![]() Only a handful studies have examined potential mediators in treatment studies for health anxiety. As stated by Kraemer, Wilson, Fairburn, and Agras (2002) studying mediators is one of the central questions of modern psychiatry as it can lead to development of more effective treatments or to treatments that have similar effectiveness but at a lower cost. This delivery model confers several advantages such as increased treatment accessibility and high control over the treatment content to which the patient is exposed (Hedman, Ljótsson, & Lindefors, 2012).ĭespite the strong empirical support for CBT in the treatment of severe health anxiety studies investigating mediators, potential treatment mechanisms, are scarce. In these trials, exposure-based CBT was administered as a therapist-guided Internet-delivered treatment. The treatment has been shown to be effective in three randomized controlled trials and has demonstrated cost- and long-term effectiveness (Hedman et al., 2013b Hedman, Andersson, Ljotsson, Axelsson, & Lekander, 2016a Hedman et al., 2011, Hedman et al., 2014). Kabat-Zin, 1994), we regarded it as potentially useful for persons with severe health anxiety when conducting exposure. As one part of mindfulness involves observing internal events without attempting to change their form (e.g. Mindfulness training is used solely as a means to increase the effect of exposure not as a stand-alone intervention as in the mindfulness-based treatment for health anxiety developed by McManus, Surawy, Muse, Vazquez-Montes, and Williams (2012). As a means to increase the willingness to undergo exposure, which is often highly anxiety-provoking, the treatment also includes mindfulness training. The main component of the treatment is therefore systematic exposure to such stimuli, which may be both external (e.g., hospitals) and internal (e.g., a pounding heart or an intrusive thought about becoming ill). Our research group has developed an exposure-based CBT protocol (Hedman et al., 2011 Hedman, Axelsson, Andersson, Lekander, & Ljotsson, 2016b Hedman et al., 2014), which assumes that severe health anxiety is perpetuated by the avoidance of health anxiety-eliciting stimuli. In the last 20 years, there has been a rapid development in psychological treatment of the disorder and several randomized controlled trials have shown that cognitive behavior therapy (CBT) is highly effective in reducing health anxiety (Olatunji et al., 2014). Severe health anxiety is highly prevalent in medical settings, associated with functional disability and rarely remits if untreated (Barsky, Fama, Bailey, & Ahern, 1998 Sunderland, Newby, & Andrews, 2013 Tyrer et al., 2011). We conclude that increasing mindful non-reactivity may be of importance for achieving successful treatment outcomes in exposure-based CBT for severe health anxiety.Ĭore features of severe health anxiety, in this paper defined as DSM-IV hypochondriasis American Psychiatric Association (1994), are a persistent fear of developing serious somatic disease, and misinterpretation of benign bodily sensations. the estimated mediation effect ( αβ) revealed a significant cross product of −0.32, which was statistically significant different from zero based on the asymmetric confidence interval method, 95% CI. The FFMQ-NR growth trajectory was significantly correlated with the SHAI trajectory ( β-path estimate = −1.82, 95% CI, p < .001. In the present study, latent process growth modeling showed that treatment condition had a significant effect on the FFMQ-NR growth trajectory ( α-path), estimate = 0.18, 95% CI, p = .015, indicating a larger increase in mindful non-reactivity among participants receiving exposure-based CBT compared to the BSM group. ![]() As previously reported, exposure-based CBT was more effective than BSM in reducing health anxiety. Participants with severe health anxiety ( N = 158) were randomized to internet-delivered exposure-based CBT or behavioral stress management (BSM) and throughout the treatment, both the mediator and outcome were measured weekly. We assessed mindful non-reactivity using the Five Facets Mindfulness Questionnaire-Non-Reactivity scale (FFMQ-NR) and health anxiety with the Short Health Anxiety Inventory (SHAI). The aim of the present study was to investigate mindful non-reactivity as a putative mediator of health anxiety outcome using data from a large scale randomized controlled trial. ![]() Exposure-based cognitive behavior therapy (CBT) has been shown to be effective in the treatment of severe health anxiety, but little is known about mediators of treatment effect.
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