Screening and Support for Health and General Anxiety at the Prince of Wales Hospital - An Exploratory Study

During Step-1, participants at selected outpatient clinics will be asked to complete an online survey via an SMS link. This survey will include self-report measures of health anxiety and general anxiety, and will take approximately 5 minutes. Those who score high on the health anxiety measure (Whitely Index-6 score =>18) will be offered follow-up contact to discuss treatment options. Those who accept will be offered access to treatment (Step-2), and will be able to choose either an internet cognitive-behavioural therapy (iCBT) course or access to a new face-to-face clinic. As this is a pilot study, with an aim to determine the acceptability of treatment options, participants will not be randomised, but will rather be able to engage in their preferred treatment. Those who participate in iCBT will be given access to This Way Up's Health Anxiety course (https://thiswayup.org.au/courses/the-health-anxiety-course/), developed by St Vincent's Hospital. This is a validated iCBT course that has been shown to be effective in managing health anxiety. This Way Up features 6 online sessions (presented as story-based slide shows), lasting approximately 1-hour, over a 12-week period, and will require some work from participants between sessions. The sessions will in turn cover information about health anxiety, reducing focus on worries, awareness of anxious thoughts, putting thoughts/fears to the test, tackling avoidance/safety behaviours, and staying well. “Homework” is provided as downloadable documents, and typically involves the applying skills and techniques learned in the sessions in the individual’s life. Throughout the program, they will have access to a clinician via email and phone. No limit is placed on how often they may contact the clinician. Adherence will be monitored using data such as number of sessions completed. Those who participate in our face-to-face program will meet with a member of the SHAPE psychiatry team to determine a treatment plan. This plan will be personalised to the participant, with the participant and clinician working together to discuss all options, as well as the pros and cons for each treatment in their specific case. This plan could feature treatments such as psychotherapy, medication, exercise physiology and social worker support. Note that this program is not testing new medications; any medications prescribed will be chosen based on clinical best-practice and used only where appropriate. Participants will engage in a minimum of one 1-hour session, with three sessions as the expected number. Number of sessions with other treatments will be determined as part of clinical review, as per best practice. Adherence will be monitored by tracking whether people return to planned follow-up appointments. Participants in Step-2 will be asked to complete online assessments (Whitely Index-6, General Anxiety Disorder-7, Patient Health Questionnaire-9, Patient Health Questionnaire-15; EuroQoL-5 Dimensions, Social Functioning Questionnaire, Credibility/Expectancy Questionnaire, Treatment Satisfaction Questionnaire, Standardised Assessment of Personality - Abbreviated Scale at 0-weeks, 6-weeks, 12-weeks and 24-weeks (follow-up). The cumulative time to complete these assessments is expected to be up to 20 minutes per time-period. Additional assessments will be administered for those attending the face-to-face clinic, including The Montreal Cognitive Assessment, Anxiety and related disorders interview schedule for DSM-5, an intrusive thoughts assessment and a semi-structured qualitative assessment of the clinic. These assessments will form part of the initial session, which may take up to 90 minutes in total.