Skip to main content

Online CBT Demonstrates Noninferiority to Face-to-Face CBT for Health Anxiety

May 27, 2020

Internet-delivered cognitive behavioral therapy (CBT) was noninferior to conventional face-to-face CBT among patients with health anxiety, or hypochondriasis, according to a study published online in JAMA Psychiatry.

“The results show that a treatment delivered exclusively online is sufficient to achieve tough and required behavioral changes,” said researcher Erik Hedman-Lagerlöf, PhD, a psychology professor and researcher in the department of clinical neuroscience, Karolinska Institutet, Stockholm, Sweden.

“This is especially relevant now when the coronavirus pandemic limits our opportunities for physical meetings, while the fear of being affected by a severe health condition is discussed more frequently.”

BLOG: Using Anxiety Amid COVID-19 as a Tool for Personal Growth

In the noninferiority clinical trial, which was conducted between 2014 and 2020, 204 patients with a primary diagnosis of health anxiety were randomly assigned to 12 weeks of treatment with either face-to-face or internet-delivered CBT. Patients in the online group had access to information online and communicated regularly with a therapist through an email-like system. All participants rated their level of health anxiety weekly using the standardized Health Anxiety Inventory.

According to the study, CBT delivered via the internet demonstrated effects comparable to CBT delivered face-to-face. However, therapists spent an average of 10 minutes per patient per week for online treatment compared with 45 minutes per week for face-to-face CBT. Internet CBT also generated lower net societal costs than face-to-face CBT.

“One significant advantage [with online CBT] is that the therapist can help more patients in the same time, but also that the treatment can be delivered regardless of the patient’s geographical location, including to people living in rural areas,” said Erland Axelsson, PhD, psychologist and researcher at the department of clinical neuroscience, Karolinska Institutet. “The fact that you can access the content and communicate with your therapist at any time of the day also means that people who struggle to take time off from work can take part in treatment.”

—Jolynn Tumolo


Axelsson E, Andersson E, Ljótsson B, Björkander D, Hedman-Lagerlöf M, Hedman-Lagerlöf E. Effect of internet vs face-to-face cognitive behavior therapy for health anxiety: a randomized noninferiority clinical trial. JAMA Psychiatry. 2020 May 13;[Epub ahead of print].

Effects of internet CBT for health anxiety on par with face-to-face treatment [press release]. Stockholm, Sweden: Karolinska Institutet; May 13, 2020.

Back to Top