Case study: CHAMP impact case study
The CHAMP study was funded by the NIHR Health Technology Assessment (HTA) programme and supported by the NIHR Clinical Research Network (CRN). Find out more about the support available from the NIHR for mental health research here.Find out more
CHAMP impact case study
CHAMP: Cognitive behaviour therapy for health anxiety in medical patients
- 8 year study, between 2010 – 2018
- 444 participants recruited, aged between 16-75
- Recruited through six hospital sites across London, Middlesex and Nottinghamshire
- Funded by NIHR’s Health Technology Assessment (HTA) programme
- Chief investigator: Professor Peter Tyrer, Emeritus Professor in Community Psychiatry at Imperial College London
Health anxiety is an under-recognised but frequent cause of distress for patients that has only recently been recognised as a potentially treatable mental health condition. Prior to the CHAMP study, there had been very little research into health anxiety within secondary care - limited to a single study treating patients with cognitive behavioural therapy (CBT). Researchers estimate that as many as one in five people attending general hospital clinics have abnormal health anxiety, while only one in ten people are diagnosed with the condition.
The estimated cost to the NHS of untreated patients attending necessary appointments could be as high as £56m. Health anxiety is often worsened by people researching symptoms online – known as “cyberchondria”. Many people with health anxiety may also link their symptoms to previous medical problems such as heart attacks - and become convinced they are at risk again. Symptoms include chest pains or headaches that persist despite medical reassurance that the patient’s distress has no physical cause.
The research team assessed 444 patients attending hospital outpatient clinics. Participants were identified as people who worried excessively about their health and frequently sought reassurance from clinicians, scoring more than 20 points on the Health Anxiety Inventory (HAI) which indicates severe health anxiety. The study examined the effectiveness of CBT-HA on the treatment group - a modified form of cognitive behavioural therapy (CBT); compared against a control group who continued to receive standard care from their outpatient clinics (typically a combination of assessment, tests and reassurance).
Patients were randomly assigned to either the treatment group, who received between four and ten hour-long sessions of CBT-HA over a period of three to four months; or to the control group. Participants were then followed up and assessed at intervals from three to six months.
Having been accepted as part of NIHR’s Clinical Research Network (CRN) portfolio, the study was eligible for CRN support and funding for research delivery. This included the provision of four research assistants during the recruitment phase of the study and support from the Mental Health Research Network (MHRN) - now part of the NIHR CRN mental health specialty.
“The main difficulty in this study was recruitment. The population we were seeing - those with excessive health anxiety who were attending medical clinics - did not realise they had a mental health problem and neither did their physicians.
“Clinical research officers from the MHRN were instrumental not only getting people in the clinics to complete questionnaires, but also introducing the idea of health anxiety and inviting participation in the trial. Over the course of the recruitment period - nearly 30,000 patients were assessed and without the help of the MHRN in North London and East Midlands we could never have completed the study satisfactorily.” Sandra O’Sullivan, LCRN Research Manager, who supported the study as part of MHRN said: “CHAMP was a huge study that involved covering clinics, mornings and afternoons – five days a week across multiple sites and multiple disease areas. Our staff were involved in engaging services and specific departments, consenting and follow-up of patients.”
Chief investigator, Professor Peter Tyrer
Outcomes and findings
- After a year, the mean HAI scores in the CBT-HA group patients were 2.97 points lower than in the control group, improving their condition from severe to moderate; while symptoms of anxiety and depression also improved more in the CBT-HA group too. This difference between treatments lessened over time - but remained moderate (2.20) after five years. The team found that the benefits of CBT-HA persisted after five years and the costs of the treatment were more than offset by the savings to health services.
- The CBT-HA was provided by either nurses, psychologists, or other health professionals trained for this intervention. The mean HAI scores in patients given treatment by nurses was found to be superior to that given by psychologists by 5.4 points after 6 months, improving patients’ condition from severe to mild.
- CBT-HA is a highly effective treatment for health anxiety, with lasting benefit over 5 years. It also improves generalised anxiety and depressive symptoms more than standard care. CBT-HA may also be cost-effective, but the high costs of the concurrent medical illnesses of study participants data obscure potential savings.
Value to the NHS
The CHAMP study has exposed a significant area of previously undetected, but treatable pathology, in medical clinics. It has shown that pathological health anxiety is very common in general hospitals, causes considerable suffering and, if untreated, leads to physical illness and premature death.
“The subject is now ripe for a NICE guideline and for commissioners to introduce services for the management of health anxiety in the NHS. It will save unnecessary tests and investigations and relieve a cause of long-term suffering. Studies are now taking place in primary care (Nottingham) and in New Zealand to extend the research base and show the way forward to better integrated mental and physical care.”
Professor Peter Tyrer, Emeritus Professor in Community Psychiatry, Imperial College London
The potential impact of CBT-HA on health anxiety patients and alleviating pressure on NHS providers was encapsulated by a research participant, who said:
“Why didn’t my doctor recognise I had health anxiety and refer me for this type of treatment? It would have been so much simpler and saved everyone a lot of trouble.”