title: Responsiveness of hypochondriacal patients with chronic low-back pain to cognitive-behavioral therapy.
abstract: BACKGROUND
  Evidence has suggested that cognitive-behavioral therapy (CBT) is effective in reducing hypochondriacal symptoms, and another line of evidence has suggested that CBT is also effective in reducing pain and the psychological conditions associated with chronic low-back pain (CLBP). The purpose of this study was to examine the effectiveness of CBT among hypochondriacal patients with and without CLBP.
  
  
  METHODS
  A total of 182 hypochondriacal patients were randomly assigned to a CBT or control group. The Somatic Symptom Inventory was used to define CLBP, and the Symptom Checklist 90R (SCL90R) was used to assess psychological symptoms. The outcome measures for hypochondriasis, the Whiteley Index (WI) and the Health Anxiety Inventory (HAI) were administered before the intervention and at 6 and 12 months after completion of the intervention.
  
  
  RESULTS
  In the total sample, both WI and HAI scores were significantly decreased after treatment in the CBT group compared with the control group. Ninety-three (51%) patients had CLBP; the SCL90R scores for somatization, depression, phobic anxiety, paranoid ideation, and general severity were significantly higher in CLBP(+) group than in the CLBP(-) group at baseline. Although the WI and HAI scores were significantly decreased after treatment in the CLBP(-) group, such significant pre- to post-changes were not found in the CLBP(+) group.
  
  
  CONCLUSIONS
  CBT was certainly effective among hypochondriacal patients without CLBP, but it appeared to be insufficient for hypochondriacal patients with CLBP. The core psychopathology of hypochondriacal CLBP should be clarified to contribute to the adequate management of hypochondriacal symptoms in CLBP patients.
authors.affiliation: Division of Psychosomatic Medicine, Teikyo University Hospital, Tokyo, Japan. mnakao@med.teikyo-u.ac.jp
authors.forename: Mutsuhiro
authors.initials: M
authors.lastname: Nakao
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Shinozaki
authors.forename: Nyryan
authors.initials: N
authors.lastname: Nolido
authors.forename: David K
authors.initials: DK
authors.lastname: Ahern
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Barsky
mesh_terms: D000328:Adult; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D006998:Hypochondriasis / Q000150:complications / Q000523:psychology / Q000628:therapy*; D057194:Intention to Treat Analysis; D017116:Low Back Pain / Q000150:complications / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011569:Psychiatric Status Rating Scales; D057566:Self Report; D012720:Severity of Illness Index