title: Cognitive therapy versus exposure therapy for hypochondriasis (health anxiety): A randomized controlled trial.
abstract: OBJECTIVE
  Cognitive-behavioral therapy has proven to be highly effective in the treatment of hypochondriasis and health anxiety. However, little is known about which therapeutic interventions are most promising. The aim of the present study was to compare the efficacy of cognitive therapy (CT) with exposure therapy (ET).
  
  
  METHODS
  Eighty-four patients with a diagnosis of hypochondriasis were randomly allocated to CT, ET, or a waiting list (WL) control group. The primary outcome measure was a standardized interview that evaluated hypochondriacal cognitions as well as behaviors conducted by independent diagnosticians. Several self-report questionnaires were evaluated as secondary outcome measures. Treatment success was evaluated at posttreatment and at 1-year follow-up.
  
  
  RESULTS
  Both CT (Hedges's g = 1.01-1.11) and ET (Hedges's g = 1.21-1.24) demonstrated their efficacy in comparison with the WL in the primary outcome measure. Moreover, a significant reduction in depressive symptoms and bodily complaints was found in the secondary outcome measures for both treatments in comparison with the WL, but anxiety symptoms were only significantly reduced by ET. In a direct comparison, no significant differences were found between CT and ET in the primary or the secondary outcome measures. Regarding safety behaviors, we found a significantly larger improvement with ET than with CT in the completer analyses.
  
  
  CONCLUSIONS
  The results suggest high efficacy of CT as well as ET in the treatment of hypochondriasis. Cognitive interventions were not a necessary condition for the change of dysfunctional cognitions. These findings are relevant to the conceptualization and psychotherapeutic treatment of hypochondriasis and health anxiety.
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Goethe University.
authors.forename: Florian
authors.initials: F
authors.lastname: Weck
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Goethe University.
authors.forename: Julia M B
authors.initials: JM
authors.lastname: Neng
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Goethe University.
authors.forename: Samantha
authors.initials: S
authors.lastname: Richtberg
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Goethe University.
authors.forename: Marion
authors.initials: M
authors.lastname: Jakob
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Goethe University.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stangier
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology; D003071:Cognition; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003863:Depression / Q000209:etiology; D005260:Female; D005858:Germany; D006801:Humans; D006998:Hypochondriasis / Q000523:psychology / Q000628:therapy*; D007171:Implosive Therapy; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D057566:Self Report; D016896:Treatment Outcome; D014850:Waiting Lists