The NHS could save more than £420m a year by offering treatment for health anxiety and “cyberchondria”, a psychological ailment caused by people obsessively looking up their symptoms online, a study has estimated.
The study, funded and published by the National Institute for Health Research, said the savings could be made just on the costs of care in hospital outpatient departments, with research showing health anxiety fades and stays away after a course of therapy.
A team including researchers from Imperial College London and King’s College London are now calling for health anxiety to be more widely recognised as a condition and for the National Institute for Health and Care Excellence (Nice) to produce guidelines on managing it.
The team estimates that at least one in five people attending hospital outpatient appointments suffers from health anxiety, although only one in 10 are ever diagnosed.
Many have recovered from a serious illness such as a heart attack or cancer and believe it is going to happen again. Symptoms such as chest pain and headaches persist even when doctors tell patients there is nothing wrong. They believe the worst possible scenarios they read online and repeatedly return for tests.
Dr Helen Tyrer, one of the study’s authors, told of the manager of a big company who was driving home when he felt very unwell. He phoned his wife and asked her to call an ambulance, which arrived as he reached his house. “He walked into the kitchen and had a cardiac arrest,” said Tyrer.
His action in calling the ambulance saved his life, she said. After treatment he was well, but so anxious that he could not return to his job. “Every time he got a headache he went to A&E. He didn’t go to work for six months,” she said.
In a trial of cognitive behaviour therapy (CBT) he did “incredibly well” and he was now back at work and leading a normal life.
Another man in the trial had been discharged from hospital after a heart attack and was terrified it would happen again. “He wouldn’t go out of the house to feed his chickens,” said Tyrer. “His wife gave up her job.”
The researchers found him in a hospital waiting room, just discharged after six months as apparently fine. “He clearly wasn’t,” she said.
In the trial, involving 444 patients, even those who were not given therapy but who had health anxiety explained to them got somewhat better, at least in the short term. “By explaining health anxiety, it makes a difference to the symptoms and has an impact on patients’ behaviour,” said Peter Tyrer, a professor of community psychiatry at Imperial, lead author and the husband of Helen Tyrer.
These were not strictly the “worried well”, said the researchers. They had been ill and had genuine symptoms, even if they were sometimes psychosomatic. In the trial they saw a doctor, such as a cardiologist, who would assess the physical symptoms alongside a psychiatrist or psychologist who would assess their anxiety. They might be prescribed breathing or relaxation exercises for their pain, alongside CBT for the anxiety.
Remarkably for a mental health study, the patients given CBT were still doing well five years later. The researchers are calling for Nice to assess the intervention and issue guidelines to the NHS, in the hope that it will be adopted in all hospital trusts.
Yvonne Lisseman Stones, a general nurse at Sherwood Forest Hospitals NHS foundation trust, who worked on the study, said it was the project that had given her the most satisfaction in her 40 years of nursing, “simply because it changes lives”.
She said: “One of my patients had stopped all physical activity because of severe health anxiety, but after therapy was able to climb Mount Snowdon, where he wrote to me and said ‘thank you for making me feel on top of the world’.”
