV hypochondriasis represents a cut-off where the Health Anxiety becomes clinically significant. Three of the most reliable and used self-report measures of Health Anxiety are the Health Anxiety Inventory (HAI), the Illness Attitude Scales (IAS) and the Whiteley Index (WI). Identifying the optimal cut-offs for classification of presence of a diagnosis of severe Health Anxiety on these measures has several advantages in clinical and research settings. The aim of this study was therefore to investigate the HAI, IAS and WI as proximal diagnostic instruments for severe Health Anxiety defined as DSM-IV hypochondriasis. Methods We investigated sensitivity, specificity and predictive value on the HAI, IAS and WI using a total of 347 adult participants of whom 158 had a diagnosis of severe Health Anxiety, 97 had obsessive-compulsive disorder and 92 were Healthy non-clinical controls. Diagnostic assessments were conducted using the Anxiety Disorder Interview Schedule. Results Optimal cut-offs for identifying a diagnosis of severe Health Anxiety was 67 on the HAI, 47 on the IAS, and 5 on the WI. Sensitivity and specificity were high, ranging from 92.6 to 99.4%. Positive and negative predictive values ranged from 91.6 to 99.4% using unadjusted prevalence rates. Conclusions The HAI, IAS and WI have very good properties as diagnostic indicators of severe Health Anxiety and can be used as cost-efficient proximal estimates of the diagnosis.
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Psychometric properties of Internet-administered measures of Health Anxiety: an investigation of the Health Anxiety Inventory, the Illness Attitude Scales, and the Whiteley Index.
Journal of Anxiety Disorders, 2015Co-Authors: Erik Hedman, Erland Axelsson, Brjánn Ljótsson, Nils Lindefors, Christian Rück, Gerhard Andersson, Erik Andersson, Mats LekanderAbstract:Abstract Background The Health Anxiety Inventory (HAI), the Illness Attitude Scales (IAS), and the Whiteley Index (WI) are three of the most widely used Health Anxiety measures, but their psychometric properties have not been investigated when administered via the Internet. Methods We investigated the three instruments' test–retest reliability, internal consistency, convergent, and discriminant validity and sensitivity to change using one sample ( n = 111) of participants with severe Health Anxiety and one sample of Healthy controls ( n = 92). Results The HAI, IAS, and WI showed high test–retest reliability ( r s ≥ .80), good convergent, and discriminant validity and were sensitive to detect change. The HAI and IAS ( α s ≥ .85), but not the WI ( α s ≤ .60) demonstrated high internal consistency. Conclusions The HAI, IAS, and WI have good psychometric properties, except for the low internal consistency of WI, when used as Internet-administered measures of Health Anxiety. Using these measures over the Internet offers highly important advantages such as increased ease of administration, reduced attrition, and cost-efficient treatment evaluation.
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Mediators in Internet-Based Cognitive Behavior Therapy for Severe Health Anxiety
PLOS ONE, 2013Co-Authors: Erik Hedman, Mats Lekander, Nils Lindefors, Christian Rück, Gerhard Andersson, Erik Andersson, Brjánn LjótssonAbstract:According to the cognitive behavioral model of severe Health Anxiety (hypochondriasis) four central maintaining mechanisms are how the individual perceives the risk of disease and how negative its consequences would be, attention to bodily sensations, and intolerance of uncertainty. The aim of the present study was to investigate the mediating role of these putative mechanisms in Internet-delivered CBT for severe Health Anxiety. We analyzed data from an RCT where participants were randomized to Internet-delivered CBT (n=40) or to a control condition (n=41). Mediators and outcome, i.e. Health Anxiety, were assessed weekly throughout the treatment, enabling fulfillment of the criterion of temporal precedence of changes occurring in the mediator in relation to the outcome to be met. The results showed that reduced perceived risk of disease, less attention to bodily symptoms, and reduced intolerance of uncertainty significantly mediated improvement in Health Anxiety. The study supports the validity of the cognitive behavioral model of Health Anxiety. The findings have theoretical and clinical implications as they indicate processes that may be causally related to the improvements observed after CBT for Health Anxiety.
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Predictors of outcome in Internet-based cognitive behavior therapy for severe Health Anxiety.
Behaviour Research and Therapy, 2013Co-Authors: Erik Hedman, Mats Lekander, Nils Lindefors, Christian Rück, Gerhard Andersson, Erik Andersson, Brjánn LjótssonAbstract:Internet-based cognitive behavior therapy (CBT) for severe Health Anxiety can be effective, but not all patients achieve full remission. Under these circumstances, knowledge about predictors is essential for the clinician in order to make reliable treatment recommendations. The primary aim of this study was to investigate clinical, demographic, and therapy process-related predictors of Internet-based CBT for severe Health Anxiety. We performed three types of analyses on data from a sample comprising participants (N = 81) who had received Internet-based CBT in a randomized controlled trial. Outcomes were a) end state Health Anxiety, b) improvement in Health Anxiety (continuous change scores), and c) clinically significant improvement. Outcomes were assessed at six-month follow-up. The results showed that the most stable predictors of both end state Health Anxiety and improvement were baseline Health Anxiety and depressive symptoms. Treatment adherence, i.e. the number of completed treatment modules, also significantly predicted outcome. Notably, Health Anxiety at baseline was positively associated with symptom improvement while depressive symptoms was negatively related to improvement. Demographic factors were largely without significant impact on end state symptoms or improvement. We conclude that baseline symptom burden and adherence to treatment have strong predictive effects in Internet-based CBT for severe Health Anxiety.
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cost effectiveness and long term effectiveness of internet based cognitive behaviour therapy for severe Health Anxiety
Psychological Medicine, 2013Co-Authors: Erik Hedman, Nils Lindefors, Christian Rück, Gerhard Andersson, Erik Andersson, Brjánn LjótssonAbstract:BACKGROUND: Severe Health Anxiety is a common condition associated with functional disability, making it a costly disorder from a societal perspective. Internet-based cognitive behaviour therapy (ICBT) is a promising treatment but no previous study has assessed the cost-effectiveness or long-term outcome of ICBT for severe Health Anxiety. The aim of this study was to investigate the cost-effectiveness and 1-year treatment effects of ICBT for severe Health Anxiety. METHOD: Cost-effectiveness and 1-year follow-up data were obtained from a randomized controlled trial (RCT) comparing ICBT (n = 40) to an attention control condition (CC, n = 41). The primary outcome measure was the Health Anxiety Inventory (HAI). A societal perspective was taken and incremental cost-effectiveness ratios (ICERs) were calculated using bootstrap sampling. RESULTS: The main ICER was -£1244, indicating the societal economic gain for each additional case of remission when administering ICBT. Baseline to 1-year follow-up effect sizes on the primary outcome measure were large (d = 1.71-1.95). CONCLUSIONS: ICBT is a cost-effective treatment for severe Health Anxiety that can produce substantial and enduring effects.
Peter Tyrer - One of the best experts on this subject based on the ideXlab platform.
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Prevalence and service implications of Health Anxiety in genitourinary medicine clinics
International Journal of Std & Aids, 2020Co-Authors: Helen Seivewright, Paul M. Salkovskis, J Green, N Mullan, G. Behr, E Carlin, Susan Young, David Goldmeier, Peter TyrerAbstract:A comparison of the prevalence of Health Anxiety in genitourinary medicine (GUM) clinics in two UK centres was carried out using a new rating scale, the Health Anxiety Inventory (HAI). The relationship of Health Anxiety to demographic and clinical variables, and its impact on service contacts, was also examined in one of these centres. 694 patients were assessed and significant Health Anxiety was identified in 8-11%. HAI scores were stable over time and high levels persisted in the absence of treatment. Attenders with sexually transmitted infections had significantly lower levels of Health Anxiety than those with other conditions. Contacts with clinic doctors and Health advisors in the nine months before and after assessment were significantly greater in those with high Health Anxiety, with doctor appointments 37% higher in the high HAI group (P = 0.005). Health Anxiety is a source of considerable morbidity in GUM clinics deserving further study.
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Recent Advances in the Understanding and Treatment of Health Anxiety.
Current Psychiatry Reports, 2018Co-Authors: Peter TyrerAbstract:To examine the diagnosis of Health Anxiety, its prevalence in different settings, public Health significance, treatment, and outcome. Health Anxiety is similar to hypochondriasis but is characterized by fear of, rather than conviction of, illness. Lifetime prevalence rates are 6% in the population and as high as 20% in hospital out-patients, leading to greater costs to Health services through unnecessary medical contacts. Its prevalence may be increasing because of excessive internet browsing (cyberchondria). Drug treatment with antidepressants has some efficacy but is not well-liked, but psychological treatments, including cognitive behavior therapy, stress management, mindfulness training, and acceptance and commitment therapy, given either individually, in groups, or over the Internet, have all proved efficacious in both the short and longer term. Untreated Health Anxiety leads to premature mortality. Health Anxiety has become an increasing clinical and public Health issue at a time when people are being formally asked to take more responsibility in monitoring their own Health. More attention by Health services is needed.
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Recent Advances in the Understanding and Treatment of Health Anxiety
Current Psychiatry Reports, 2018Co-Authors: Peter TyrerAbstract:Purpose of Review To examine the diagnosis of Health Anxiety, its prevalence in different settings, public Health significance, treatment, and outcome. Recent Findings Health Anxiety is similar to hypochondriasis but is characterized by fear of, rather than conviction of, illness. Lifetime prevalence rates are 6% in the population and as high as 20% in hospital out-patients, leading to greater costs to Health services through unnecessary medical contacts. Its prevalence may be increasing because of excessive internet browsing (cyberchondria). Drug treatment with antidepressants has some efficacy but is not well-liked, but psychological treatments, including cognitive behavior therapy, stress management, mindfulness training, and acceptance and commitment therapy, given either individually, in groups, or over the Internet, have all proved efficacious in both the short and longer term. Untreated Health Anxiety leads to premature mortality. Summary Health Anxiety has become an increasing clinical and public Health issue at a time when people are being formally asked to take more responsibility in monitoring their own Health. More attention by Health services is needed.
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Health Anxiety: detection and treatment
BJPsych Advances, 2018Co-Authors: Peter Tyrer, Helen TyrerAbstract:SUMMARYHealth Anxiety is an important new diagnosis that is increasing in frequency because of changing attitudes towards Health, particularly excessive use of Health information on the internet (cyberchondria). People with abnormal Health Anxiety become over-diligent monitors of their Health, misinterpret most somatic sensations as evidence of disease, consult medical professionals unnecessarily and frequently, and are often over-investigated. Relatively few patients with Health Anxiety present to psychiatrists; most are seen in primary and secondary medical care. This paper reviews the diagnosis and presenting features of Health Anxiety, its identification in practice and its treatment. A range of simple psychological treatments have been shown to have long-lasting benefit for the disorder but are greatly under-used.LEARNING OBJECTIVES•To be able to identify abnormal Health Anxiety with the aid of probe questions•To respond to people whom you have identified with excessive Health Anxiety in a way that facilitates its treatment•To learn a few simple techniques derived from cognitive–behavioural therapy that can lead to long-term benefitDECLARATION OF INTERESTNone.
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prevalence of Health Anxiety problems in medical clinics
Journal of Psychosomatic Research, 2011Co-Authors: Peter Tyrer, Paul M. Salkovskis, J Green, Sylvia Cooper, Mike J Crawford, Simon Dupont, David Murphy, Georgina Smith, Duolao Wang, Sharandeep BhogalAbstract:OBJECTIVES: To determine the prevalence of significant Health Anxiety (hypochondriasis) in patients aged 16-75 in cardiology, respiratory medicine, neurological, endocrine and gastrointestinal clinics in general hospitals in London, Middlesex and North Nottinghamshire. METHOD: The Health Anxiety Inventory (HAI) (short form) was administered to patients attending the five clinics over a 21 month period and all those who scored 20 or more invited to take part in a further assessment for a randomised controlled trial. RESULTS: Of 43,205 patients attending the clinics 28,991 (67.1%) were assessed and of these, after exclusion of ineligible patients 5747 (19.8%) had significant Health Anxiety. 444 subsequently agreed to take part in a randomised controlled trial of treatment. The prevalence levels varied by clinic with neurology (24.7%) having the highest prevalence followed by respiratory medicine (20.9%), gastroenterology (19.5%), cardiology (19.1%), and endocrinology (17.5%). CONCLUSION: Abnormal Health Anxiety is common and a significant problem in those attending medical clinics and deserves greater awareness.
Erik Andersson - One of the best experts on this subject based on the ideXlab platform.
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Health Anxiety in obsessive compulsive disorder and obsessive compulsive symptoms in severe Health Anxiety: An investigation of symptom profiles.
Journal of Anxiety Disorders, 2016Co-Authors: Erik Hedman, Erland Axelsson, Brjánn Ljótsson, Christian Rück, Gerhard Andersson, Erik AnderssonAbstract:Abstract Severe Health Anxiety (SHA) shares features with obsessive-compulsive disorder (OCD) and in recent years there has been a debate as to whether the two disorders may represent two facets of the same condition. Few studies have however investigated the overlap and differences in symptom profiles between the disorders. The primary aim of the present study was to investigate these aspects using one sample of participants with a principal diagnosis of SHA and one sample of participants with a principal OCD diagnosis. The second aim was to examine differences in improvement trajectories on measures of Health Anxiety and OCD symptoms in patients with SHA receiving treatment with exposure and response prevention. We compared persons participating in clinical trials with a principal diagnosis of SHA (N = 290) to persons with a principal diagnosis of OCD (n = 95) on measures of Health Anxiety, OCD symptoms, and depressive symptoms. A subsample of SHA participants (n = 99) received exposure and response prevention (ERP) for SHA over 12 weeks and was assessed at baseline and post-treatment. The results showed large and significant differences between SHA and OCD patients on measures of Health Anxiety (ds = 2.99–3.09) and OCD symptoms (ds = 1.64–2.14), while they had equivalent levels of depressive symptoms (d = 0.19, 95% CI [−0.04, 0.43]). In the SHA sample 7.6% had comorbid OCD, and in the OCD sample 9.5% had SHA. For participants with a principal diagnosis of SHA, ERP led to large reductions of Health Anxiety, but effects on OCD symptoms were small to moderate. Among participants with comorbid OCD, effect sizes were large on measures of Health Anxiety and moderate to large on OCD measures. We conclude that SHA and OCD are separate psychiatric disorders with limited overlap in symptom profiles.
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Optimal cut-off points on the Health Anxiety inventory, illness attitude scales and whiteley index to identify severe Health Anxiety.
PLOS ONE, 2015Co-Authors: Erik Hedman, Mats Lekander, Brjánn Ljótsson, Nils Lindefors, Christian Rück, Gerhard Andersson, Erik AnderssonAbstract:Background Health Anxiety can be viewed as a dimensional phenomenon where severe Health Anxiety in form of DSM-IV hypochondriasis represents a cut-off where the Health Anxiety becomes clinically significant. Three of the most reliable and used self-report measures of Health Anxiety are the Health Anxiety Inventory (HAI), the Illness Attitude Scales (IAS) and the Whiteley Index (WI). Identifying the optimal cut-offs for classification of presence of a diagnosis of severe Health Anxiety on these measures has several advantages in clinical and research settings. The aim of this study was therefore to investigate the HAI, IAS and WI as proximal diagnostic instruments for severe Health Anxiety defined as DSM-IV hypochondriasis. Methods We investigated sensitivity, specificity and predictive value on the HAI, IAS and WI using a total of 347 adult participants of whom 158 had a diagnosis of severe Health Anxiety, 97 had obsessive-compulsive disorder and 92 were Healthy non-clinical controls. Diagnostic assessments were conducted using the Anxiety Disorder Interview Schedule. Results Optimal cut-offs for identifying a diagnosis of severe Health Anxiety was 67 on the HAI, 47 on the IAS, and 5 on the WI. Sensitivity and specificity were high, ranging from 92.6 to 99.4%. Positive and negative predictive values ranged from 91.6 to 99.4% using unadjusted prevalence rates. Conclusions The HAI, IAS and WI have very good properties as diagnostic indicators of severe Health Anxiety and can be used as cost-efficient proximal estimates of the diagnosis.
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Psychometric properties of Internet-administered measures of Health Anxiety: an investigation of the Health Anxiety Inventory, the Illness Attitude Scales, and the Whiteley Index.
Journal of Anxiety Disorders, 2015Co-Authors: Erik Hedman, Erland Axelsson, Brjánn Ljótsson, Nils Lindefors, Christian Rück, Gerhard Andersson, Erik Andersson, Mats LekanderAbstract:Abstract Background The Health Anxiety Inventory (HAI), the Illness Attitude Scales (IAS), and the Whiteley Index (WI) are three of the most widely used Health Anxiety measures, but their psychometric properties have not been investigated when administered via the Internet. Methods We investigated the three instruments' test–retest reliability, internal consistency, convergent, and discriminant validity and sensitivity to change using one sample ( n = 111) of participants with severe Health Anxiety and one sample of Healthy controls ( n = 92). Results The HAI, IAS, and WI showed high test–retest reliability ( r s ≥ .80), good convergent, and discriminant validity and were sensitive to detect change. The HAI and IAS ( α s ≥ .85), but not the WI ( α s ≤ .60) demonstrated high internal consistency. Conclusions The HAI, IAS, and WI have good psychometric properties, except for the low internal consistency of WI, when used as Internet-administered measures of Health Anxiety. Using these measures over the Internet offers highly important advantages such as increased ease of administration, reduced attrition, and cost-efficient treatment evaluation.
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Mediators in Internet-Based Cognitive Behavior Therapy for Severe Health Anxiety
PLOS ONE, 2013Co-Authors: Erik Hedman, Mats Lekander, Nils Lindefors, Christian Rück, Gerhard Andersson, Erik Andersson, Brjánn LjótssonAbstract:According to the cognitive behavioral model of severe Health Anxiety (hypochondriasis) four central maintaining mechanisms are how the individual perceives the risk of disease and how negative its consequences would be, attention to bodily sensations, and intolerance of uncertainty. The aim of the present study was to investigate the mediating role of these putative mechanisms in Internet-delivered CBT for severe Health Anxiety. We analyzed data from an RCT where participants were randomized to Internet-delivered CBT (n=40) or to a control condition (n=41). Mediators and outcome, i.e. Health Anxiety, were assessed weekly throughout the treatment, enabling fulfillment of the criterion of temporal precedence of changes occurring in the mediator in relation to the outcome to be met. The results showed that reduced perceived risk of disease, less attention to bodily symptoms, and reduced intolerance of uncertainty significantly mediated improvement in Health Anxiety. The study supports the validity of the cognitive behavioral model of Health Anxiety. The findings have theoretical and clinical implications as they indicate processes that may be causally related to the improvements observed after CBT for Health Anxiety.
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Predictors of outcome in Internet-based cognitive behavior therapy for severe Health Anxiety.
Behaviour Research and Therapy, 2013Co-Authors: Erik Hedman, Mats Lekander, Nils Lindefors, Christian Rück, Gerhard Andersson, Erik Andersson, Brjánn LjótssonAbstract:Internet-based cognitive behavior therapy (CBT) for severe Health Anxiety can be effective, but not all patients achieve full remission. Under these circumstances, knowledge about predictors is essential for the clinician in order to make reliable treatment recommendations. The primary aim of this study was to investigate clinical, demographic, and therapy process-related predictors of Internet-based CBT for severe Health Anxiety. We performed three types of analyses on data from a sample comprising participants (N = 81) who had received Internet-based CBT in a randomized controlled trial. Outcomes were a) end state Health Anxiety, b) improvement in Health Anxiety (continuous change scores), and c) clinically significant improvement. Outcomes were assessed at six-month follow-up. The results showed that the most stable predictors of both end state Health Anxiety and improvement were baseline Health Anxiety and depressive symptoms. Treatment adherence, i.e. the number of completed treatment modules, also significantly predicted outcome. Notably, Health Anxiety at baseline was positively associated with symptom improvement while depressive symptoms was negatively related to improvement. Demographic factors were largely without significant impact on end state symptoms or improvement. We conclude that baseline symptom burden and adherence to treatment have strong predictive effects in Internet-based CBT for severe Health Anxiety.
Brjánn Ljótsson - One of the best experts on this subject based on the ideXlab platform.
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Health Anxiety in obsessive compulsive disorder and obsessive compulsive symptoms in severe Health Anxiety: An investigation of symptom profiles.
Journal of Anxiety Disorders, 2016Co-Authors: Erik Hedman, Erland Axelsson, Brjánn Ljótsson, Christian Rück, Gerhard Andersson, Erik AnderssonAbstract:Abstract Severe Health Anxiety (SHA) shares features with obsessive-compulsive disorder (OCD) and in recent years there has been a debate as to whether the two disorders may represent two facets of the same condition. Few studies have however investigated the overlap and differences in symptom profiles between the disorders. The primary aim of the present study was to investigate these aspects using one sample of participants with a principal diagnosis of SHA and one sample of participants with a principal OCD diagnosis. The second aim was to examine differences in improvement trajectories on measures of Health Anxiety and OCD symptoms in patients with SHA receiving treatment with exposure and response prevention. We compared persons participating in clinical trials with a principal diagnosis of SHA (N = 290) to persons with a principal diagnosis of OCD (n = 95) on measures of Health Anxiety, OCD symptoms, and depressive symptoms. A subsample of SHA participants (n = 99) received exposure and response prevention (ERP) for SHA over 12 weeks and was assessed at baseline and post-treatment. The results showed large and significant differences between SHA and OCD patients on measures of Health Anxiety (ds = 2.99–3.09) and OCD symptoms (ds = 1.64–2.14), while they had equivalent levels of depressive symptoms (d = 0.19, 95% CI [−0.04, 0.43]). In the SHA sample 7.6% had comorbid OCD, and in the OCD sample 9.5% had SHA. For participants with a principal diagnosis of SHA, ERP led to large reductions of Health Anxiety, but effects on OCD symptoms were small to moderate. Among participants with comorbid OCD, effect sizes were large on measures of Health Anxiety and moderate to large on OCD measures. We conclude that SHA and OCD are separate psychiatric disorders with limited overlap in symptom profiles.
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Optimal cut-off points on the Health Anxiety inventory, illness attitude scales and whiteley index to identify severe Health Anxiety.
PLOS ONE, 2015Co-Authors: Erik Hedman, Mats Lekander, Brjánn Ljótsson, Nils Lindefors, Christian Rück, Gerhard Andersson, Erik AnderssonAbstract:Background Health Anxiety can be viewed as a dimensional phenomenon where severe Health Anxiety in form of DSM-IV hypochondriasis represents a cut-off where the Health Anxiety becomes clinically significant. Three of the most reliable and used self-report measures of Health Anxiety are the Health Anxiety Inventory (HAI), the Illness Attitude Scales (IAS) and the Whiteley Index (WI). Identifying the optimal cut-offs for classification of presence of a diagnosis of severe Health Anxiety on these measures has several advantages in clinical and research settings. The aim of this study was therefore to investigate the HAI, IAS and WI as proximal diagnostic instruments for severe Health Anxiety defined as DSM-IV hypochondriasis. Methods We investigated sensitivity, specificity and predictive value on the HAI, IAS and WI using a total of 347 adult participants of whom 158 had a diagnosis of severe Health Anxiety, 97 had obsessive-compulsive disorder and 92 were Healthy non-clinical controls. Diagnostic assessments were conducted using the Anxiety Disorder Interview Schedule. Results Optimal cut-offs for identifying a diagnosis of severe Health Anxiety was 67 on the HAI, 47 on the IAS, and 5 on the WI. Sensitivity and specificity were high, ranging from 92.6 to 99.4%. Positive and negative predictive values ranged from 91.6 to 99.4% using unadjusted prevalence rates. Conclusions The HAI, IAS and WI have very good properties as diagnostic indicators of severe Health Anxiety and can be used as cost-efficient proximal estimates of the diagnosis.
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Psychometric properties of Internet-administered measures of Health Anxiety: an investigation of the Health Anxiety Inventory, the Illness Attitude Scales, and the Whiteley Index.
Journal of Anxiety Disorders, 2015Co-Authors: Erik Hedman, Erland Axelsson, Brjánn Ljótsson, Nils Lindefors, Christian Rück, Gerhard Andersson, Erik Andersson, Mats LekanderAbstract:Abstract Background The Health Anxiety Inventory (HAI), the Illness Attitude Scales (IAS), and the Whiteley Index (WI) are three of the most widely used Health Anxiety measures, but their psychometric properties have not been investigated when administered via the Internet. Methods We investigated the three instruments' test–retest reliability, internal consistency, convergent, and discriminant validity and sensitivity to change using one sample ( n = 111) of participants with severe Health Anxiety and one sample of Healthy controls ( n = 92). Results The HAI, IAS, and WI showed high test–retest reliability ( r s ≥ .80), good convergent, and discriminant validity and were sensitive to detect change. The HAI and IAS ( α s ≥ .85), but not the WI ( α s ≤ .60) demonstrated high internal consistency. Conclusions The HAI, IAS, and WI have good psychometric properties, except for the low internal consistency of WI, when used as Internet-administered measures of Health Anxiety. Using these measures over the Internet offers highly important advantages such as increased ease of administration, reduced attrition, and cost-efficient treatment evaluation.
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Mediators in Internet-Based Cognitive Behavior Therapy for Severe Health Anxiety
PLOS ONE, 2013Co-Authors: Erik Hedman, Mats Lekander, Nils Lindefors, Christian Rück, Gerhard Andersson, Erik Andersson, Brjánn LjótssonAbstract:According to the cognitive behavioral model of severe Health Anxiety (hypochondriasis) four central maintaining mechanisms are how the individual perceives the risk of disease and how negative its consequences would be, attention to bodily sensations, and intolerance of uncertainty. The aim of the present study was to investigate the mediating role of these putative mechanisms in Internet-delivered CBT for severe Health Anxiety. We analyzed data from an RCT where participants were randomized to Internet-delivered CBT (n=40) or to a control condition (n=41). Mediators and outcome, i.e. Health Anxiety, were assessed weekly throughout the treatment, enabling fulfillment of the criterion of temporal precedence of changes occurring in the mediator in relation to the outcome to be met. The results showed that reduced perceived risk of disease, less attention to bodily symptoms, and reduced intolerance of uncertainty significantly mediated improvement in Health Anxiety. The study supports the validity of the cognitive behavioral model of Health Anxiety. The findings have theoretical and clinical implications as they indicate processes that may be causally related to the improvements observed after CBT for Health Anxiety.
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Predictors of outcome in Internet-based cognitive behavior therapy for severe Health Anxiety.
Behaviour Research and Therapy, 2013Co-Authors: Erik Hedman, Mats Lekander, Nils Lindefors, Christian Rück, Gerhard Andersson, Erik Andersson, Brjánn LjótssonAbstract:Internet-based cognitive behavior therapy (CBT) for severe Health Anxiety can be effective, but not all patients achieve full remission. Under these circumstances, knowledge about predictors is essential for the clinician in order to make reliable treatment recommendations. The primary aim of this study was to investigate clinical, demographic, and therapy process-related predictors of Internet-based CBT for severe Health Anxiety. We performed three types of analyses on data from a sample comprising participants (N = 81) who had received Internet-based CBT in a randomized controlled trial. Outcomes were a) end state Health Anxiety, b) improvement in Health Anxiety (continuous change scores), and c) clinically significant improvement. Outcomes were assessed at six-month follow-up. The results showed that the most stable predictors of both end state Health Anxiety and improvement were baseline Health Anxiety and depressive symptoms. Treatment adherence, i.e. the number of completed treatment modules, also significantly predicted outcome. Notably, Health Anxiety at baseline was positively associated with symptom improvement while depressive symptoms was negatively related to improvement. Demographic factors were largely without significant impact on end state symptoms or improvement. We conclude that baseline symptom burden and adherence to treatment have strong predictive effects in Internet-based CBT for severe Health Anxiety.
