title: Therapist differences in a randomised trial of the outcome of cognitive behaviour therapy for health anxiety in medical patients.
abstract: BACKGROUND
  Health anxiety is common in medical settings and can be treated successfully by cognitive behaviour therapy. However it is not clear who might be best placed to deliver this therapy.
  
  
  OBJECTIVE
  In a planned secondary analysis of data from a randomised trial of adapted cognitive behaviour therapy for health anxiety we compared outcomes of therapy delivered by nurses and other professional groups.
  
  
  METHODS
  A randomised controlled trial with two treatment arms, 5-10 sessions of cognitive behaviour therapy adapted health anxiety or standard care.
  
  
  METHODS
  Cardiology, endocrine, gastroenterology, neurological and respiratory clinics in six general hospitals in the UK covering urban, suburban and rural areas.
  
  
  METHODS
  Medical patients attending the clinics who had pathological health anxiety and also scored for a diagnosis of hypochondriasis.
  
  
  METHODS
  Patients were randomised to one of two treatment arms, 5-10 sessions of cognitive behaviour therapy adapted health anxiety or standard care delivered by naive therapists (not randomised) who were trained in advance before delivering the treatment. Independent assessment of outcomes by researchers masked to allocation status at 3m, 6m, 12m and 24m.
  
  
  RESULTS
  444 patients were randomised in the trial, 219 to cognitive behaviour therapy adapted health anxiety and 225 to standard care. 373 (84%) completed assessments after two years. Those treated by nurses (n=66) had improvement in health anxiety, generalised anxiety and depression outcomes that were significantly better and twice as great as those of the professional groups of assistant psychologists (n=87) and graduate workers (n=66) (P<0.01 over all time points). The number needed to treat to show superiority of nurse-delivered treatment over other treatment delivery was 4 at 6 months and 6 at one year.
  
  
  CONCLUSIONS
  General nurses, after suitable training, are very effective therapists for patients with health anxiety in medical clinics and should be the therapists of choice for patients in these settings.
authors.affiliation: Centre for Mental Health, Imperial College, Claybrook Road, London W6 8LN, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Tyrer
authors.affiliation: Centre for Mental Health, Imperial College, Claybrook Road, London W6 8LN, UK. Electronic address: p.tyrer@imperial.ac.uk.
authors.forename: Peter
authors.initials: P
authors.lastname: Tyrer
authors.affiliation: Department of Nursing, King's Mill Hospital, Sutton-in-Ashfield, Nottinghamshire NG17 4JL, UK.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Lisseman-Stones
authors.affiliation: Medical Services, King Faisal Specialist Hospital, Riyadh, Saudi Arabia.
authors.forename: Sharon
authors.initials: S
authors.lastname: McAllister
authors.affiliation: Centre for Mental Health, Imperial College, Claybrook Road, London W6 8LN, UK.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Cooper
authors.affiliation: Department of Psychology, University of Bath, Bath BA2 7AY, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Salkovskis
authors.affiliation: Centre for Mental Health, Imperial College, Claybrook Road, London W6 8LN, UK.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Crawford
authors.affiliation: Greenacres Centre, Hillingdon Hospital, Pield Heath Road, Uxbridge UB8 3NN, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Dupont
authors.affiliation: Central and North West London NHS Foundation Trust, Hampstead Road, London NW1 7QY, UK.
authors.forename: John
authors.initials: J
authors.lastname: Green
authors.affiliation: Department of Clinical Psychology, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
authors.forename: David
authors.initials: D
authors.lastname: Murphy
authors.affiliation: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Duolao
authors.initials: D
authors.lastname: Wang
mesh_terms: D001008:Anxiety Disorders / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000193:education; D006801:Humans; D009726:Nurses; D016896:Treatment Outcome; D000078329:Workforce
keywords: Cognitive behaviour therapy; Depression; Generalised anxiety; Health anxiety; Hypochondriasis; Medical out-patients; Outcomes; Randomised controlled trial; Social functioning