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The pandemic pushed much of medical care to online, virtual platforms, virtually overnight. But is Internet-based health care, particularly mental health care, a safe and viable option? A new study published in JAMA Psychiatry looked at the effects of Internet versus face-to-face cognitive behavior therapy (CBT) for health anxiety. 

“Severe health anxiety, sometimes referred to as hypochondriasis, is a common and often debilitating problem with substantial economic consequences,” study author Erland Axelsson told us. “Conventional face-to-face CBT can be highly efficacious for individuals with health anxiety.”

According to the Anxiety and Depression Association of America, 40 million adults in the United States suffer from an anxiety disorder, making it the most common mental illness for Americans.

Approximately two-thirds of patients respond to treatment, and every other patient reaches a point where he or she no longer suffers from severe health anxiety. However, access to face-to-face CBT is poor.

“Previous studies have shown promising effects of Internet-delivered cognitive behavior therapy (ICBT), which requires much less therapist time, and that can easily be administered across geographical distances,” Axelsson told us. “This was the first randomized controlled trial where ICBT was compared directly to face-to-face CBT in the treatment of health anxiety, so as to assess if ICBT is non-inferior (i.e., more or less on par with) face-to-face treatment.”

The primary hypothesis of the researchers was that ICBT would be non-inferior to face-to-face CBT in its effect on health anxiety. The study was conducted at a primary care clinic in Stockholm, Sweden, where 204 individuals who suffered from health anxiety were recruited.

“All patients were randomized to receive either 12 weeks of ICBT or 12 weeks of conventional, face-to-face CBT,” Axelsson told us. “Patients in both treatments were encouraged to work with the same behavioral strategies and exercises, and the treatments differed only in their delivery format.”

Whereas in the face-to-face treatment, most of the information was conveyed through weekly meetings with a therapist, in ICBT, the corresponding information was instead conveyed in text form via a secure web-based platform and patients had regular contact with their therapist via an email-like messaging system.

“Patients regularly completed self-rated questionnaires via Internet so as to enable the measurement of health anxiety and other psychiatric symptoms up to 12 months after treatment,” Axelsson told us. “In the primary analysis, we compared the average reduction in health anxiety in ICBT to the average reduction in health anxiety in face-to-face CBT over the treatment period.”

The primary finding was that ICBT is non-inferior to face-to-face CBT for health anxiety, at least in the short term. This means that it would be possible to substantially increase access to evidence-based treatment for health anxiety by disseminating ICBT more widely.

“Based on promising findings in previous studies, we hypothesized that ICBT would be non-inferior to face-to-face CBT,” Axelsson told us. “The results of this study highlight the potential benefits of disseminating ICBT more widely, and thereby improving access to efficacious psychological treatment for health anxiety.”

In ICBT, therapists are able to treat more patients in the same amount of time, treatment can be made available regardless of geographical distances, and there is no need for the patient to take time off from work to take part in treatment.

“There is a need for additional research on further improving the effects of ICBT,” Axelsson told us, “and successfully implementing ICBT in various routine care contexts.”