Cognitive behavioral therapy shows promise for hypochondria, as patients with persistent fears or beliefs of serious, undiagnosed illness significantly reduced symptoms and anxieties after participating in therapy that examined possible factors for their fears, according to a study in the March 24th issue of The Journal of the American Medical Association.

According to information in the article, hypochondriasis occurs in as many as 5 percent of medical outpatients and can be a disabling and chronic condition. Hypochondriasis generally has not been responsive to psychological and pharmacological treatment and is costly for the health care system. Until recently, no specific treatment has been clearly demonstrated to be effective.

An American team examined whether cognitive behavior therapy would alleviate the symptoms of hypochondriasis more effectively than medical care as usual. Test therapy consisted of 6 individually administered, weekly 90-minute sessions. Each session was tightly scripted and devoted to 1 of 5 factors that cause patients to amplify symptoms and misattribute them to serious disease: attention and bodily hypervigilance, beliefs about symptom etiology, circumstances and context, illness and sick role behaviors, and mood.

Each session consisted of educational information about the symptom amplifiers, an illustrative exercise, and a discussion to personalize the material presented. Therapy was accompanied by a consultation letter sent to the patient's primary care physician. Participants were recruited from primary care practices and from volunteers responding to public announcements.

The study, conducted between September 1997 and November 2001, included 102 individuals who were assigned to cognitive behavioral therapy and 85 people who were assigned to medical care as usual. Participants were assessed immediately before initiation of therapy and 6 and 12 months after the completion of treatment.

"Using an intent-to-treat analytic strategy, a consistent pattern of statistically and clinically significant treatment effects was found at both 6-and 12-month follow-up, adjusting for baseline covariates that included educational level, generalized psychiatric distress, and participant status (patient versus volunteer)," the authors wrote. "At 12-month follow-up, cognitive behavioral therapy patients had significantly lower levels of hypochondriacal symptoms, beliefs, and attitudes and health-related anxiety. They also had significantly less impairment of social role functioning and intermediate activities of daily living."