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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
Karolinska Inst, Sweden.
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology. Orebro Univ, Sweden.ORCID iD: 0000-0002-9736-8228
Karolinska Inst, Sweden.
Karolinska Inst, 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
PERGAMON-ELSEVIER SCIENCE LTD , 2020. Vol. 69, article id 102172
Keywords [en]
Cognitive behaviour therapy; Health anxiety; Hypochondriasis; Illness anxiety disorder; Mediation; Somatic symptom disorder
National Category
Applied Psychology
Identifiers
URN: urn:nbn:se:liu:diva-163457DOI: 10.1016/j.janxdis.2019.102172ISI: 000509005800007PubMedID: 31864217OAI: oai:DiVA.org:liu-163457DiVA, id: diva2:1393705
Note

Funding Agencies|Karolinska InstitutetKarolinska Institutet; Region Stockholm

Available from: 2020-02-17 Created: 2020-02-17 Last updated: 2020-02-17

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PsychologyFaculty of Arts and SciencesDepartment of Otorhinolaryngology
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