The comparative effectiveness of psychological interventions for health anxiety: systematic review and a network meta-analysis of randomised controlled trials

BACKGROUND: Health anxiety, characterised by excessive worry about having or acquiring a serious illness, significantly impacts mental health and well-being. Determining which psychological interventions and components should be considered as first-line treatments requires robust evidence. AIMS: This study aimed to evaluate the efficacy of various psychological interventions and their essential components in managing health anxiety. METHOD: A comprehensive search was conducted across multiple academic databases, including PubMed, Embase, PsyINFO, Web of Science, Scopus and the Cochrane Central Register of Controlled Trials, with updates until 16 January 2025. Randomised clinical trials investigating the efficacy of psychological interventions among adults with substantial levels of health anxiety were included. We employed random-effects network meta-analysis for treatment comparison, and component network meta-analysis to assess the impacts of key therapeutic elements. RESULTS: A total of 35 trials involving 3263 participants (67% female; mean age 37 years, s.d. = 6) were analysed. The results revealed significant effects for several therapies, including cognitive-behavioural therapy (CBT), exposure therapy, acceptance and commitment therapy, metacognitive therapy, and mindfulness-based cognitive therapy, as well as behavioural stress management, compared with a waiting list control. However, cognitive bias modification, imagery therapy and short-term psychodynamic psychotherapy did not show significant effects. Component analysis indicated that exposure and response prevention, cognitive restructuring and mindfulness were linked to improved treatment outcomes. CONCLUSIONS: Both CBT and third-wave CBT are reasonable first-line choices for managing health anxiety. Effective CBT packages for health anxiety should integrate key components such as exposure and response prevention, cognitive restructuring and mindfulness.