Phone or video call therapy improves health anxiety and saves money, study finds

A new study by mental health experts from NIHR CLAHRC EM has found that easy-access, remotely-delivered psychological treatment can significantly reduce extreme health anxiety in people who repeatedly go to the doctor, or hospital emergency departments.

The researchers from the University of Nottingham’s Institute of Mental Health along with NIHR CLAHRC EM carried out a multi-centre trial to compare the effects of cognitive behavioural therapy (CBT) delivered by phone or video calling, to standard treatment via their GP and the mental health referral system. 

The NIHR-funded study found that the randomly selected group of patients who received sessions of remote CBT via telephone or online video calling had markedly reduced health anxiety in the 12 months after the start of this treatment and the cost savings to the NHS were more than £1,000 per patient. The results, published in BMC Medicine, also show that general anxiety and depression in these patients improved over the same period, as did their overall health.

Professor of Psychiatry, Richard Morriss, from the University of Nottingham, NIHR CLAHRC East Midlands, NIHR MindTech MedTech Co-operative and NIHR Nottingham Biomedical Research Centre said: "This study has important implications for future clinical practice, we think. Health anxiety has been a growing problem for some time now and it means more and more people are seeking unscheduled on-the-day help or medical investigation from already over-stretched GPs and hospital emergency departments. Conversely, health anxiety can be in the form of a phobia which can prevent people from seeking medical attention leading to serious illness if symptoms are ignored.

"CBT is a well-tested and long-lasting effective treatment for severe health anxiety but despite this uptake is typically low because of stigma and negative experiences of mental health services. We found that people were more likely to engage in telephone or video calling therapy and it was easier for many people to access. It has huge potential, we think, to reduce these patients’ anxiety, and the knock-on effect will be less demand for emergency appointments in both GP surgeries and hospitals.”

Professor Kamlesh Khunti, Director of the NIHR CLAHRC East Midlands, said: “This study is an excellent example of how innovation, technology and smart thinking can come together to improve care and reduce costs in a pressurised NHS. At NIHR CLAHRC East Midlands we are tasked with ensuring the learning from research gets to the frontline of healthcare as swiftly as possible to ensure patients benefit from improved care. The evidence gained from this study can now pave the way for further adoption across the health service.”

Health anxiety manifests itself in people in many ways. It can be a constant worry about their health, frequent checking for signs of illness such as lumps, pain and symptoms such as a tight feeling in the chest or raised heart rate which can be caused by the anxiety itself. Often people will seek urgent medical attention to get reassurance or spend a lot of time online searching for health information. Cognitive Behavioural Therapy has been proven to deliver an effective treatment by teaching people techniques for breaking the cycle of anxious thoughts and behaviours that can dominate their lives.

In this new study, the researchers recruited 156 patients from emergency departments, walk-in centres, hospital outpatients’ clinics and GP practices offering same-day appointments across the Midlands. All of these patients had had two or more unscheduled medical consultations unrelated to any clinical pathology in the past 12 months and met the criteria for clinical health anxiety as measured by the Short Health Anxiety Inventory (SHAI).

Half were randomly selected to receive the usual standard care for their health anxiety and half were given the remote CBT via phone or online video calling. There were no clinically important differences at baseline assessment for any demographic or clinical characteristics between the two patient groups. 

Between 6 and 12 CBT sessions were offered, delivered by a team of experienced CBT therapists using a video-conferencing tool called WebEx. Patients also received reminders about each session via text or email. 

The study showed that both groups of patients experienced a reduction in health anxiety over the treatment period but those in the remote CBT group had a much larger reduction – 72% no longer experienced health anxiety during the treatment and this positive effect was maintained in nearly half the patients a year on. 

The researchers conclude that targeted remote delivery of CBT is a feasible, clinically effective and cost-saving method of improving self-management in repeat users of unscheduled medical care with severe health anxiety, with whom the health services have previously struggled to engage.

The research drew on the expertise of the NIHR MindTech MedTech Co-operative and the Nottingham NIHR Biomedical Research Centre’s Mental Health and Technology Unit. 

Photo credit: Ehimetalor Unuabona