Cognitive-Behavioral Therapy for Health Anxiety

Recruiting in Palo Alto (17 mi)

Overseen ByRobert E Brady, PhD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Waitlist Available

Sponsor: Dartmouth-Hitchcock Medical Center

No Placebo Group

Trial Summary

What is the purpose of this trial?This study is a randomized controlled pilot trial using a hybrid type 1 effectiveness-implementation design to evaluate the feasibility, acceptability, and preliminary effectiveness of a brief cognitive-behavioral intervention delivered by medical assistants in a primary care setting. The trial compares clinical outcomes of participants assigned to the intervention condition to those of participants assigned to a usual care condition. The clinical outcome is change on a self-report measure of health anxiety. Assessments occur at baseline, four weeks, and 12 weeks post-treatment. The study will also measure engagement with the intervention and assess feasibility and acceptability of the intervention in terms of fidelity of trained study therapists and ratings of the intervention by participants. The usual care condition consists of a referral to a mental health provider. The intervention is comprised of four sessions of individually administered cognitive-behavioral therapy addressing health anxiety. Treatment focuses on building motivation for change, psychoeducation about health anxiety, cognitive restructuring, and situational and interoceptive exposure. The study will recruit from three primary care clinics within the Dartmouth-Hitchcock Health system. The study will also assess facilitators and barriers to implementation using qualitative analyses of interview responses provided by the medical assistants delivering the intervention, primary care providers, and clinic administrators at the study sites.

Eligibility Criteria

This trial is for adults aged 18-85 with health anxiety or somatic symptom disorder, who see their primary care provider often and have high self-reported health anxiety. They must be patients at specific Dartmouth-Hitchcock clinics and speak English. Those with chronic illnesses requiring frequent visits, unmanaged psychosis or bipolar disorder, or active suicidal thoughts cannot join.

Inclusion Criteria

I visit my primary care doctor much more often than most people my age and gender.

Have a primary care provider at Dartmouth-Hitchcock Medical Center-General Internal Medicine, Dartmouth-Hitchcock Heater Road Clinic, or Dartmouth-Hitchcock Manchester

You frequently worry about your health, scoring 2 or more on a health anxiety test.

+2 more

Exclusion Criteria

Chronic medical illness necessitating an increased visit frequency confirmed through consultation with the patient's primary care provider

I do not speak English.

You have untreated or uncontrolled mental health conditions like psychosis or bipolar disorder.

+1 more

Participant Groups

The study tests a short cognitive-behavioral therapy (CBT) for health anxiety in primary care versus usual care which involves referral to a mental health provider. The CBT includes four sessions focusing on motivation, education about health anxiety, thought restructuring, and exposure exercises. Outcomes are measured over 12 weeks post-treatment.

2Treatment groups

Experimental Treatment

Group I: Referral to mental health providerExperimental Treatment1 Intervention

Provider makes referral to a mental health provider

Group II: Cognitive-Behavioral TherapyExperimental Treatment1 Intervention

Brief Cognitive-Behavioral Therapy for Health Anxiety