Dimensions of dependence and their influence on the outcome of cognitive behaviour therapy for health anxiety: randomized controlled trial.
The personality trait of dependence is common in health-seeking behaviour. We therefore examined its impact in a large randomized controlled trial of psychological treatment for health anxiety.



To test whether dependent personality traits were positive or negative in determining the outcome of an adapted form of cognitive behaviour therapy for health anxiety (CBT-HA) over the course of 5 years and whether dependent personality dysfunction could be viewed dimensionally in a similar way to the new ICD-11 diagnostic system for general personality disorder.



Dependent personality dysfunction was assessed using a self-rated questionnaire, the Dependent Personality Questionnaire, at baseline in a randomized controlled trial of 444 patients from medical clinics with pathological health anxiety treated with a modified form of CBT-HA or standard treatment in the medical clinics, with assessment on five occasions over 5 years. Dependent personality dysfunction was assessed using four severity groups.



Patients with mild and moderate dependent personality disorder treated with CBT-HA showed the greatest reduction in health anxiety compared with standard care, and those with no dependent dysfunction showed the least benefit. Patients with higher dependent traits received significantly more treatment sessions (8.6) than those with low trait levels (5.4) (p < 0.01).



The results suggest that patients treated with cognitive behaviour therapy for health anxiety respond better if they have moderate dependent personality. The reasons for this may be related to better adherence to psychological treatment and greater negative effects of frequent reassurance and excessive consultation in those treated in standard care. Copyright © 2016 John Wiley & Sons, Ltd.
Centre for Mental Health, Imperial College, London, UK.
Peter
P
Tyrer
Department of Statistics, Liverpool School of Tropical Medicine, Liverpool, UK.
Duolao
D
Wang
Centre for Mental Health, Imperial College, London, UK.
Helen
H
Tyrer
Centre for Mental Health, Imperial College, London, UK.
Mike
M
Crawford
Centre for Mental Health, Imperial College, London, UK.
Sylvia
S
Cooper
D000328:Adult; D001008:Anxiety Disorders / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003858:Dependency, Psychological; D003859:Dependent Personality Disorder / Q000150:complications / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010552:Personality Assessment; D016896:Treatment Outcome
cognitive behaviour therapy; dependent personality; health anxiety; randomised controlled trial