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Mediators of treatment effect in minimal-contact cognitive behaviour therapy for severe health anxiety: A theory-driven analysis based on a randomised controlled trial
Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Örebro University, School of Law, Psychology and Social Work. Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
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2020 (English)In: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 69, article id 102172Article in journal (Refereed) Published
Abstract [en]

Cognitive behaviour therapy (CDT) is efficacious for severe health anxiety, but little is known about mechanisms. We analysed putative mediators of change based on 13 weekly assessments in a randomised controlled trial (N = 132) of exposure-based minimal-contact CBT (guided Internet-delivered CBT, unguided Internet-delivered CBT and bibliotherapy) vs. a waitlist control for severe health anxiety. We hypothesised that the effect of CBT on health anxiety would be mediated by non-reactivity to inner experiences, health anxiety behaviours and perceived competence. We also explored somatosensory amplification. In parallel process growth models, nonreactivity, health anxiety behaviours and perceived competence - but not somatosensory amplification - were influenced by CBT and associated with health anxiety. Random intercepts cross-lagged panel models were used to study within-individual ordering of change. None of the putative mediators systematically predicted subsequent changes in health anxiety. Rather, changes in health anxiety predicted subsequent changes in all putative mediators. In summary, CBT influenced health anxiety behaviours, non-reactivity to inner experiences and perceived competence, and these variables were associated with the outcome. However, their role as mediators was not corroborated because we found no evidence that changes in these variables predicted subsequent changes in health anxiety. We encourage further research into mediators of CBT for health anxiety.

Place, publisher, year, edition, pages
Elsevier, 2020. Vol. 69, article id 102172
Keywords [en]
Cognitive behaviour therapy, Health anxiety, Hypochondriasis, Illness anxiety disorder, Mediation, Somatic symptom disorder
National Category
Psychology
Identifiers
URN: urn:nbn:se:oru:diva-79814DOI: 10.1016/j.janxdis.2019.102172ISI: 000509005800007PubMedID: 31864217Scopus ID: 2-s2.0-85076741455OAI: oai:DiVA.org:oru-79814DiVA, id: diva2:1392178
Funder
The Karolinska Institutet's Research FoundationStockholm County CouncilAvailable from: 2020-02-06 Created: 2020-02-06 Last updated: 2020-02-06Bibliographically approved

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