Mainstream cognitive behavioural theory stipulates that clinically significant health anxiety persists over time at least partially due to negatively reinforced health-related behaviours, but there exists no broad and psychometrically valid measure of such behaviours.

To draft and evaluate a new self-report scale – the Health Anxiety Behavior Inventory (HABI) – for the measurement of negatively reinforced health anxiety behaviours.

We drafted the HABI from a pool of 20 candidate items administered in a clinical trial at screening, and before and after cognitive behaviour therapy (n=204). A psychometric evaluation focused on factor structure, internal consistency, convergent and discriminant validity, test–retest reliability, and sensitivity to change.

Based on factor analysis, the HABI was completed as a 12-item instrument with a four-dimensional factor structure corresponding to the following scales: (i) bodily preoccupation and checking, (ii) information- and reassurance-seeking, (iii) prevention and planning, and (iv) overt avoidance. Factor inter-correlations were modest. The internal consistency (α=.73–.87) and 2-week test–retest reliability (r=.75–.90) of the scales was adequate. The bodily preoccupation and checking, and information- and reassurance-seeking scales were most strongly correlated with the cognitive and emotional components of health anxiety (r=0.41, 0.48), and to a lower extent correlated to depressive symptoms and disability. Change scores in all HABI scales correlated with improvement in the cognitive and emotional components of health anxiety during cognitive behaviour therapy.

The HABI appears to reliably measure negatively reinforced behaviours commonly seen in clinically significant health anxiety, and might be clinically useful in the treatment of health anxiety.

A few former studies suggested that there are partial overlaps in abnormal brain structure and cognitive function between hypochondriasis (HS) and schizophrenia (SZ). But their differences in brain activity and cognitive function were unclear.

Twenty-one HS patients, 23 SZ patients, and 24 healthy controls (HC) underwent resting-state functional magnetic resonance imaging (rs-fMRI) with the regional homogeneity analysis (ReHo), subsequently exploring the relationship between ReHo value and cognitive functions. The support vector machines (SVM) were used on effectiveness evaluation of ReHo for differentiating HS from SZ.

Compared with HC, HS showed significantly increased ReHo values in right middle temporal gyrus (MTG), left inferior parietal lobe (IPL), and right fusiform gyrus (FG), while SZ showed increased ReHo in left insula, decreased ReHo values in right paracentral lobule. Additionally, HS showed significantly higher ReHo values in FG, MTG, and left paracentral lobule, but lower in insula than SZ. The higher ReHo values in insula were associated with worse performance in MATRICS consensus cognitive battery (MCCB) in HS group. SVM analysis showed a combination of the ReHo values in insula and FG was able to satisfactorily distinguish the HS and SZ patients.

Our results suggested that the altered default mode network (DMN), of which abnormal spontaneous neural activity occurs in multiple brain regions, might play a key role in the pathogenesis of HS, and the resting-state alterations of insula are closely related to cognitive dysfunction in HS. Furthermore, the combination of the ReHo in FG and insula was a relatively ideal indicator to distinguish HS from SZ.

Health anxiety is common, disabling and costly due to patients’ extensive use of health care services. Internet-delivered treatment may overcome barriers of accessibility to specialized treatment. We aimed to evaluate the efficacy of internet-delivered acceptance and commitment therapy (iACT).

A randomized, controlled trial of iACT versus an internet-delivered discussion forum (iFORUM), performed in a Danish university hospital setting. Patients self-referred and underwent video-diagnostic assessment. Eligible patients (≥18 years) with health anxiety were randomized to 12 weeks of intervention. The randomization was blinded for the assessor. The primary outcome was between-group unadjusted mean differences in health anxiety symptoms measured by the Whiteley-7 Index (WI-7, range 0–100) from baseline to 6-month follow-up (6-MFU) using intention to treat and a linear mixed model. The study is registered at clinicaltrials.gov, number NCT02735434.

A total of 151 patients self-referred, and 101 patients were randomized to iACT (n = 53) or iFORUM (n = 48). A mean difference in change over time of 19.0 points [95% confidence interval (CI) 10.8–27.2, p < 0.001] was shown on the WI-7, and a large standardized effect size of d = 0.80 (95% CI 0.38–1.23) at 6-MFU. The number needed to treat was 2.8 (95% CI 1.8–6.1, p < 0.001), and twice as many patients in iACT were no longer clinical cases (35% v. 16%; risk ratio 2.17, 95% CI 1.00–4.70, p = 0.050). Adverse events were few and insignificant.

iACT for health anxiety led to sustained effects at 6-MFU. The study contributes to the development of easily accessible treatment options and deserves wider application.

Cognitive behavioural models of hypochondriasis assume that dysfunctional illness-related beliefs are involved in the genesis and maintenance of the disorder. The role that other more general dysfunctional beliefs about thoughts play in this disorder has also been highlighted. Internal triggers such as illness-related intrusive thoughts could activate these beliefs.

The present paper examines whether general dysfunctional beliefs about distressing thoughts, such as intolerance of uncertainty, over-estimation of threat, and thought-action fusion-likelihood, mediate between illness-related intrusive thoughts and health anxiety symptoms.

A group of participants composed of individuals with hypochondriasis (n = 31; 51.5% women; mean age = 32.74 years, SD = 9.96) and community individuals (n = 219; 54.3% women; mean age = 39.56 years, SD = 15.20) completed a series of questionnaires to assess illness-related intrusive thoughts (INPIE), dysfunctional beliefs about thoughts (OBSI-R), and health anxiety symptoms (SHAI).

Results from a multiple parallel mediation analysis indicate that over-estimation of threat partially mediated the relationship between illness-related intrusive thoughts and health anxiety symptoms.

The results support the importance of the tendency to over-estimate the threat in the relationship between intrusive thoughts related to illness contents and health anxiety. Conceptual and clinical implications of these results are discussed.

Severe health anxiety is a chronic and costly disorder if untreated. Patient self-referral may lower barriers to treatment and decrease diagnostic delay.

This study evaluated the accuracy of self-referral for severe health anxiety and compared characteristics of patients self-referred to internet-delivered treatment with patients referred by a clinician to face-to-face treatment.

Two trials in the same clinic employed different referral methods for health anxiety, namely self-referral and clinician-referral (trial registration: clinicaltrials.gov: NCT01158430 and NCT02735434). The trials were conducted at different time points but with largely comparable eligibility criteria. The accuracy of the recruitment methods was compared by looking at the number of eligible patients in the two trials. Patients completed a baseline questionnaire and subsequently underwent a diagnostic interview by experienced clinicians. Mean differences in self-report and clinical data explored between-group demographic and clinical characteristics.

In total, 101/151 (67%) self-referred patients were eligible compared with 126/254 (50%) clinician-referred patients (P = 0.001). Self-referred patients were 3.4 years older (P = 0.008) and had a somewhat higher educational level (P = 0.030). Patients who self-referred reported significantly higher levels of health anxiety, emotional distress and somatic symptoms compared with clinician-referred patients. Yet, they had less clinician-assessed comorbid anxiety disorders (P<0.001) and better physical health-related quality of life (P<0.001) suggesting a more distinct symptom profile.

Self-referral was found to be an accurate method to recruit highly relevant patients with treatment-demanding health anxiety. Thus, both self-referral and clinician-referral seem feasible and valid referral methods, but they may recruit patients with slightly different characteristics.

None.

Severe health anxiety is frequent and costly, yet rarely diagnosed or treated. Earlier treatment studies show problems with recruitment, dropout and recovery. In the current study, the authors aimed to test the effect of acceptance and commitment group therapy (ACT-G) compared to waitlist in patients with severe health anxiety.

During March 2010 to April 2012, 126 consecutively referred patients meeting research criteria for severe health anxiety were block-randomized (1:1) to ACT-G or a 10 months’ waitlist (Clinicaltrials.gov, no. NCT01158430). Patients allocated to ACT-G were treated in seven groups of nine patients between December 2010 and October 2012 and received nine weekly 3-h group sessions and a booster session consisting of ACT techniques. The primary outcome was decided a priori as the mean change in self-reported illness worry on the Whiteley-7 Index (WI) from baseline to 10 months’ follow-up. Secondary outcomes were improvement in emotional distress and health-related quality of life at 10 months’ follow-up.

Intention-to-treat analysis showed a statistically significant mean difference of 20.5 points [95% confidence interval (CI) 11.7–29·4, p < 0.001] on the WI between the groups at 10 months, and the between-group effect sizes were large (Cohen's d = 0.89, 95% CI 0.50–1.29). The number needed to treat was 2.4 (95% CI 1.4–3.4, p < 0.001). Diagnosis and treatment were well accepted by the patients.

ACT-G seems feasible, acceptable and effective in treating severe health anxiety.

The aim of the study was to investigate the prevalence rates of obsessive-compulsive disorder (OCD) and hypochondriasis in schizophrenic patients treated with atypical antipsychotics (AAPs) and to investigate the different comorbidity rates of OCD and hypochondriasis between clozapine-treated patients and patients treated with other AAPs.

We therefore recruited 60 schizophrenic patients treated with clozapine or other AAPs. We assessed the prevalence rates of OCD or OC symptoms and hypochondriasis or hypochondriac symptoms in the whole group of patients and in clozapine-treated patients versus patients treated with other AAPs.

Schizophrenic patients had a higher comorbidity rate of OCD (26.6% vs 1–3%) and hypochondriasis (20% vs 1%) than the general population. These comorbidities were more frequent in schizophrenic patients treated with clozapine versus patients treated with other AAPs (36.7% vs 16.7% and 33.3% vs 6.7%). Clozapine-treated patients showed a higher mean Y-BOCS and HY-BOCS score when compared to patients treated with other AAPs (10.90 vs 5.90, p = .099; 15.40 vs 8.93, p = .166). A statistical significant correlation was found between the Y-BOCS and HY-BOCS scores of the whole group (r = .378, p = 0.03). Furthermore, we found an inverse correlation between the global level of functioning and the diagnosis of hypochondriasis (p = .048) and the severity of hypochondriac symptoms (p = .047).

Hypochondriasis could represent an important clinical feature of schizophrenic patients treated with atypical antipsychotics, and further research is needed in this field.

Direct comparisons of brain function between obsessive compulsive disorder (OCD) and other anxiety or OCD spectrum disorders are rare. This study aimed to investigate the specificity of altered frontal-striatal and limbic activations during planning in OCD, a prototypical anxiety disorder (panic disorder) and a putative OCD spectrum disorder (hypochondriasis).

The Tower of London task, a ‘frontal-striatal’ task, was used during functional magnetic resonance imaging measurements in 50 unmedicated patients, diagnosed with OCD (n=22), panic disorder (n=14) or hypochondriasis (n=14), and in 22 healthy subjects. Blood oxygen level-dependent (BOLD) signal changes were calculated for contrasts of interest (planning versus baseline and task load effects). Moreover, correlations between BOLD responses and both task performance and state anxiety were analysed.

Overall, patients showed a decreased recruitment of the precuneus, caudate nucleus, globus pallidus and thalamus, compared with healthy controls. There were no statistically significant differences in brain activation between the three patient groups. State anxiety was negatively correlated with dorsal frontal-striatal activation. Task performance was positively correlated with dorsal frontal-striatal recruitment and negatively correlated with limbic and ventral frontal-striatal recruitment. Multiple regression models showed that adequate task performance was best explained by independent contributions from dorsolateral prefrontal cortex (positive correlation) and amygdala (negative correlation), even after controlling for state anxiety.

Patients with OCD, panic disorder and hypochondriasis share similar alterations in frontal-striatal brain regions during a planning task, presumably partly related to increased limbic activation.