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CBT delivered by nurses can cut drain on NHS services due to anxious patients

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A form of psychotherapy that can be delivered by nurses helps patients overcome health anxiety and could prevent thousands of unnecessary trips to GP surgeries and hospitals, a trial has indicated.

Researchers found a modified form of cognitive behaviour therapy for health anxiety (CBT-HA) could successfully be used to treat patients who excessively worry about their health and frequently consult health professionals for reassurance.

“It has the potential to be used widely in general hospital settings under appropriate supervision”

Peter Tyrer

The study authors said the relatively simple intervention could help reduce the estimated £56m that was currently spent on unnecessary appointments and diagnostic tests each year.

Health anxiety, which can have a crippling effect on people’s lives, is often triggered by a genuine health crisis such as heart attack and then made worse by people researching their symptoms online.

Symptoms can include chest pains and headaches, which persist despite a clinician’s reassurance that there is no underlying physical cause, such as an undiagnosed illness.

Project lead Peter Tyrer, professor of community psychiatry at Imperial College London, said: “The problem is that the symptoms of health anxiety are misinterpreted as those of physical illness and so most sufferers attend medical practitioners in both primary and secondary care asking for help in searching for a physical diagnosis, so ignoring the mental core of the condition.

“We found health anxiety was common in those with other physical illness,” he said. “So, people after apparently successful treatment of heart attacks would interpret minor symptoms as warnings of further attacks, cut down on all their activities, create more suffering, and have their lives thrown into chaos and disarray.”

“This project was the one in which I have gained most professional satisfaction, simply because it changes lives”

Yvonne Lisseman Stone

The trial, which was funded by the National Institute of Health Research (NIHR), saw 444 patients recruited from cardiology, endocrinology, gastroenterology, neurology and respiratory departments at five hospitals in England.

Participants, aged 16 to 75, all displayed severe health anxiety and were randomly assigned to either receive sessions of CBT-HA or get standard care.

The researchers found those whose who underwent therapy saw anxiety scores reduced from severe to moderate, while symptoms of anxiety and depression also diminished.

The study also showed trainee psychiatrists and nurses could be trained to deliver the sessions – with appropriate supervision – and nurses were particularly good at it, achieving some of the best results.

Treatment by nurses was found to be superior to standard care by some way, helping improve patients’ condition from severe to mild.

Yvonne Lisseman Stones, a general nurse at Sherwood Forest Hospitals NHS Foundation Trust, was involved in the study and described it as one of the most rewarding experiences of her career.

“After almost 40 years in nursing, this project was the one in which I have gained most professional satisfaction, simply because it changes lives,” she said.

She added: “One of my patients had stopped all physical activity because of severe health anxiety, but after therapy was able to climb Mount Snowdon, where he wrote to me and said, ‘thank you for making me feel on top of the world’.”

Imperial College London

Nurse-delivered CBT ‘cuts service use by anxious patients’

Peter Tyrer

Patients were tracked for five years and the study found the benefits of the intervention had lasted, with the costs more than offset by savings to health services.

“CBT-HA allows therapists with no previous experience to be trained relatively easily. It therefore has the potential to be used widely in general hospital settings under appropriate supervision,” said Professor Tyrer.

The study findings, which are part of the NHS health technology assessment programme, have been published online in the NIHR Journals Library.

Professor Tyrer highlighted that further research was needed to identify and treat “the growing problem of health anxiety in hospitals”.

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Readers' comments (1)

  • Sounds very promising, but this is reporting on findings from a trial published in 2013.

    P Tyrer et al. ‘Clinical and cost-effectiveness of cognitive behaviour therapy for health anxiety in medical patients: a multicentre randomised controlled trial.’ The Lancet, Published Online October 18, 2013 http://dx.doi.org/10.1016/S0140-6736(13)61905-4

    Four years later - where is the implementation and the training?

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