Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Trial registry numbers: Approved by the Danish Data Protection Agency (ID no. 790861).

Keywords: COVID-19; Health anxiety; acceptance and commitment therapy; hypochondriasis; internet treatment.

背景： 健康焦虑（HA）的特点是过度担忧患有严重疾病，即使在得到医疗保证后这种担忧也会持续存在。新冠疫情及其广泛的媒体报道和封锁措施可能会诱发或加剧健康焦虑。在疫情期间，由于封锁和社会隔离的限制，治疗选择可能受限，因此对于因健康担忧而自我隔离的人们来说，在线提供的远程治疗方法特别有用。本研究旨在评估针对与新冠相关的健康焦虑的互联网交付接受承诺疗法（iACT）的有效性。

方法： 在一家丹麦大学医院中进行了一项未受控的全国实施项目。患者通过视频自我推荐，符合条件者（年龄≥18岁）接受了为期12周的iACT治疗。主要结果指标是通过Whiteley-6-R指数测量的健康焦虑症状。次要结果包括躯体症状、抑郁、焦虑、生活质量以及生活满意度。基线到治疗后的变化使用配对t检验和Cohen's d效应量进行分析。

结果： 在223名筛查患者中，105人符合条件并被纳入研究，其中67人在治疗结束后回答了问卷调查。所有结果指标均观察到显著改善，尤其是健康焦虑（d = 1.40）和焦虑（d = 0.80），以及更好的生活质量（d = 0.65）和生活满意度（d = 0.64）。

结论： 将自我推荐和在线治疗纳入常规护理中是可行的，并且似乎对于治疗与新冠相关的健康焦虑有效。然而，对于自我推荐参与者来说，在疫情期间实施这种在线治疗方法时，较低的资格率和动机可能是一个限制因素。此外，在日常照护中收集数据也可能面临挑战。

试验注册号： 丹麦数据保护局批准（ID编号：790861）。

关键词： COVID-19；健康焦虑；接受承诺疗法；疑病症；互联网治疗。