Psychotherapies for hypochondriasis

Hypochondriasis is a condition in which the sufferer believes or fears that they have an undiagnosed serious illness. It can cause much anxiety and repeated seeking of medical help and traditionally has been considered difficult to treat. A number of different psychotherapies have been suggested as treatments for sufferers of hypochondriasis, some of which have been tested in clinical trials.

The objective of this review was to assess whether any form of psychotherapy is effective in the management of people suffering from hypochondriasis. Six studies were included in the review. Analysis of data suggested that, compared to being on a waiting list, forms of cognitive and behaviour therapy, or a non-specific therapy called behavioural stress management all improve the symptoms of hypochondriasis. However, the numbers of people in the studies were small and it was not possible to tell how much of an improvement each therapy made. It is possible that the improvements seen were due to non-specific factors involved in regular contact with a therapist rather than specific properties of these forms of psychotherapy. It was also not possible to make comparisons between the different types of psychotherapy. A study of psychoeducation was not considered to be sufficient evidence that this form of psychotherapy is effective.

Authors' conclusions: 

Cognitive therapy, behavioural therapy, cognitive behavioural therapy and behavioural stress management are effective in reducing symptoms of hypochondriasis. However, studies included in the review used small numbers of participants and do not allow estimation of effect size, comparison between different types of psychotherapy or whether people are "cured". Most long-term outcome data were uncontrolled. Further studies should make use of validated rating scales, assess treatment acceptability and effect on resource use, and determine the active ingredients and nonspecific factors that are important in psychotherapy for hypochondriasis.

Read the full abstract...

Hypochondriasis is associated with significant medical morbidity and high health resource use. Recent studies have examined the treatment of hypochondriasis using various forms of psychotherapy.


To examine the effectiveness and comparative effectiveness of any form of psychotherapy for the treatment of hypochondriasis.

Search strategy: 

1. CCDANCTR-Studies and CCDANCTR-References were searched on 7/8/2007, CENTRAL, Medline, PsycINFO, EMBASE, Cinahl, ISI Web of Knowledge, AMED and WorldCat Dissertations; Current Controlled Trials meta-register (mRCT), CenterWatch, NHS National Research Register and; 2. Communication with authors of relevant studies and other clinicians in the field; 3. Handsearching reference lists of included studies and relevant review articles, and electronic citation search in ISI Web of Knowledge for all included studies.

Selection criteria: 

All randomised controlled studies, both published and unpublished, in any language, in which adults with hypochondriasis were treated with a psychological intervention.

Data collection and analysis: 

Data were extracted independently by two authors using a standardised extraction sheet. Study quality was assessed independently by the two authors qualitatively and using a standardised scale. Meta-analyses were performed using RevMan software. Standardised or weighted mean differences were used to pool data for continuous outcomes and odds ratios were used to pool data for dichotomous outcomes, together with 95% confidence intervals.

Main results: 

Six studies were included, with a total of 440 participants. The interventions examined were cognitive therapy (CT), behavioural therapy (BT), cognitive behavioural therapy (CBT), behavioural stress management (BSM) and psychoeducation. All forms of psychotherapy except psychoeducation showed a significant improvement in hypochondriacal symptoms compared to waiting list control (SMD (random) [95% CI] = -0.86 [-1.25 to -0.46]). For some therapies, significant improvements were found in the secondary outcomes of general functioning (CBT), resource use (psychoeducation), anxiety (CT, BSM), depression (CT, BSM) and physical symptoms (CBT). These secondary outcome findings were based on smaller numbers of participants and there was significant heterogeneity between studies.

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