Personality change following internet-based cognitive behavior therapy for severe health anxiety

Erik Hedman, Gerhard Andersson, Nils Lindefors, Petter Gustavsson, Mats Lekander, Christian Rück, Erik Andersson, Brjánn Ljótsson, Erik Hedman, Gerhard Andersson, Nils Lindefors, Petter Gustavsson, Mats Lekander, Christian Rück, Erik Andersson, Brjánn Ljótsson

Abstract

Personality traits have traditionally been viewed as stable, but recent studies suggest that they could be affected through psychological treatment. Internet-based cognitive behavior therapy (ICBT) for severe health anxiety (DSM-IV hypochondriasis) has been shown to be effective in reducing health anxiety, but its effect on measures of personality traits has not been investigated. The main aim of this study was to investigate the impact of ICBT on personality traits in the three broad dimensions--neuroticism, extraversion and aggression. We hypothesized that participants in ICBT would reduce their level of neuroticism compared to controls that did not receive the active treatment. No specific predictions were made regarding extraversion and aggression. Data from a randomized controlled trial were used in which participants were allocated to 12 weeks of ICBT (n = 40) or to a basic attention control condition (n = 41). Personality traits were assessed with the Swedish Universities Scales of Personality and the primary outcome of health anxiety was the Health Anxiety Inventory. There was a significant interaction effect of group and time on neuroticism-related scales, indicating larger pre- to post-treatment reductions in the Internet-based CBT group compared to the control condition. Analyses at 6-month follow-up showed that changes were stable. Traits relating to extraversion and aggression were largely unchanged. This study is the first to demonstrate that a brief ICBT intervention for severe health anxiety causes long-term changes in measures of personality traits related to neuroticism. The treatment thus has a broader impact than just reducing health anxiety.

Trial registration: Clinicaltrials.gov (ID NCT00828152).

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Psychic Trait Anxiety across assessment…
Figure 1. Psychic Trait Anxiety across assessment points.
Note: * = p<.05 for interaction effect of group and time (pre-to-post); Pre, pre-treatment; Post, post-treatment; 6 MFU, 6-month follow-up; CC, control condition; ICBT, Internet-based CBT.
Figure 2. Somatic Trait Anxiety across assessment…
Figure 2. Somatic Trait Anxiety across assessment points.
Note: * = p<.05 for interaction effect of group and time (pre-to-post); Pre, pre-treatment; Post, post-treatment; 6 MFU, 6-month follow-up; CC, control condition; ICBT, Internet-based CBT.
Figure 3. Stress Susceptibility across assessment points.
Figure 3. Stress Susceptibility across assessment points.
Note: * = p<.05 for interaction effect of group and time (pre-to-post); Pre, pre-treatment; Post, post-treatment; 6 MFU, 6-month follow-up; CC, control condition; ICBT, Internet-based CBT.
Figure 4. Embitterment across assessment points.
Figure 4. Embitterment across assessment points.
Note: * = p<.05 for interaction effect of group and time (pre-to-post); Pre, pre-treatment; Post, post-treatment; 6 MFU, 6-month follow-up; CC, control condition; ICBT, Internet-based CBT.

References

    1. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association. xxxvii 943 p. p.
    1. Noyes R Jr, Kathol RG, Fisher MM, Phillips BM, Suelzer MT, et al. (1993) The validity of DSM-III-R hypochondriasis. Arch Gen Psychiatry 50:961–970.
    1. Barsky AJ, Wyshak G, Klerman GL, Latham KS (1990) The prevalence of hypochondriasis in medical outpatients. Soc Psychiatry Psychiatr Epidemiol 25:89–94.
    1. Barsky AJ, Fama JM, Bailey ED, Ahern DK (1998) A Prospective 4- to 5-Year Study of DSM-III-R Hypochondriasis. Arch Gen Psychiatry 55:737–744.
    1. Noyes R Jr, Kathol RG, Fisher MM, Phillips BM, Suelzer MT, et al. (1994) Psychiatric comorbidity among patients with hypochondriasis. Gen Hosp Psychiatry 16:78–87.
    1. Seivewright H, Green J, Salkovskis P, Barrett B, Nur U, et al. (2008) Cognitive-behavioural therapy for health anxiety in a genitourinary medicine clinic: randomised controlled trial. Br J Psychiatry 193:332–337.
    1. Greeven A, van Balkom AJ, Visser S, Merkelbach JW, van Rood YR, et al. (2007) Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a randomized controlled trial. Am J Psychiatry 164:91–99.
    1. Clark D, Salkovskis P, Hackmann A, Wells A, Fennell M, et al. (1998) Two psychological treatments for hypochondriasis. A randomised controlled trial. Br J Psychiatry 173:218–225.
    1. Speckens AEM, van Hemert AM, Spinhoven P, Hawton KE, Bolk JH, et al. (1995) Cognitive behavioural therapy for medically unexplained physical symptoms: a randomised controlled trial. BMJ 311:1328–1332.
    1. Hedman E, Andersson G, Andersson E, Ljotsson B, Ruck C, et al. (2011) Internet-based cognitive-behavioural therapy for severe health anxiety: randomised controlled trial. Br J Psychiatry 198:230–236.
    1. Andersson G (2009) Using the Internet to provide cognitive behaviour therapy. Behav Res Ther 47:175–180.
    1. Hedman E, Ljótsson B, Lindefors N (2012) Cognitive behavior therapy via the Internet: a systematic review of applications, clinical efficacy and cost-effectiveness. Expert Rev Pharmacoecon Outcomes Res 12:745–764.
    1. Andersson G, Cuijpers P, Carlbring P, Riper H, Hedman E (2014) Internet-based vs. face-to-face cognitive behaviour therapy for psychiatric and somatic disorders: a systematic review and meta-analysis. World Psychiatry 13:288–295.
    1. Eysenck HJ, Eysenck MW (1985) Personality and Individual Differences: A Natural Science Approach. New York: Plenum Press.
    1. John OP, Naumann LP, Soto CJ (2008) Paradigm shift to the integrative Big Five trait taxonomy: History, measurement and conceptual issues. In: John OP, Robins RW, Pervin LA, editors. Handbook of Personality: Theory and research New York: Guilford Press.
    1. Burger JM (1993) Personality. Pacific grove, CA: Brooks/Cole Publishing Company.
    1. Flaskerud JH (2012) Temperament and personality: from Galen to DSM 5. Issues Ment Health Nurs 33:631–634.
    1. Spinhoven P, Elzinga BM, Hovens JG, Roelofs K, van Oppen P, et al. (2011) Positive and negative life events and personality traits in predicting course of depression and anxiety. Acta Psychiatr Scand 124:462–473.
    1. Brandes M, Bienvenu OJ (2006) Personality and anxiety disorders. Curr Psychiatry Rep 8:263–269.
    1. Gustavsson JP, Bergman H, Edman G, Ekselius L, Knorring Lv, et al. (2000) Swedish universities Scales of Personality (SSP): construction, internal consistency and normative data. Acta Psychiatr Scand 102:217–225.
    1. Roberts BW, Mroczek D (2008) Personality Trait Change in Adulthood. Current directions in psychological science 17:31–35.
    1. Ludtke O, Roberts BW, Trautwein U, Nagy G (2011) A random walk down university avenue: life paths, life events, and personality trait change at the transition to university life. J Pers Soc Psychol 101:620–637.
    1. Staats AW (1993) Personality theory, abnormal psychology, and psychological measurement. Behav Modif 17:8–42.
    1. Eysenck HJ (1959) Learning theory and behaviour therapy. Br J Psychiatry 105:61–75.
    1. Gray JA (1991) The neuropsychology of temperament. In: Strelau J, Angleitner A, editors. Explorations in Temperament. International perspectives on theory and measurement London: Plenum Press.
    1. Wilczek A, Barber JP, Gustavsson JP, Asberg M, Weinryb RM (2004) Change after long-term psychoanalytic psychotherapy. J Am Psychoanal Assoc 52:1163–1184.
    1. Cloninger CR, Svrakic DM, Przybeck TR (1993) A psychobiological model of temperament and character. Arch Gen Psychiatry 50:975–990.
    1. Mortberg E, Bejerot S, Aberg Wistedt A (2007) Temperament and character dimensions in patients with social phobia: patterns of change following treatments? Psychiatry Res 152:81–90.
    1. Lyoo IK, Yoon T, Kang DH, Kwon JS (2003) Patterns of changes in temperament and character inventory scales in subjects with obsessive-compulsive disorder following a 4-month treatment. Acta Psychiatr Scand 107:298–304.
    1. Aguera Z, Krug I, Sanchez I, Granero R, Penelo E, et al. (2012) Personality changes in bulimia nervosa after a cognitive behaviour therapy. European eating disorders review: the journal of the Eating Disorders Association 20:379–385.
    1. Tang TZ, DeRubeis RJ, Hollon SD, Amsterdam J, Shelton R, et al. (2009) Personality change during depression treatment: a placebo-controlled trial. Arch Gen Psychiatry 66:1322–1330.
    1. Johansson R, Lyssarides C, Andersson G, Rousseau A (2013) Personality change after Internet-delivered cognitive behavior therapy for depression. PeerJ 1:e39.
    1. Hedman E, Andersson G, Andersson E, Ljótsson B, Ruck C, et al. (2011) Internet-based cognitive-behavioural therapy for severe health anxiety: randomised controlled trial. Br J Psychiatry 198:230–236.
    1. Hedman E, Andersson E, Lindefors N, Andersson G, Ruck C, et al. (2013) Cost-effectiveness and long-term effectiveness of internet-based cognitive behaviour therapy for severe health anxiety. Psychol Med 43:363–374.
    1. Gustavsson JP, Weinryb RM, Göransson S, Pedersen NL, Åsberg M (1997) Stability and predictive ability of personality traits across 9 years. Personality and Individual Differences 22:783–791.
    1. Farde L, Gustavsson JP, Jonsson E (1997) D2 dopamine receptors and personality traits. Nature 385:590.
    1. Cervenka S, Gustavsson JP, Halldin C, Farde L (2010) Association between striatal and extrastriatal dopamine D2-receptor binding and social desirability. Neuroimage 50:323–328.
    1. Salkovskis PM, Rimes KA, Warwick HM, Clark DM (2002) The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychol Med 32:843–853.
    1. Taylor S, Asmundson GJG (2004) Treating health anxiety: a cognitive-behavioral approach. New York: Guilford Press. xv 299 p. p.
    1. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, et al. (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59 Suppl 20.
    1. Rohde P, Lewinsohn PM, Seeley JR (1997) Comparability of Telephone and Face-to-Face Interviews in Assessing axis I and II Disorders. Am J Psychiatry 154:1593–1598.
    1. Hedman E, Ljotsson B, Blom K, El Alaoui S, Kraepelien M, et al. (2013) Telephone versus internet administration of self-report measures of social anxiety, depressive symptoms, and insomnia: psychometric evaluation of a method to reduce the impact of missing data. J Med Internet Res 15:e229.
    1. Hedman E, Ljótsson B, Rück C, Furmark T, Carlbring P, et al. (2010) Internet administration of self-report measures commonly used in research on social anxiety disorder: A psychometric evaluation. Computers in Human Behavior 26:736–740.
    1. Carlbring P, Brunt S, Bohman S, Austin D, Richards J, et al. (2007) Internet vs. paper and pencil administration of questionnaires commonly used in panic/agoraphobia research. Computers in Human Behavior 23:1421–1434.
    1. Svanborg P, Åsberg M (1994) A new self-rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale. Acta Psychiatr Scand 89:21–28.
    1. Furer P, Walker JR, Stein MB (2007) Treating health anxiety and fear of death: a practitioner's guide. New York, NY: Springer. xv268 p. p.
    1. Furer P, Walker JR (2005) Treatment of hypochondriasis with exposure. Journal of Contemporary Psychotherapy 35:251–267.
    1. McManus F, Surawy C, Muse K, Vazquez-Montes M, Williams JM (2012) A Randomized Clinical Trial of Mindfulness-Based Cognitive Therapy Versus Unrestricted Services for Health Anxiety (Hypochondriasis). J Consult Clin Psychol.
    1. Lovas DA, Barsky AJ (2010) Mindfulness-based cognitive therapy for hypochondriasis, or severe health anxiety: A pilot study. J Anxiety Disord 24:931–935.
    1. Treanor M (2011) The potential impact of mindfulness on exposure and extinction learning in anxiety disorders. Clin Psychol Rev 31:617–625.
    1. Hedman E, Ljótsson B, Andersson E, Rück C, Andersson G, et al. (2010) Effectiveness and Cost Offset Analysis of Group CBT for Hypochondriasis Delivered in a Psychiatric Setting: An Open Trial. Cogn Behav Ther 39:239–250.
    1. Noyes R Jr, Reich JH, Suelzer M, Christiansen J (1991) Personality traits associated with panic disorder: change associated with treatment. Compr Psychiatry 32:283–294.
    1. Reich J, Noyes R Jr, Coryell W, O'Gorman TW (1986) The effect of state anxiety on personality measurement. Am J Psychiatry 143:760–763.
    1. Karsten J, Penninx BW, Riese H, Ormel J, Nolen WA, et al. (2012) The state effect of depressive and anxiety disorders on big five personality traits. J Psychiatr Res 46:644–650.
    1. Rück C, Edman G, Åsberg M, Svanborg P (2006) Long-term changes in self-reported personality following capsulotomy in anxiety patients. Nord J Psychiatry 60:486–491.
    1. Posternak MA, Miller I (2001) Untreated short-term course of major depression: a meta-analysis of outcomes from studies using wait-list control groups. J Affect Disord 66:139–146.
    1. Lahey BB (2009) Public health significance of neuroticism. Am Psychol 64:241–256.
    1. Cuijpers P, Smit F, Penninx BW, de Graaf R, ten Have M, et al. (2010) Economic costs of neuroticism: a population-based study. Arch Gen Psychiatry 67:1086–1093.
    1. Svanborg P, Gustavsson PJ, Mattila-Evenden M, Asberg M (1999) Assessment of maladaptiveness: a core issue in the diagnosing of personality disorders. J Pers Disord 13:241–256.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner