Related Experiment Video
Updated: Jul 18, 2025
Investigating Pain-Related Avoidance Behavior using a Robotic Arm-Reaching Paradigm
Published on: October 3, 2020
Unwanted outcomes in cognitive behavior therapy for pathological health anxiety: a systematic review and a secondary
Erland Axelsson1,2,3, Erik Hedman-Lagerlöf4,5
1Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
Introduction:
Cognitive behavior therapy (CBT) is effective for pathological health anxiety, but little is known about unwanted outcomes.
Areas Covered:
We investigated unwanted outcomes in the form of adverse events, overall symptom deterioration, and dropouts in CBT for pathological health anxiety based on a systematic review of 19 randomized controlled trials (PubMed, PsycInfo, and OATD; last updated 2 June 2023; pooled N = 2188), and then a secondary original study of two randomized controlled trials (pooled N = 336). In the systematic review, 10% of participants in CBT reported at least one adverse event and 17% dropped out. Heterogeneity was substantial. In the original investigation, 17% reported at least one adverse event, 0-10% met criteria for overall symptom deterioration, and 10-19% dropped out. In guided Internet-delivered CBT, dropouts were more common with lower education and lower credibility/expectancy ratings. Higher adherence was associated with a larger reduction in health anxiety.
Expert Opinion:
Unwanted effects are routinely seen in CBT for pathological health anxiety, but, under typical circumstances, appear to be acceptable in light of the treatment's efficacy. There is a need for more consistent methods to improve our understanding adverse events, dropouts, and overall symptom deterioration, and how these outcomes can be prevented.
Related Concept Videos
01:22Behavior Therapy
Exposure therapy is a cornerstone of behavioral treatment for anxiety disorders. It involves systematic exposure to feared stimuli, either in real...
01:18Anxiety: Overview
Individuals with anxiety often experience a range of physical and emotional symptoms, including sweating, trembling, tachycardia, and disturbances in sleep patterns. These symptoms vary in intensity and frequency but are generally disruptive and distressing.
01:25Beck's Cognitive Therapy
Arbitrary Inference
Arbitrary inference involves making conclusions without sufficient...
01:25Cognitive Therapy
01:14Avoidance Learning and Learned Helplessness
Avoidance learning occurs when an organism learns that a specific behavior can prevent an unpleasant outcome. For example, a student who receives a bad grade may start studying harder to avoid future poor grades. This behavior persists even when the negative outcome is no longer present. Avoidance learning is powerful because it maintains behavior in the absence of the...
01:30Generalized Anxiety Disorder