Sudden gains in internet-based cognitive behaviour therapy for severe health anxiety.
OBJECTIVE
A sudden gain is defined as a large and stable individual improvement occurring between two consecutive treatment sessions. Sudden gains have been shown to predict better long-term improvement in several treatment studies, including cognitive behavioural therapy for depression and anxiety disorders, but have not been studied in the treatment of health anxiety or any form of internet-based cognitive behavioural therapy. The aim of this study was to investigate the role of sudden gains in internet-based cognitive behavioural therapy for severe health anxiety.


METHODS
We examined the occurrence and significance of sudden gains in measures of health anxiety in 81 participants receiving internet-based cognitive behavioural therapy. We compared patients with sudden gains, patients without sudden gains, and patients with gradual gains.


RESULTS
Thirteen participants (16%) experienced one sudden gain in health anxiety with individual sudden gains distributed across the treatment. As expected, patients with a sudden gain showed larger improvements than patients without a sudden gain at post-treatment (d = 1.04) and at one-year follow-up (d = 0.91) on measures of health anxiety.


CONCLUSIONS
Consistent with previous studies, sudden gains in internet-based cognitive behavioural therapy are associated with significantly larger and stable treatment effects up to one-year follow-up.
Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden. Electronic address: kire.hedman@ki.se.
Erik
E
Hedman
Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden. Electronic address: mats.lekander@ki.se.
Mats
M
Lekander
Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden. Electronic address: brjann.ljotsson@ki.se.
Brjánn
B
Ljótsson
Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden. Electronic address: nils.lindefors@ki.se.
Nils
N
Lindefors
Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden. Electronic address: christian.ruck@ki.se.
Christian
C
Rück
Department of Psychology, Boston University, Boston, MA, USA. Electronic address: shofmann@bu.edu.
Stefan G
SG
Hofmann
Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden. Electronic address: erik.m.andersson@ki.se.
Erik
E
Andersson
Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden; Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; Swedish Institute for Disability Research, Linköping University, Linköping, Sweden. Electronic address: gerhard.andersson@ki.se.
Gerhard
G
Andersson
Department of Psychology I, University of Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, University of Würzburg, Germany. Electronic address: schulz@psychologie.uni-wuerzburg.de.
Stefan M
SM
Schulz
D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D006998:Hypochondriasis / Q000628:therapy*; D020407:Internet; D008297:Male; D011569:Psychiatric Status Rating Scales; D019114:Remote Consultation; D016896:Treatment Outcome
Cognitive behaviour therapy; Health anxiety; Internet; Sudden gains