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Psychotherapies for hypochondriasis

  • Review
  • Intervention

Authors


Abstract

Background

Hypochondriasis is associated with significant medical morbidity and high health resource use. Recent studies have examined the treatment of hypochondriasis using various forms of psychotherapy.

Objectives

To examine the effectiveness and comparative effectiveness of any form of psychotherapy for the treatment of hypochondriasis.

Search methods

1. CCDANCTR-Studies and CCDANCTR-References were searched on 7/8/2007, CENTRAL, Medline, PsycINFO, EMBASE, Cinahl, ISI Web of Knowledge, AMED and WorldCat Dissertations; Current Controlled Trials meta-register (mRCT), CenterWatch, NHS National Research Register and clinicaltrials.gov; 2. Communication with authors of relevant studies and other clinicians in the field; 3. Handsearching reference lists of included studies and relevant review articles, and electronic citation search in ISI Web of Knowledge for all included studies.

Selection criteria

All randomised controlled studies, both published and unpublished, in any language, in which adults with hypochondriasis were treated with a psychological intervention.

Data collection and analysis

Data were extracted independently by two authors using a standardised extraction sheet. Study quality was assessed independently by the two authors qualitatively and using a standardised scale. Meta-analyses were performed using RevMan software. Standardised or weighted mean differences were used to pool data for continuous outcomes and odds ratios were used to pool data for dichotomous outcomes, together with 95% confidence intervals.

Main results

Six studies were included, with a total of 440 participants. The interventions examined were cognitive therapy (CT), behavioural therapy (BT), cognitive behavioural therapy (CBT), behavioural stress management (BSM) and psychoeducation. All forms of psychotherapy except psychoeducation showed a significant improvement in hypochondriacal symptoms compared to waiting list control (SMD (random) [95% CI] = -0.86 [-1.25 to -0.46]). For some therapies, significant improvements were found in the secondary outcomes of general functioning (CBT), resource use (psychoeducation), anxiety (CT, BSM), depression (CT, BSM) and physical symptoms (CBT). These secondary outcome findings were based on smaller numbers of participants and there was significant heterogeneity between studies.

Authors' conclusions

Cognitive therapy, behavioural therapy, cognitive behavioural therapy and behavioural stress management are effective in reducing symptoms of hypochondriasis. However, studies included in the review used small numbers of participants and do not allow estimation of effect size, comparison between different types of psychotherapy or whether people are "cured". Most long-term outcome data were uncontrolled. Further studies should make use of validated rating scales, assess treatment acceptability and effect on resource use, and determine the active ingredients and nonspecific factors that are important in psychotherapy for hypochondriasis.

摘要

背景

慮病症之心理治療

慮病症與顯著的內科疾患以及大量的醫療資源使用有關。近來已有些研究在檢視使用不同形式的心理治療對於慮病症的成效。

目標

檢視各種形式的心理治療對於慮病症的治療效果與相對效果。

搜尋策略

1. 2007年7月8日搜尋CCDANCTRStudies與CCDANCTRReferences, CENTRAL, Medline, PsycINFO, EMBASE, Cinahl, ISI Web of Knowledge, AMED 與 WorldCat Dissertations; Current Controlled Trials metaregister (mRCT), CenterWatch, NHS National Research Register 與 clinicaltrials.gov;2. 與相關研究的作者以及此領域的其他臨床工作者聯繫;3. 手動尋找納入研究的相關參考文獻以及相關的回顧文章,並在ISI Web of Knowledge對於所有納入研究做電子文獻引用搜尋。

選擇標準

納入所有使用心理治療處理成人慮病症的隨機對照試驗,不論是發表的或未發表的或使用任何語言。

資料收集與分析

兩位作者使用標準化的表單獨立地擷取資料。兩位作者以質性的方式,使用標準化的量表獨立地評估研究的品質。使用RevMan軟體來進行後設分析。對於連續性的結果變項使用標準化或加權的平均值差異來分析處理資料,而對二分的結果變項則使用勝算比與95%信賴區間來分析處理資料。

主要結論

納入六個研究,總共440個參與者。所檢視的治療為認知治療(CT),行為治療(BT),認知行為治療(CBT),行為壓力處理(BSM),以及心理教育。除了心理教育之外,所有形式的心理治療與等候名單的控制組相比,對於慮病症的症狀都呈現出顯著的改善(SMD (隨機) [95% CI] = −0.86 [1.25 to −0.46])。有一些治療在次要的結果變項上有顯著的改善,如:一般功能(CBT)、資源使用(心理教育)、焦慮(CT,BSM)、憂鬱(CT,BSM)與生理症狀(CBT)。產生這些次要結果變項的個案數較少,同時各研究間也有顯著的異質性。

作者結論

認知治療,行為治療,認知行為治療以及行為壓力處理對於降低慮病症的症狀是有效的。然而,此回顧所納入的研究使用的是小樣本的參與者,無法估計效果量、比較不同形式的心理治療效果,或評估患者是否真的「被治好」。大部分長期的結果資料都缺乏與控制組的比較。將來的研究應使用有效度的評量表,評估治療的被接受度,對於患者使用醫療資源的影響,以及找出對慮病症的心理治療中有效的治療因子與非特定因子。

翻譯人

本摘要由彰化基督教醫院陳美雀翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

慮病症患者相信或害怕他們患有沒有被診斷出來的嚴重疾病。這會導致高度的焦慮與重複詢求醫療協助。傳統上認為慮病症是難以治療的。不同的心理治療被建議用來治療慮病症患者,其中有些在臨床試驗中被驗證。這篇回顧的目的在於評估哪一種心理治療在治療慮病症患者上是有效的。回顧納入6個研究。對資料的分析顯示,與等候名單相較,認知與行為治療,或一種稱為行為壓力處理的非特異治療,都改善了慮病症的症狀。然而,研究樣本小,沒辦法評估每種治療的療效有多大。有可能患者的改善是來自於定期與治療者接觸的非特定因素,而非這些心理治療的特定性質。此外也沒辦法比較不同心理治療的效果。一個有關心理教育的研究顯示並沒有充分的證據支持這種心理治療是有效的。

Plain language summary

Psychotherapies for hypochondriasis

Hypochondriasis is a condition in which the sufferer believes or fears that they have an undiagnosed serious illness. It can cause much anxiety and repeated seeking of medical help and traditionally has been considered difficult to treat. A number of different psychotherapies have been suggested as treatments for sufferers of hypochondriasis, some of which have been tested in clinical trials.

The objective of this review was to assess whether any form of psychotherapy is effective in the management of people suffering from hypochondriasis. Six studies were included in the review. Analysis of data suggested that, compared to being on a waiting list, forms of cognitive and behaviour therapy, or a non-specific therapy called behavioural stress management all improve the symptoms of hypochondriasis. However, the numbers of people in the studies were small and it was not possible to tell how much of an improvement each therapy made. It is possible that the improvements seen were due to non-specific factors involved in regular contact with a therapist rather than specific properties of these forms of psychotherapy. It was also not possible to make comparisons between the different types of psychotherapy. A study of psychoeducation was not considered to be sufficient evidence that this form of psychotherapy is effective.

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