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• W2042898543 abstract "In a recent controlled trial of treatments for hypochondriasis, we found that cognitive therapy was better than an equally credible alternative, psychosocial intervention (behavioural stress management), and concluded that this finding indicates cognitive therapy is a specific treatment for hypochondriasis.1Clark DM Salkovskis PM Hackmann A et al.Two psychological treatments for hypochondriasis: a randomised controlled trial.Br J Psychiatry. 1998; 173: 218-225Crossref PubMed Scopus (221) Google Scholar In a provocatively titled Dec 5 commentary, David Ben-Tovim and Adrian Esterman2Ben-Tovim DI Esterman A Zero progress with hypochondriasis.Lancet. 1998; 352: 1798-1799Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar claim our conclusion is incorrect because we used an active treatment, rather than a sham treatment as the control condition. They are wrong. If a sham treatment was acceptable to patients, it would have simply controlled for the effects of therapist attention. Our control treatment involved the same amount of therapist time as cognitive therapy and, in addition, also matched cognitive therapy in terms of patients' ratings of treatment credibility, expectation of improvement, and use of structured homework assignments. The fact that cognitive therapy was better than such a stringent control condition in eight of ten measures of hypochondriasis at the end of treatment is particularly impressive evidence for a specific effect. By contrast with most pharmacotherapy treatment trials, which Ben-Tovim and Esterman seem to view as the gold standard, we included data on patients' symptoms at several postintervention follow-up points (3, 6, and 12 months). Throughout the follow-up year, patients who had received either treatment remained better than at before treatment. In addition, the number of measures that showed a significant difference between cognitive therapy and behavioural stress management declined (to three measures at 3 and 6 months and one measure at 12 months). Ben-Tovim and Esterman interpret the more moderate difference between treatments during follow-up as further evidence for a lack of specific effect. This interpretation gives an unsafe conclusion. Additional, non-protocol, specialist treatment was banned during the intervention period but not during follow-up. It is therefore possible that differences in relative status of patients in the two groups during follow-up were the result of interventions unconnected to the trial. For this reason, the only safe conclusion about the follow-up data is that cognitive therapy and behavioural stress management produce improvements that can be sustained in current practice. On the basis of their erroneous conclusion about the absence of a specific effect in our trial, Ben-Tovim and Esterman conclude that they should continue to treat hypochondriacal patients with judicious, regular access to a physician. This conclusion ignores the fact that there is no evidence that such an approach is better than even no treatment, whereas controlled trials have shown that cognitive behaviour therapy is better than routine treatment,1Clark DM Salkovskis PM Hackmann A et al.Two psychological treatments for hypochondriasis: a randomised controlled trial.Br J Psychiatry. 1998; 173: 218-225Crossref PubMed Scopus (221) Google Scholar, 3Warwick HMC Clark DM Cobb AM Salkovskis PM A controlled trial of cognitive-behavioural treatment of hypochondriasis.Br J Psychiatry. 1996; 169: 189-195Crossref PubMed Scopus (214) Google Scholar, 4Avia MD Ruiz MA Olivares ME et al.The meaning of psychological symptoms: effectiveness of a group intervention with hypochondriacal patients.Behaviour Res Ther. 1996; 34: 23-31Crossref PubMed Scopus (65) Google Scholar optimum medical care,5Speckens AEM van Hemert AM Spinhoven P et al.Cognitive behavioural therapy for medically unexplained physical symptoms: a randomised controlled trial.BMJ. 1995; 311: 1328-1332Crossref PubMed Scopus (271) Google Scholar and equally credible psychosocial treatment1Clark DM Salkovskis PM Hackmann A et al.Two psychological treatments for hypochondriasis: a randomised controlled trial.Br J Psychiatry. 1998; 173: 218-225Crossref PubMed Scopus (221) Google Scholar in hypochondriasis and unexplained physician symptoms. A specific treatment for hypochondriasis?Authors' reply Full-Text PDF" @default.
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• W2042898543 title "A specific treatment for hypochondriasis?" @default.
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• W2042898543 doi "https://doi.org/10.1016/s0140-6736(05)75465-9" @default.
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