Internet-delivered acceptance and commitment therapy for COVID-19 related health anxiety: a pragmatic study

Health anxiety (HA) is characterized by excessive worries about having a serious illness, persisting even after medical reassurance. The COVID-19 pandemic, with widespread media coverage and lockdowns, may induce or exacerbate HA. During a pandemic, treatment options can be limited by lockdowns and social distancing, making remote, internet-delivered therapies particularly useful for individuals isolating due to health worries. This study aimed to assess the effectiveness of an internet-delivered Acceptance and Commitment Therapy (iACT) for COVID-19-related HA.

In a Danish university hospital, an uncontrolled national implementation project was conducted. Patients self-referred were assessed via video, and those eligible (≥18 years) received 12 weeks of iACT. The primary outcome was HA symptoms measured by the Whiteley-6-R Index. Secondary outcomes included somatic symptoms, depression, anxiety, quality of life, and life satisfaction. Changes from baseline to post-treatment were analyzed using paired t-tests and Cohen's d for effect size.

Out of 223 screened patients, 105 were eligible for enrollment, and 67 responded to post-treatment questionnaires. Significant improvements were observed across all outcomes, particularly for HA (d = 1.40) and anxiety (d = 0.80), along with better quality of life (d = 0.65) and life satisfaction (d = 0.64).

Implementation of self-referral and internet-delivered treatment into routine care was feasible and seemed to be effective in treating COVID-19-related HA. However, for self-referred participants, the poor eligibility and motivation may be a limitation when implementing this online treatment during a pandemic. In addition, collecting data in routine care may be a challenge.

Approved by the Danish Data Protection Agency (ID no. 790861).