Psychotherapies for hypochondriasis

Alex Thomson; Lisa Page

doi:10.1002/14651858.CD006520.pub2

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Figure 1

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Figure 2

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Figure 3

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Analysis 1.1

Comparison 1 All forms of psychotherapy vs Waiting List/Usual Medical Care/Tablet Placebo, Outcome 1 Hypochondriasis.

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Analysis 1.2

Comparison 1 All forms of psychotherapy vs Waiting List/Usual Medical Care/Tablet Placebo, Outcome 2 Depression.

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Analysis 1.3

Comparison 1 All forms of psychotherapy vs Waiting List/Usual Medical Care/Tablet Placebo, Outcome 3 Anxiety.

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Analysis 1.4

Comparison 1 All forms of psychotherapy vs Waiting List/Usual Medical Care/Tablet Placebo, Outcome 4 Physical Symptoms.

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Analysis 1.5

Comparison 1 All forms of psychotherapy vs Waiting List/Usual Medical Care/Tablet Placebo, Outcome 5 Dropout rates.

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Analysis 2.1

Comparison 2 Cognitive Therapy vs Waiting List, Outcome 1 Hypochondriasis.

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Analysis 2.2

Comparison 2 Cognitive Therapy vs Waiting List, Outcome 2 Depression.

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Analysis 2.3

Comparison 2 Cognitive Therapy vs Waiting List, Outcome 3 Anxiety.

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Analysis 2.4

Comparison 2 Cognitive Therapy vs Waiting List, Outcome 4 Dropout rates.

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Analysis 3.1

Comparison 3 Behavioural Therapy vs Waiting List, Outcome 1 Hypochondriasis.

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Analysis 3.2

Comparison 3 Behavioural Therapy vs Waiting List, Outcome 2 Depression.

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Analysis 3.3

Comparison 3 Behavioural Therapy vs Waiting List, Outcome 3 Dropout rates.

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Analysis 4.1

Comparison 4 Cognitive Behavioural Therapy vs Waiting List/Usual Medical Care/ Tablet Placebo, Outcome 1 Hypochondriasis.

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Analysis 4.2

Comparison 4 Cognitive Behavioural Therapy vs Waiting List/Usual Medical Care/ Tablet Placebo, Outcome 2 General functioning.

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Analysis 4.3

Comparison 4 Cognitive Behavioural Therapy vs Waiting List/Usual Medical Care/ Tablet Placebo, Outcome 3 Depression.

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Analysis 4.4

Comparison 4 Cognitive Behavioural Therapy vs Waiting List/Usual Medical Care/ Tablet Placebo, Outcome 4 Anxiety.

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Analysis 4.5

Comparison 4 Cognitive Behavioural Therapy vs Waiting List/Usual Medical Care/ Tablet Placebo, Outcome 5 Physical Symptoms.

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Analysis 4.6

Comparison 4 Cognitive Behavioural Therapy vs Waiting List/Usual Medical Care/ Tablet Placebo, Outcome 6 Dropout rates.

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Analysis 5.1

Comparison 5 Behavioural Stress Management vs Waiting List, Outcome 1 Hypochondriasis.

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Analysis 5.2

Comparison 5 Behavioural Stress Management vs Waiting List, Outcome 2 Depression.

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Analysis 5.3

Comparison 5 Behavioural Stress Management vs Waiting List, Outcome 3 Anxiety.

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Analysis 5.4

Comparison 5 Behavioural Stress Management vs Waiting List, Outcome 4 Dropout rates.

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Analysis 6.1

Comparison 6 Psychoeducation vs Waiting List, Outcome 1 Hypochondriasis.

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Analysis 6.2

Comparison 6 Psychoeducation vs Waiting List, Outcome 2 Resource use.

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Analysis 6.3

Comparison 6 Psychoeducation vs Waiting List, Outcome 3 Physical symptoms.

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Analysis 6.4

Comparison 6 Psychoeducation vs Waiting List, Outcome 4 Dropout rates.

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Analysis 7.1

Comparison 7 Subgroup analysis by diagnostic criteria, Outcome 1 Hypochondriasis.

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Analysis 8.1

Comparison 8 Subgroup analysis by total psychotherapy exposure time., Outcome 1 Hypochondriasis.

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Analysis 9.1

Comparison 9 Subgroup analysis by rating scales used, Outcome 1 Hypochondriasis.

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Analysis 10.1

Comparison 10 Sensitivity analysis by QRS score, Outcome 1 Hypochondriasis.

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Analysis 11.1

Comparison 11 All studies regardless of time to outcome, Outcome 1 Hypochondriasis ‐ all studies.

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Table 1. Outcome measures used in the analyses

Study	Therapies	Primary Outcome	General Functioning	Resource Use	Psychological Sx	Physical Sx
Barsky 2004	CBT	Whitely Index (specified in paper)	FSQ ‐ intermediate activities of daily living subscale			SSI
Clark 1998	CT; BSM	VAS ‐ health worry‐related distress‐disability ‐ self‐rated (selected by review authors)			BDI; BAI
Fava 2000	ET	IAS ‐ hypochondriasis subscale (selected by review authors)		No. of visits to physicians in 3 month period		RSSS
Greeven 2007	CBT	Whitely Index (specified in paper)			MADRS; BAS
Visser 2001	CT; BT	IAS Health Anxiety subscale (specified in paper)			BDI
Warwick 1996	CBT	VAS ‐ Health anxiety ‐ self‐rated (selected by review authors)			BDI; BAI

Table 1. Outcome measures used in the analyses

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Comparison 1. All forms of psychotherapy vs Waiting List/Usual Medical Care/Tablet Placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Hypochondriasis Show forest plot	5	247	Std. Mean Difference (IV, Random, 95% CI)	‐0.86 [‐1.25, ‐0.46]

2 Depression Show forest plot	4	230	Std. Mean Difference (IV, Random, 95% CI)	‐0.78 [‐1.31, ‐0.24]

3 Anxiety Show forest plot	3	164	Std. Mean Difference (IV, Random, 95% CI)	‐0.96 [‐1.64, ‐0.27]

4 Physical Symptoms Show forest plot	2	207	Std. Mean Difference (IV, Random, 95% CI)	‐0.41 [‐0.69, ‐0.13]

5 Dropout rates Show forest plot	5	247	Odds Ratio (M‐H, Random, 95% CI)	1.17 [0.58, 2.34]

Comparison 1. All forms of psychotherapy vs Waiting List/Usual Medical Care/Tablet Placebo

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Comparison 2. Cognitive Therapy vs Waiting List

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Hypochondriasis Show forest plot	2	78	Std. Mean Difference (IV, Random, 95% CI)	‐1.26 [‐1.76, ‐0.77]

2 Depression Show forest plot	2	78	Mean Difference (IV, Random, 95% CI)	‐7.42 [‐11.28, ‐3.55]

3 Anxiety Show forest plot	1	38	Mean Difference (IV, Fixed, 95% CI)	‐14.5 [‐23.41, ‐5.59]

4 Dropout rates Show forest plot	2	79	Odds Ratio (M‐H, Random, 95% CI)	1.08 [0.33, 3.52]

Comparison 2. Cognitive Therapy vs Waiting List

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Comparison 3. Behavioural Therapy vs Waiting List

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Hypochondriasis Show forest plot	1	42	Mean Difference (IV, Fixed, 95% CI)	‐0.60 [‐1.11, ‐0.09]

2 Depression Show forest plot	1	42	Mean Difference (IV, Fixed, 95% CI)	0.30 [‐5.10, 5.70]

3 Dropout rates Show forest plot	1	48	Odds Ratio (M‐H, Fixed, 95% CI)	0.93 [0.26, 3.29]

Comparison 3. Behavioural Therapy vs Waiting List

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Comparison 4. Cognitive Behavioural Therapy vs Waiting List/Usual Medical Care/ Tablet Placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Hypochondriasis Show forest plot	3		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1 Immediately post treatment	2	104	Std. Mean Difference (IV, Random, 95% CI)	‐0.80 [‐1.62, 0.01]
1.2 12 month follow‐up	1	187	Std. Mean Difference (IV, Random, 95% CI)	‐0.43 [‐0.72, ‐0.14]
2 General functioning Show forest plot	1	187	Mean Difference (IV, Fixed, 95% CI)	11.19 [5.29, 17.09]

3 Depression Show forest plot	2	107	Std. Mean Difference (IV, Random, 95% CI)	‐0.82 [‐1.88, 0.23]

4 Anxiety Show forest plot	2	103	Std. Mean Difference (IV, Random, 95% CI)	‐0.79 [‐1.70, 0.12]

5 Physical Symptoms Show forest plot	1	187	Mean Difference (IV, Fixed, 95% CI)	‐0.24 [‐0.40, ‐0.08]

6 Dropout rates Show forest plot	3	294	Odds Ratio (M‐H, Random, 95% CI)	1.14 [0.56, 2.32]

Comparison 4. Cognitive Behavioural Therapy vs Waiting List/Usual Medical Care/ Tablet Placebo

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Comparison 5. Behavioural Stress Management vs Waiting List

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Hypochondriasis Show forest plot	1	38	Mean Difference (IV, Fixed, 95% CI)	‐2.40 [‐3.87, ‐0.93]

2 Depression Show forest plot	1	38	Mean Difference (IV, Fixed, 95% CI)	‐12.7 [‐19.67, ‐5.73]

3 Anxiety Show forest plot	1	37	Mean Difference (IV, Fixed, 95% CI)	‐14.9 [‐23.21, ‐6.59]

4 Dropout rates Show forest plot	1	32	Odds Ratio (M‐H, Fixed, 95% CI)	2.82 [0.11, 74.51]

Comparison 5. Behavioural Stress Management vs Waiting List

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Comparison 6. Psychoeducation vs Waiting List

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Hypochondriasis Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	‐1.30 [‐4.64, 2.04]

2 Resource use Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	‐6.0 [‐11.70, ‐0.30]

3 Physical symptoms Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	‐2.20 [‐8.73, 4.33]

4 Dropout rates Show forest plot	1	20	Odds Ratio (M‐H, Fixed, 95% CI)	2.25 [0.17, 29.77]

Comparison 6. Psychoeducation vs Waiting List

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Comparison 7. Subgroup analysis by diagnostic criteria

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Hypochondriasis Show forest plot	6		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1 DSM‐IIIR	2	93	Std. Mean Difference (IV, Random, 95% CI)	‐1.30 [‐1.79, ‐0.81]
1.2 DSM‐IV	3	154	Std. Mean Difference (IV, Random, 95% CI)	‐0.61 [‐0.97, ‐0.24]
1.3 Idiosyncratic criteria	1	187	Std. Mean Difference (IV, Random, 95% CI)	‐0.43 [‐0.72, ‐0.14]

Comparison 7. Subgroup analysis by diagnostic criteria

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Comparison 8. Subgroup analysis by total psychotherapy exposure time.

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Hypochondriasis Show forest plot	6		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1 <10 hours total therapist time	3	279	Std. Mean Difference (IV, Random, 95% CI)	‐0.43 [‐0.66, ‐0.19]
1.2 >10 hours total therapist time	3	155	Std. Mean Difference (IV, Random, 95% CI)	‐1.15 [‐1.52, ‐0.78]

Comparison 8. Subgroup analysis by total psychotherapy exposure time.

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Comparison 9. Subgroup analysis by rating scales used

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Hypochondriasis Show forest plot	6		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1 Validated scale/subscale	4	341	Std. Mean Difference (IV, Random, 95% CI)	‐0.51 [‐0.73, ‐0.29]
1.2 Visual analogue scale	2	93	Std. Mean Difference (IV, Random, 95% CI)	‐1.30 [‐1.79, ‐0.81]

Comparison 9. Subgroup analysis by rating scales used

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Comparison 10. Sensitivity analysis by QRS score

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Hypochondriasis Show forest plot	6		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1 QRS <= 25	2	94	Std. Mean Difference (IV, Random, 95% CI)	‐1.06 [‐1.52, ‐0.61]
1.2 QRS > 25	4	340	Std. Mean Difference (IV, Random, 95% CI)	‐0.61 [‐0.99, ‐0.22]

Comparison 10. Sensitivity analysis by QRS score

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Comparison 11. All studies regardless of time to outcome

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Hypochondriasis ‐ all studies Show forest plot	6	434	Std. Mean Difference (IV, Random, 95% CI)	‐0.75 [‐1.09, ‐0.41]

Comparison 11. All studies regardless of time to outcome

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