Title: Cognitive-behavioural therapy for Health Anxiety in Medical Patients (CHAMP)
Funder: Department of Health and Social Care

Abstract: Significant health anxiety (hypochondriasis) affects about 1 in 7 attenders at general medical clinics and is a major source of morbidity as well as an additional burden on the health service because of the unnecessary investigations that are often performed in such patients. This condition is rarely detected or treated in conventional care. There is a successful treatment, cognitive behaviour therapy adapted for health anxiety, shown to be of value in small trials and which also suggests that it reduces clinic attendance subsequently. The CHAMP study investigates whether this treatment given by trained staff seconded from their ordinary work in medical clinics, supported by colleagues with expertise in the treatment, not only reduces health anxiety and associated symptoms, but also improves social function, occupational performance and quality of life, and offsets the cost of treatment by saving on unnecessary medical investigations and appointments subsequently. This is to be done using a randomized controlled trial design in which patients with significant health anxiety (hypochondriasis) attending medical clinics in four centres will be allocated randomly to 5-10 sessions of cognitive behaviour therapy, backed up by a booklet on this treatment for health anxiety, or to a single explanatory interview about health anxiety. The aim is to recruit about 465 patients in four centres over a fifteen month period in repiratory medicine, cardiology, endocrinology and gastroenterology clinics. Patients will be seen by research assistants masked to knowledge of treatment allocation after 6, 12 and 24 months to complete ratings of clinical progress, and full information will be obtained on health service costs in both primary and secondary care over this time period as well. It is hypothesised that not only will symptoms and functioning will improved but also that there will be reduced costs in the active treatment arm after two years.

Lay abstract: Hypochondriasis, or health anxiety, is a significant problem in all parts of clinical practice, but has been largely ignored by services until recently. Our studies, and those of others, suggest that between 1 in 4 and 1 in 10 of all those attending medical clinics have significant health anxiety and this accounts for both considerable suffering and unnecessary use of resources. One of the characteristics of those with severe health anxiety is that it persists and leads to frequent medical consultations in both primary and secondary care. This represents a significant drain on health service resources at a time of considerable cost pressures, and, in addition, the symptoms of health anxiety are highly troubling and disturbing, are associated with much time off work, and adversely affect social functioning. In a pilot randomised controlled trial of treatment in a genitourinary medicine clinic, we found that a short course of cognitive behaviour therapy (CBT) was highly effective, and significantly better than a simple explanatory interview, in reducing health anxiety and that these benefits are maintained over a period of one year. We also found that the number of consultations in both general practice and the clinics fell in those in the active treatment group over one year but the savings made here were small as costs of investigations are relatively low. We are now planning a large three-centre trial of CBT versus a short explanatory interview to treat health anxiety in cardiology, respiratory medicine, gastroenterology and endocrinology clinics, where such anxiety is more common than in genuitourinary medicine. We propose to identify all those attending in one year with significant health anxiety (score 20 or more on the Health Anxiety Inventory together with a diagnostic interview) with the help of clinical nurse specialists and clinical studies officers from the MHRN. Treatment will be by nurses trained in CBT and assessments of functioning, generalised anxiety and quality of life will be made by full-time researchers at each centre, and both health service and employment costs assessed at baseline and at 6 monthly intervals for two years, with the sample of 465 patients testing the primary hypothesis that the costs of treatment would be offset by savings on attendance and investigations over 2 years.

Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH