Internet-delivered cognitive behavioral therapy found to be noninferior to in-person therapy for health anxiety

1. Internet-delivered cognitive behavioral therapy for patients with health anxiety was found to be noninferior to face-to-face CBT.

Evidence Rating: 1 (Excellent)

Health anxiety is a common and often chronic mental health problem, and affects a significant portion of the population. Current first line therapy involves face-to-face cognitive behavior therapy (CBT), and though this method is often found to be an effective management strategy, constant face-to-face CBT incurs significant costs, requires greater commitment (standard is weekly appointments over 3 months), and may be out of reach to populations with reduced healthcare availability and accessibility. As an increasing number of health services are being paired with virtual alternatives, researchers sought to investigate whether internet delivered CBT is a noninferior alternative to face-to-face therapy. In this randomized noninferiority clinical trial, 204 adult patients with a principal diagnosis of DSM-5 somatic symptom disorder or illness anxiety disorder were recruited between 2014 and 2017 and were assigned randomly to either receive internet delivered CBT (ICBT) or face-to-face CBT over 12 weeks. Response to treatment, as the primary outcome, was measured by change in health anxiety over the treatment period as measured by the Health Anxiety Inventory (HAI). Interestingly, therapists were spending 10 minutes per patient per week in the ICBT treatment group, versus 45.6 minutes in the face-to-face CBT. Despite this, in the intention-to-treat analysis, ICBT was found to be noninferior to individual face-to-face CBT, as the estimated difference in effect over the treatment period was 0.00 points on the primary outcome (HAI), and the upper limit of the 1-sided 95% CI was 1.98, within the noninferiority margin of 2.25. There were no significant differences in rates of adverse outcomes between either group. In further health economic analysis, it was estimated that the net societal cost per patient was $3584 lower in ICBT versus face-to-face CBT. Study findings are highly supportive of the implementation of ICBT into regular practice as an effective alternative to face-to-face CBT for health anxiety.

Click to read the study in JAMA Psychiatry

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