Therapist differences in a randomised trial of the outcome of cognitive behaviour therapy for health anxiety in medical patients

Helen Tyrer; Peter Tyrer; Yvonne Lisseman-Stones; Sharon McAllister; Sylvia Cooper; Paul Salkovskis; Michael J. Crawford; Simon Dupont; John Green; David Murphy; Duolao Wang

doi:10.1016/j.ijnurstu.2014.11.013

Therapist differences in a randomised trial of the outcome of cognitive behaviour therapy for health anxiety in medical patients

Helen Tyrer, Peter Tyrer, Yvonne Lisseman-Stones, Sharon McAllister, Sylvia Cooper, Paul Salkovskis, Michael J. Crawford, Simon Dupont, John Green, David Murphy, Duolao Wang

Clinical Sciences

Research output: Contribution to journal › Article › peer-review

28 Citations (Scopus)

Abstract

Background

Health anxiety is common in medical settings and can be treated successfully by cognitive behaviour therapy. However it is not clear who might be best placed to deliver this therapy.

Objectives

In a planned secondary analysis of data from a randomised trial of adapted cognitive behaviour therapy for health anxiety we compared outcomes of therapy delivered by nurses and other professional groups.

Design

A randomised controlled trial with two treatment arms, 5–10 sessions of cognitive behaviour therapy adapted health anxiety or standard care.

Setting

Cardiology, endocrine, gastroenterology, neurological and respiratory clinics in six general hospitals in the UK covering urban, suburban and rural areas.

Participants

Medical patients attending the clinics who had pathological health anxiety and also scored for a diagnosis of hypochondriasis.

Methods

Patients were randomised to one of two treatment arms, 5–10 sessions of cognitive behaviour therapy adapted health anxiety or standard care delivered by naive therapists (not randomised) who were trained in advance before delivering the treatment. Independent assessment of outcomes by researchers masked to allocation status at 3 m, 6 m, 12 m and 24 m.

Results

444 patients were randomised in the trial, 219 to cognitive behaviour therapy adapted health anxiety and 225 to standard care. 373 (84%) completed assessments after two years. Those treated by nurses (n = 66) had improvement in health anxiety, generalised anxiety and depression outcomes that were significantly better and twice as great as those of the professional groups of assistant psychologists (n = 87) and graduate workers (n = 66) (P < 0.01 over all time points). The number needed to treat to show superiority of nurse-delivered treatment over other treatment delivery was 4 at 6 months and 6 at one year.

Conclusion

General nurses, after suitable training, are very effective therapists for patients with health anxiety in medical clinics and should be the therapists of choice for patients in these settings.

Original language	English
Pages (from-to)	686-694
Number of pages	9
Journal	International Journal of Nursing Studies
Volume	52
Issue number	3
DOIs	https://doi.org/10.1016/j.ijnurstu.2014.11.013
Publication status	Published - 1 Mar 2015

Keywords

Cognitive behaviour therapy
Depression
Generalised anxiety
Health anxiety
Hypochondriasis
Medical out-patients
Outcomes
Randomised controlled trial
Social functioning

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10.1016/j.ijnurstu.2014.11.013

Cite this

Tyrer, H., Tyrer, P., Lisseman-Stones, Y., McAllister, S., Cooper, S., Salkovskis, P., Crawford, M. J., Dupont, S., Green, J., Murphy, D., & Wang, D. (2015). Therapist differences in a randomised trial of the outcome of cognitive behaviour therapy for health anxiety in medical patients. International Journal of Nursing Studies, 52(3), 686-694. https://doi.org/10.1016/j.ijnurstu.2014.11.013

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title = "Therapist differences in a randomised trial of the outcome of cognitive behaviour therapy for health anxiety in medical patients",

abstract = "BackgroundHealth anxiety is common in medical settings and can be treated successfully by cognitive behaviour therapy. However it is not clear who might be best placed to deliver this therapy.ObjectivesIn a planned secondary analysis of data from a randomised trial of adapted cognitive behaviour therapy for health anxiety we compared outcomes of therapy delivered by nurses and other professional groups.DesignA randomised controlled trial with two treatment arms, 5–10 sessions of cognitive behaviour therapy adapted health anxiety or standard care.SettingCardiology, endocrine, gastroenterology, neurological and respiratory clinics in six general hospitals in the UK covering urban, suburban and rural areas.ParticipantsMedical patients attending the clinics who had pathological health anxiety and also scored for a diagnosis of hypochondriasis.MethodsPatients were randomised to one of two treatment arms, 5–10 sessions of cognitive behaviour therapy adapted health anxiety or standard care delivered by naive therapists (not randomised) who were trained in advance before delivering the treatment. Independent assessment of outcomes by researchers masked to allocation status at 3 m, 6 m, 12 m and 24 m.Results444 patients were randomised in the trial, 219 to cognitive behaviour therapy adapted health anxiety and 225 to standard care. 373 (84\%) completed assessments after two years. Those treated by nurses (n = 66) had improvement in health anxiety, generalised anxiety and depression outcomes that were significantly better and twice as great as those of the professional groups of assistant psychologists (n = 87) and graduate workers (n = 66) (P < 0.01 over all time points). The number needed to treat to show superiority of nurse-delivered treatment over other treatment delivery was 4 at 6 months and 6 at one year.ConclusionGeneral nurses, after suitable training, are very effective therapists for patients with health anxiety in medical clinics and should be the therapists of choice for patients in these settings.",

keywords = "Cognitive behaviour therapy, Depression, Generalised anxiety, Health anxiety, Hypochondriasis, Medical out-patients, Outcomes, Randomised controlled trial, Social functioning",

author = "Helen Tyrer and Peter Tyrer and Yvonne Lisseman-Stones and Sharon McAllister and Sylvia Cooper and Paul Salkovskis and Crawford, \{Michael J.\} and Simon Dupont and John Green and David Murphy and Duolao Wang",

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doi = "10.1016/j.ijnurstu.2014.11.013",

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Tyrer, H, Tyrer, P, Lisseman-Stones, Y, McAllister, S, Cooper, S, Salkovskis, P, Crawford, MJ, Dupont, S, Green, J, Murphy, D & Wang, D 2015, 'Therapist differences in a randomised trial of the outcome of cognitive behaviour therapy for health anxiety in medical patients', International Journal of Nursing Studies, vol. 52, no. 3, pp. 686-694. https://doi.org/10.1016/j.ijnurstu.2014.11.013

TY - JOUR

T1 - Therapist differences in a randomised trial of the outcome of cognitive behaviour therapy for health anxiety in medical patients

AU - Tyrer, Helen

AU - Tyrer, Peter

AU - Lisseman-Stones, Yvonne

AU - McAllister, Sharon

AU - Cooper, Sylvia

AU - Salkovskis, Paul

AU - Crawford, Michael J.

AU - Dupont, Simon

AU - Green, John

AU - Murphy, David

AU - Wang, Duolao

PY - 2015/3/1

Y1 - 2015/3/1

N2 - BackgroundHealth anxiety is common in medical settings and can be treated successfully by cognitive behaviour therapy. However it is not clear who might be best placed to deliver this therapy.ObjectivesIn a planned secondary analysis of data from a randomised trial of adapted cognitive behaviour therapy for health anxiety we compared outcomes of therapy delivered by nurses and other professional groups.DesignA randomised controlled trial with two treatment arms, 5–10 sessions of cognitive behaviour therapy adapted health anxiety or standard care.SettingCardiology, endocrine, gastroenterology, neurological and respiratory clinics in six general hospitals in the UK covering urban, suburban and rural areas.ParticipantsMedical patients attending the clinics who had pathological health anxiety and also scored for a diagnosis of hypochondriasis.MethodsPatients were randomised to one of two treatment arms, 5–10 sessions of cognitive behaviour therapy adapted health anxiety or standard care delivered by naive therapists (not randomised) who were trained in advance before delivering the treatment. Independent assessment of outcomes by researchers masked to allocation status at 3 m, 6 m, 12 m and 24 m.Results444 patients were randomised in the trial, 219 to cognitive behaviour therapy adapted health anxiety and 225 to standard care. 373 (84%) completed assessments after two years. Those treated by nurses (n = 66) had improvement in health anxiety, generalised anxiety and depression outcomes that were significantly better and twice as great as those of the professional groups of assistant psychologists (n = 87) and graduate workers (n = 66) (P < 0.01 over all time points). The number needed to treat to show superiority of nurse-delivered treatment over other treatment delivery was 4 at 6 months and 6 at one year.ConclusionGeneral nurses, after suitable training, are very effective therapists for patients with health anxiety in medical clinics and should be the therapists of choice for patients in these settings.

AB - BackgroundHealth anxiety is common in medical settings and can be treated successfully by cognitive behaviour therapy. However it is not clear who might be best placed to deliver this therapy.ObjectivesIn a planned secondary analysis of data from a randomised trial of adapted cognitive behaviour therapy for health anxiety we compared outcomes of therapy delivered by nurses and other professional groups.DesignA randomised controlled trial with two treatment arms, 5–10 sessions of cognitive behaviour therapy adapted health anxiety or standard care.SettingCardiology, endocrine, gastroenterology, neurological and respiratory clinics in six general hospitals in the UK covering urban, suburban and rural areas.ParticipantsMedical patients attending the clinics who had pathological health anxiety and also scored for a diagnosis of hypochondriasis.MethodsPatients were randomised to one of two treatment arms, 5–10 sessions of cognitive behaviour therapy adapted health anxiety or standard care delivered by naive therapists (not randomised) who were trained in advance before delivering the treatment. Independent assessment of outcomes by researchers masked to allocation status at 3 m, 6 m, 12 m and 24 m.Results444 patients were randomised in the trial, 219 to cognitive behaviour therapy adapted health anxiety and 225 to standard care. 373 (84%) completed assessments after two years. Those treated by nurses (n = 66) had improvement in health anxiety, generalised anxiety and depression outcomes that were significantly better and twice as great as those of the professional groups of assistant psychologists (n = 87) and graduate workers (n = 66) (P < 0.01 over all time points). The number needed to treat to show superiority of nurse-delivered treatment over other treatment delivery was 4 at 6 months and 6 at one year.ConclusionGeneral nurses, after suitable training, are very effective therapists for patients with health anxiety in medical clinics and should be the therapists of choice for patients in these settings.

KW - Cognitive behaviour therapy

KW - Depression

KW - Generalised anxiety

KW - Health anxiety

KW - Hypochondriasis

KW - Medical out-patients

KW - Outcomes

KW - Randomised controlled trial

KW - Social functioning

U2 - 10.1016/j.ijnurstu.2014.11.013

DO - 10.1016/j.ijnurstu.2014.11.013

M3 - Article

SN - 0020-7489

VL - 52

SP - 686

EP - 694

JO - International Journal of Nursing Studies

JF - International Journal of Nursing Studies

IS - 3

ER -

Therapist differences in a randomised trial of the outcome of cognitive behaviour therapy for health anxiety in medical patients

Abstract

Keywords

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