A pilot study of processes of change in group-based acceptance and commitment therapy for health anxiety

Author(s):
Ditte Hoffmann, Lea Halsboe, Trine Eilenberg, Jens S. Jensen, Lisbeth Frostholm

Background
Health anxiety or hypochondriasis is a disabling and persistent disorder with a high prevalence in primary care, and insufficient treatment opportunities and knowledge of treatment processes. Acceptance and Commitment Therapy (ACT) is a third-wave behavioral therapy, which has shown positive treatment effects in a variety of mental disorders. ACT is proposed to work through the process of ‘psychological flexibility’, but no studies have yet examined possible processes of change in an ACT-based treatment of health anxiety.

Aim
The pilot study investigated whether changes in ‘psychological flexibility’ and ‘mindfulness’ mediated treatment outcome in health anxiety symptoms.

Methods
34 Danish patients with severe health anxiety were allocated to 10 sessions of group-based ACT. The patients completed self-report questionnaires at baseline, at end of treatment and at 6-month follow-up, measuring health anxiety symptoms (Whiteley Index), psychological flexibility (AAQ-II) and mindfulness (FFMQ).

Results
Paired t-tests showed that psychological flexibility and mindfulness increased significantly during treatment (effect sizes ranged from SRM=.55–.76, p<.05). Regression analysis and Likelihood Ratio Tests showed that in particular psychological flexibility was significantly associated with the previously reported 49% reduction in health anxiety symptoms at 6-month followup.

Conclusions
Findings from the uncontrolled study indicated that the decrease in health anxiety symptoms at 6-month follow-up was associated with the change in psychological flexibility and mindfulness during treatment. These findings support the processes of change proposed in ACT.

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