Therapist differences in a randomised trial of the outcome of cognitive behaviour therapy for health anxiety in medical patients

Helen Tyrer, Peter Tyrer, Yvonne Lisseman-Stones, Sharon McAllister, Sylvia Cooper, Paul Salkovskis, Michael J. Crawford, Simon Dupont, John Green, David Murphy, Duolao Wang

Research output: Contribution to journalArticle

12 Citations (Scopus)
87 Downloads (Pure)

Abstract

Background: Health anxiety is common in medical settings and can be treated successfully by cognitive behaviour therapy. However it is not clear who might be best placed to deliver this therapy. Objectives: In a planned secondary analysis of data from a randomised trial of adapted cognitive behaviour therapy for health anxiety we compared outcomes of therapy delivered by nurses and other professional groups. Design: A randomised controlled trial with two treatment arms, 5-10 sessions of cognitive behaviour therapy adapted health anxiety or standard care. Setting: Cardiology, endocrine, gastroenterology, neurological and respiratory clinics in six general hospitals in the UK covering urban, suburban and rural areas. Participants: Medical patients attending the clinics who had pathological health anxiety and also scored for a diagnosis of hypochondriasis. Methods: Patients were randomised to one of two treatment arms, 5-10 sessions of cognitive behaviour therapy adapted health anxiety or standard care delivered by naive therapists (not randomised) who were trained in advance before delivering the treatment. Independent assessment of outcomes by researchers masked to allocation status at 3. m, 6. m, 12. m and 24. m. Results: 444 patients were randomised in the trial, 219 to cognitive behaviour therapy adapted health anxiety and 225 to standard care. 373 (84%) completed assessments after two years. Those treated by nurses (n = 66) had improvement in health anxiety, generalised anxiety and depression outcomes that were significantly better and twice as great as those of the professional groups of assistant psychologists (n = 87) and graduate workers (n = 66) (P <. 0.01 over all time points). The number needed to treat to show superiority of nurse-delivered treatment over other treatment delivery was 4 at 6 months and 6 at one year. Conclusion: General nurses, after suitable training, are very effective therapists for patients with health anxiety in medical clinics and should be the therapists of choice for patients in these settings.

Original languageEnglish
Pages (from-to)686-694
Number of pages9
JournalInternational Journal of Nursing Studies
Volume52
Issue number3
Early online date4 Dec 2014
DOIs
Publication statusPublished - Mar 2015

Fingerprint

Cognitive Therapy
Anxiety
Health
Nurses
Therapeutics
Hypochondriasis
Numbers Needed To Treat
Gastroenterology
Cardiology
General Hospitals
Randomized Controlled Trials
Research Personnel
Outcome Assessment (Health Care)
Depression
Psychology

Keywords

  • Cognitive behaviour therapy
  • Depression
  • Generalised anxiety
  • Health anxiety
  • Hypochondriasis
  • Medical out-patients
  • Outcomes
  • Randomised controlled trial
  • Social functioning

Cite this

Therapist differences in a randomised trial of the outcome of cognitive behaviour therapy for health anxiety in medical patients. / Tyrer, Helen; Tyrer, Peter; Lisseman-Stones, Yvonne; McAllister, Sharon; Cooper, Sylvia; Salkovskis, Paul; Crawford, Michael J.; Dupont, Simon; Green, John; Murphy, David; Wang, Duolao.

In: International Journal of Nursing Studies, Vol. 52, No. 3, 03.2015, p. 686-694.

Research output: Contribution to journalArticle

Tyrer, H, Tyrer, P, Lisseman-Stones, Y, McAllister, S, Cooper, S, Salkovskis, P, Crawford, MJ, Dupont, S, Green, J, Murphy, D & Wang, D 2015, 'Therapist differences in a randomised trial of the outcome of cognitive behaviour therapy for health anxiety in medical patients', International Journal of Nursing Studies, vol. 52, no. 3, pp. 686-694. https://doi.org/10.1016/j.ijnurstu.2014.11.013
Tyrer, Helen ; Tyrer, Peter ; Lisseman-Stones, Yvonne ; McAllister, Sharon ; Cooper, Sylvia ; Salkovskis, Paul ; Crawford, Michael J. ; Dupont, Simon ; Green, John ; Murphy, David ; Wang, Duolao. / Therapist differences in a randomised trial of the outcome of cognitive behaviour therapy for health anxiety in medical patients. In: International Journal of Nursing Studies. 2015 ; Vol. 52, No. 3. pp. 686-694.
@article{15e7fa2f494c49d8bbccf056a6eb1335,
title = "Therapist differences in a randomised trial of the outcome of cognitive behaviour therapy for health anxiety in medical patients",
abstract = "Background: Health anxiety is common in medical settings and can be treated successfully by cognitive behaviour therapy. However it is not clear who might be best placed to deliver this therapy. Objectives: In a planned secondary analysis of data from a randomised trial of adapted cognitive behaviour therapy for health anxiety we compared outcomes of therapy delivered by nurses and other professional groups. Design: A randomised controlled trial with two treatment arms, 5-10 sessions of cognitive behaviour therapy adapted health anxiety or standard care. Setting: Cardiology, endocrine, gastroenterology, neurological and respiratory clinics in six general hospitals in the UK covering urban, suburban and rural areas. Participants: Medical patients attending the clinics who had pathological health anxiety and also scored for a diagnosis of hypochondriasis. Methods: Patients were randomised to one of two treatment arms, 5-10 sessions of cognitive behaviour therapy adapted health anxiety or standard care delivered by naive therapists (not randomised) who were trained in advance before delivering the treatment. Independent assessment of outcomes by researchers masked to allocation status at 3. m, 6. m, 12. m and 24. m. Results: 444 patients were randomised in the trial, 219 to cognitive behaviour therapy adapted health anxiety and 225 to standard care. 373 (84{\%}) completed assessments after two years. Those treated by nurses (n = 66) had improvement in health anxiety, generalised anxiety and depression outcomes that were significantly better and twice as great as those of the professional groups of assistant psychologists (n = 87) and graduate workers (n = 66) (P <. 0.01 over all time points). The number needed to treat to show superiority of nurse-delivered treatment over other treatment delivery was 4 at 6 months and 6 at one year. Conclusion: General nurses, after suitable training, are very effective therapists for patients with health anxiety in medical clinics and should be the therapists of choice for patients in these settings.",
keywords = "Cognitive behaviour therapy, Depression, Generalised anxiety, Health anxiety, Hypochondriasis, Medical out-patients, Outcomes, Randomised controlled trial, Social functioning",
author = "Helen Tyrer and Peter Tyrer and Yvonne Lisseman-Stones and Sharon McAllister and Sylvia Cooper and Paul Salkovskis and Crawford, {Michael J.} and Simon Dupont and John Green and David Murphy and Duolao Wang",
year = "2015",
month = "3",
doi = "10.1016/j.ijnurstu.2014.11.013",
language = "English",
volume = "52",
pages = "686--694",
journal = "International Journal of Nursing Studies",
issn = "0020-7489",
publisher = "Elsevier",
number = "3",

}

TY - JOUR

T1 - Therapist differences in a randomised trial of the outcome of cognitive behaviour therapy for health anxiety in medical patients

AU - Tyrer, Helen

AU - Tyrer, Peter

AU - Lisseman-Stones, Yvonne

AU - McAllister, Sharon

AU - Cooper, Sylvia

AU - Salkovskis, Paul

AU - Crawford, Michael J.

AU - Dupont, Simon

AU - Green, John

AU - Murphy, David

AU - Wang, Duolao

PY - 2015/3

Y1 - 2015/3

N2 - Background: Health anxiety is common in medical settings and can be treated successfully by cognitive behaviour therapy. However it is not clear who might be best placed to deliver this therapy. Objectives: In a planned secondary analysis of data from a randomised trial of adapted cognitive behaviour therapy for health anxiety we compared outcomes of therapy delivered by nurses and other professional groups. Design: A randomised controlled trial with two treatment arms, 5-10 sessions of cognitive behaviour therapy adapted health anxiety or standard care. Setting: Cardiology, endocrine, gastroenterology, neurological and respiratory clinics in six general hospitals in the UK covering urban, suburban and rural areas. Participants: Medical patients attending the clinics who had pathological health anxiety and also scored for a diagnosis of hypochondriasis. Methods: Patients were randomised to one of two treatment arms, 5-10 sessions of cognitive behaviour therapy adapted health anxiety or standard care delivered by naive therapists (not randomised) who were trained in advance before delivering the treatment. Independent assessment of outcomes by researchers masked to allocation status at 3. m, 6. m, 12. m and 24. m. Results: 444 patients were randomised in the trial, 219 to cognitive behaviour therapy adapted health anxiety and 225 to standard care. 373 (84%) completed assessments after two years. Those treated by nurses (n = 66) had improvement in health anxiety, generalised anxiety and depression outcomes that were significantly better and twice as great as those of the professional groups of assistant psychologists (n = 87) and graduate workers (n = 66) (P <. 0.01 over all time points). The number needed to treat to show superiority of nurse-delivered treatment over other treatment delivery was 4 at 6 months and 6 at one year. Conclusion: General nurses, after suitable training, are very effective therapists for patients with health anxiety in medical clinics and should be the therapists of choice for patients in these settings.

AB - Background: Health anxiety is common in medical settings and can be treated successfully by cognitive behaviour therapy. However it is not clear who might be best placed to deliver this therapy. Objectives: In a planned secondary analysis of data from a randomised trial of adapted cognitive behaviour therapy for health anxiety we compared outcomes of therapy delivered by nurses and other professional groups. Design: A randomised controlled trial with two treatment arms, 5-10 sessions of cognitive behaviour therapy adapted health anxiety or standard care. Setting: Cardiology, endocrine, gastroenterology, neurological and respiratory clinics in six general hospitals in the UK covering urban, suburban and rural areas. Participants: Medical patients attending the clinics who had pathological health anxiety and also scored for a diagnosis of hypochondriasis. Methods: Patients were randomised to one of two treatment arms, 5-10 sessions of cognitive behaviour therapy adapted health anxiety or standard care delivered by naive therapists (not randomised) who were trained in advance before delivering the treatment. Independent assessment of outcomes by researchers masked to allocation status at 3. m, 6. m, 12. m and 24. m. Results: 444 patients were randomised in the trial, 219 to cognitive behaviour therapy adapted health anxiety and 225 to standard care. 373 (84%) completed assessments after two years. Those treated by nurses (n = 66) had improvement in health anxiety, generalised anxiety and depression outcomes that were significantly better and twice as great as those of the professional groups of assistant psychologists (n = 87) and graduate workers (n = 66) (P <. 0.01 over all time points). The number needed to treat to show superiority of nurse-delivered treatment over other treatment delivery was 4 at 6 months and 6 at one year. Conclusion: General nurses, after suitable training, are very effective therapists for patients with health anxiety in medical clinics and should be the therapists of choice for patients in these settings.

KW - Cognitive behaviour therapy

KW - Depression

KW - Generalised anxiety

KW - Health anxiety

KW - Hypochondriasis

KW - Medical out-patients

KW - Outcomes

KW - Randomised controlled trial

KW - Social functioning

UR - http://www.scopus.com/inward/record.url?scp=84919628890&partnerID=8YFLogxK

UR - http://dx.doi.org/10.1016/j.ijnurstu.2014.11.013

U2 - 10.1016/j.ijnurstu.2014.11.013

DO - 10.1016/j.ijnurstu.2014.11.013

M3 - Article

VL - 52

SP - 686

EP - 694

JO - International Journal of Nursing Studies

JF - International Journal of Nursing Studies

SN - 0020-7489

IS - 3

ER -