Effects of text message reminders of safety behavior reduction on health anxiety: A randomized control trial

Cognitive-behavioral models posit that maladaptive safety behaviors are a key maintenance factor in health anxiety. Although existing cognitive-behavioral therapies emphasize the reduction of safety behaviors, targeting them directly has not been examined as a specific treatment for health anxiety. Accordingly, the current study employed a randomized controlled trial to evaluate the efficacy of a safety behavior reduction intervention for health anxiety. Participants with elevated health anxiety (N = 106) were recruited from across the United States and randomized to receive one of two 1-month text message interventions, which included reminders to avoid use of health-related safety behaviors (SB) or to focus on the present (PC). Symptoms were assessed at baseline, mid-treatment, post-treatment, and at 1-month follow-up. As predicted, safety behavior use decreased significantly in the SB intervention group but not in the PC group. However, health anxiety decreased significantly in the PC group but not in the SB group. Maladaptive illness attitudes also decreased significantly (and similarly) in both groups. A cross-lag panel analysis did show that less safety behavior use predicted lower health anxiety and lower negative attitudes about illness at the next assessment. However, negative attitudes about illness, but not health anxiety, predicted less safety behavior use at the next assessment. These findings suggest that while a reduction in safety behaviors is linked to reductions in health anxiety, simply text messaging reminders to reduce safety behaviors is not an incrementally effective treatment for health anxiety.