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Talk therapy may ease health-related anxiety: study

By C. E. Huggins

NEW YORK (Reuters Health) - Talk therapy performed by nurses and other clinic staff may help people with health anxiety stop worrying about being sick when they're not, a new study suggests.

The goal of so-called cognitive behavior therapy, or CBT, is to help people understand how their thoughts and attitudes affect how they feel and how they respond to situations. It then addresses practical steps people can take to improve negative thoughts and outcomes.

Prior studies have found CBT helped treat health anxiety when performed by specialist therapists in primary care and mental health care settings.

But little research has been conducted in specialty clinics, where people with health anxiety may be seen for both valid medical conditions and unfounded health complaints brought on by their fears of having a serious disease.

"In all developed countries there are specialized nurses who have additional training to help with those patients who are more difficult or have more complex problems," Dr. Peter Tyrer told Reuters Health in an email. He led the new study at Imperial College in London, UK.

Tyrer said the findings suggest that in addition to training in heart or brain diseases, for instance, those nurses can spend some time learning talk therapy focused on health anxiety.

That way, "they can not only detect people who have high health anxiety but also treat them," he said.

Marla Deibler, a clinical psychologist who was not involved with Tyrer's study, said the researchers "have an interesting idea - to provide a quick and cost-effective intervention to provide care in a controlled setting."

However, she added, the study findings are "validating what we know, that any kind of cognitive behavioral intervention for anxiety is helpful."

The need to provide crash-course training to nurses and others new to CBT might be less pressing in the U.S. than in the UK, Deibler said. She is the founder and executive director of the Center for Emotional Health of Greater Philadelphia.

She explained that due to the push toward evidence-based mental health care over the past decade, "there are lots of cognitive behavioral psychologists in the U.S.; this may not be the same in the UK."

"In the U.S. we have health psychologists who work with medical doctors so that we don't miss the opportunity to help patients who might decline the opportunity to go to a mental health provider, which unfortunately is still a problem," she told Reuters Health.

Tyrer and his colleagues studied 444 people ages 16 to 75 whose responses on a questionnaire showed they had high health anxiety. The participants were recruited from specialty clinics treating heart, stomach and other disorders.

They were randomly placed in either a study group where participants received five to ten CBT sessions or a comparison group. Those in the comparison group got care as usual, such as testing to rule out the conditions they feared and reassurance from their doctor that they were not sick.

One year later, the researchers found health anxiety levels had dropped to normal among 14 percent of people in the study group and 7 percent of those who had received standard care.

People in the therapy group also had greater improvements in anxiety and depression, based on personal reports, at six months and one year. And improvements in health anxiety and depression were still clear two years after the study, the researchers reported in The Lancet.

Health care costs were not lower in the therapy group as the researchers had speculated, however. Costs appeared to be comparable between the two groups.

The study's 14-percent improvement rate with therapy "is not that impressive" compared to other trials of CBT, according to Deibler.

Still, she said, "this article really highlights the utility of a quick and simple cognitive behavioral therapy."

Such therapy can only work for those who take advantage of it. Many people originally recruited to participate in Tyrer's study opted out for unreported reasons.

"This was largely because they did not want to, because their wish to find a medical cause for their problems overcame their wish to find a treatment for their anxiety," Tyrer said.

"One of the tasks of the specialized staff working in these clinics will be to identify these people, and persuade them that their constant seeking of reassurance and wish to have disease excluded is not the right way forward."

Deibler added, "If you give these patients quality mental health care you can prevent clogging emergency rooms with non-medical presentations."

SOURCE: http://bit.ly/HkcrlA The Lancet, online October 18, 2013.

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