CHAMP: Cognitive behaviour therapy for Health ...

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CHAMP: Cognitive behaviour therapy for Health Anxiety in. Medical Patients ... Clark, 2002) was administered to patients aged 16–75 in cardiology, respiratory ...

CHAMP: Cognitive behaviour therapy for Health Anxiety in Medical Patients Gemma Walker a, Stephanie Kings b, David Trevor b a

Centre for Mental Health, Department of Medicine, Imperial College, London, UK b East Midlands and South Yorkshire Mental Health Research Network Hub, Nottingham, UK

Background Health Anxiety is characterised by excessive and preoccupying health related worry; affecting every part of a patient’s life. It may result in seeking health advice, the need for reassurance, costs to clinician time and expensive medical tests.

Objectives 1) To determine the clinical effectiveness of health anxiety directed cognitive behaviour therapy relating to improved social functioning, quality of life and reduced health anxiety 1 and 2 years after therapy. 2) To determine the cost effectiveness of health anxiety directed cognitive behaviour therapy 2 years after therapy 3) To consider the prevalence of health anxiety.

Method The Health Anxiety Inventory (HAI) (short form) (Salkovskis, Rimes, Warwick & Clark, 2002) was administered to patients aged 16–75 in cardiology, respiratory medicine, neurological, endocrine and gastrointestinal clinics in general hospitals in London, Middlesex and North Nottinghamshire over a 21 month period. Patients with a score of 20 or above were invited to take part in a further assessment for a randomised controlled trial. The study equally randomised 444 eligible patients to an active treatment group of 5-10 cognitive behaviour therapy sessions versus a control group for clinical and economic outcome comparisons. Outcome measures were administered at baseline, 3, 6, 12 and 24 months. Treatment arms: 1) Active treatment : Patients who received the active treatment received 5 to 10, 60 minute sessions of CBT administered by nurses close by to the clinic, so that it may be viewed as being part of the clinics function rather than a (possibly stigmatized) external psychiatric service. 2) Control group: Patients in the control group received an explanatory summary of health anxiety (also given to the active group) prior to randomisation.

Results Prevalence: Of 43,205 patients 67.1% were assessed of these, 19.8% of eligible patients had significant health anxiety. 444 subsequently agreed to take part in the randomised controlled trial of treatment. Neurology had the highest prevalence of health anxiety (24.7%) , followed by respiratory medicine (20.9%), gastroenterology (19.5%), cardiology (19.1%), and endocrinology (17.5%). Randomised Controlled trial: Preliminary results are promising with many positive comments from therapy patients. This study hopes to demonstrate that the therapy can be clinically and cost effective by reducing psychological distress and excessive or unnecessary service use amongst health anxious patients.

Table 1. Prevalence of significant health anxiety in cardiology, endocrine, gastrointestinal, neurology and respiratory medicine clinics.

Clinic type Cardiology Endocrine Gastroentology Neurology Respiratory medicine All

Total Number with Prevalence assessed HAI scores >20 rate 6303 1206 19.13 5637 986 17.49 8924 1737 19.46 3205 792 24.71 4922 28, 991

1026 5747

20.85 19.82

p-value 0.0093**

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