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Internet-based Cognitive Behavioral Therapy for Severe Health Anxiety

According to a new study published in The British Journal of Psychiatry, internet-based cognitive behavior therapy (CBT) may be an effective treatment for individuals with health anxiety. Participants (n=81) in the current study were randomly assigned to either an internet-based CBT group (n=40) or to a control group (an online discussion forum) (n=41). Participants in the CBT group received a 12-week treatment intervention that incorporated mindfulness training (teaching participants to observe their bodily sensations without trying to control them), a 12-module self-help text, and a discussion forum (in which participants could anonymously communicate with other members of the same group.) Participants in the CBT group also had access to a therapist through a secure online system, however there were neither face-to-face nor telephone contacts during the study. Participants in the control condition were encouraged to utilize the discussion forum to discuss their health anxiety and ways of coping with it. At post treatment, results showed that the internet-based CBT group displayed superior improvements over the control group. In fact, two-thirds of participants in the CBT group no longer met criteria for health anxiety. Further, large treatment effects were also maintained at the 6-month follow up. These findings suggest that internet-based CBT for health anxiety may be a promising alternative treatment for individuals without access to face-to-face therapy.

Erik Hedman, Gerhard Andersson, Erik Andersson, Brjann Ljotsson, Christian Ruck, Gordon J. G. Asmundson and Nils Lindefors (2011). “Internet-based cognitive-behavioral therapy for severe health anxiety: randomized controlled trial”. The British Journal of Psychiatry.

Using CBT and Smart Phones for the Self-Management of Chronic Pain

In this age of technology, internet interventions are becoming more common in the practice of Cognitive Behavioral Therapy (CBT).  Chronic Widespread Pain (CWP) causes patients to live in constant pain, as well as fear of that pain, which can lead to avoidant behavior and depression.  Kristjansdottir et al (2011) hope to develop an intervention program that will help patients with CWP to self-manage their pain.  Using CBT with a focus on mindfulness and the acceptance of pain, researchers developed a four week intervention that is administered to the patients via Web-enabled smart phones.  In the present study, the researchers look into the feasibility of the intervention.

Six women with CWP were recruited to participate in the intervention.  Each participant first met one-on-one with a therapist where she was asked about her condition, informed of the intervention, and lent a web-enabled phone.  For the next four weeks, the participants received an SMS text message three times a day (morning, evening, and a random time between 11:30 am and 2 pm) reminding the participants to fill out an online diary.  This diary included a set of questions asking about current thoughts and pain awareness.  Within 90 minutes, each participant received online feedback from a therapist, who was supervised by two other professionals of mindfulness meditation and CBT.

Each online diary included questions regarding the usefulness of the previous diary’s feedback.  The effects of the intervention were quantified by use of the Chronic Pain Acceptance Questionnaire (CPAQ) and the Pain Catastrophizing Scale (PSC), given to participants before and after the intervention.  Half-way through the intervention, and after completion, researchers met with participants to ask them about their experiences and opinions.

Kristjansdottir et al found that the participants were responsive to the intervention and saw it as supportive and useful.  Despite minimal technical difficulties, the program was found to be user-friendly and feasible.  Future randomized studies can adapt the program and explore its effects on CWP.

Kristjansdottir, O. B., Fors, E. A., Eide, E., Finset, A., van Dulmen, S., Wigers, S. H., & Eide, H. (2011).  Written online situational feedback via mobile phone to support self-management of chronic widespread pain: A usability study of web-based intervention.  BMC Musculosketital Disorders, 12(51).