Acceptance and Commitment Group Therapy (ACT) for Patients With Health Anxiety
Condition: Hypochondriasis; Somatization Disorder
MeSH terms: Hypochondriasis; Somatoform Disorders
Study type: Interventional

Summary: 
      The purpose of this study is to determine the effect of Acceptance and Commitment Therapy
      (ACT) in groups on functional level, emotional problems, and use of health care in patients
      with severe health anxiety in a randomized, controlled design.
    

Detailed description: 
      Health anxiety disorder or Hypochondriasis is a prevalent somatoform disorder, but a rarely
      used diagnosis in clinical practice despite studies having reported prevalence between
      0.8-9.5% in primary care (Fink et al, 2004). As a consequence, the disorder is rarely
      treated.

      The lack of valid, reliable, and generally accepted diagnostic criteria has been a major
      obstacle in clinical practice and Hypochondriasis studies, which causes problems particularly
      in distinguishing Hypochondriasis patients from other patients presenting with medically
      unexplained symptoms or functional symptoms.

      In 2004, the investigators introduced a radically revised definition of Hypochondriasis.
      Hypochondriasis is viewed as a stigmatizing label, and the designation health anxiety has
      been suggested as replacement. This new diagnosis is empirically established. The essential
      feature of health anxiety is that the patients present with cognitive symptoms such as
      unfounded worrying about their health. In contrast to other somatoform disorders, the
      patients are not necessarily plagued by physical symptoms.

      The new diagnostic criteria include the symptom 'obsessive rumination about illness' plus at
      least one of the symptoms 'worry or preoccupation with fears of harboring an illness or with
      bodily functions', 'suggestibility or autosuggestibility', 'an unrealistic fear of being
      infected or contaminated', 'an excessive fascination with medical information', or 'fear of
      taking prescribed medication'.

      In the current study, health anxiety is diagnosed by use of newly introduced empirically
      established positive criteria for Health anxiety (Fink et al, 2004).

      Most patients with health anxiety disorder receive the majority of their care in primary care
      settings. They are often unhappy with the services they receive, and primary care providers
      often feel unprepared to address symptoms that primarily appear functional.

      During the past 5 years, the investigators have treated patients suffering from severe
      functional disorder (i.e. Bodily distress syndrome or Somatization disorder) in randomized
      controlled trials (RCTs) - at the Research Clinic. The investigators reject many patients
      suffering from health anxiety, who have no other treatment opportunities, and there is an
      impending need for treatment opportunities. The investigators research group has done
      research in epidemiology, psychopathology and diagnostics of Health anxiety, and the
      investigators are part of international networks regarding the revision of the diagnostic
      criteria of the Diagnostic and Statistical Manual of Mental Disorders V (DSM-V) and the
      International Classification of Diseases 11 (ICD-11).

      RCTs have shown that Cognitive Behavioral Therapy (CBT) has effect on health anxiety (Barsky
      & Ahern, 2004; Greeven et al., 2007), and one of the trials also showed effect of
      anti-depressant medication (Greeven et al., 2007).

      In general, the treatment of health anxiety is sparsely investigated both as to psychotherapy
      and medical treatment.

      The investigators wish to examine the effect of Acceptance and Commitment Therapy (ACT) in
      groups on functional level, emotional problems, and use of health care in patients with
      severe health anxiety in a randomized, controlled design.

      Health anxiety disorder is a burden for the sufferers and costly for society due to lost
      working years because of early onset of the disorder and high health care costs. The
      development of evidence-based treatment offering these patients the same professional
      treatment as patients with other disorders may lead to better quality of life for the
      patients and reduction in health care costs.
    

Intervention name(s): ACT group therapy
Intervention type(s): Behavioral
Intervention description(s): Group therapy (ACT) in groups of 9 patients in 9 weekly 3.5-hours sessions & 1 booster session 1 month after 9th session, a total of 35.5 hours
Other intervention name(s): Third generation cognitive behavioral therapy
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Hypochondriasis; Acceptance and Commitment Therapy; ACT