Trends in Psychiatry and Psychotherapy
Trends in Psychiatry and Psychotherapy
Original Article

Video-based cognitive-behavioral intervention for COVID-19 anxiety: a randomized controlled trial

Reza Shabahang, Mara S. Aruguete, Lynn McCutcheon

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Objective: Cognitive-behavioral interventions can be effective for relieving anxiety associated with coronavirus disease 2019 (COVID‑19), but complications such as social distancing, quarantine, a shortage of experts, and delayed care provisions have made it difficult to access face-to-face therapeutic interventions. The purpose of this study was to investigate the efficacy of a video-based cognitivebehavioral intervention for reducing COVID‑19 anxiety. Method: In the present randomized controlled trial, 150 college students with severe COVID‑19 anxiety were randomly assigned to either an intervention (n = 75) or a waiting list control (n = 75) group. The intervention group participated in a video-based cognitive-behavioral program consisting of nine 15- 20-minute sessions (three days a week for three weeks). Dependent measures included the COVID‑19 Anxiety Questionnaire, Short Health Anxiety Inventory, Anxiety Sensitivity Index-3, Somatosensory Amplification Scale, Experience of Parasocial Interaction Scale, and Source Credibility Scale. Results: Participants who were randomly assigned to the cognitive-behavioral program reported high parasocial interaction, source credibility, and satisfaction with the intervention. Eighty percent reported that the video-based intervention was a beneficial alternative to traditional face-to-face therapeutic intervention. At post-treatment evaluation, the video-based cognitive-behavioral intervention group showed a significant reduction in COVID‑19 anxiety, health anxiety, anxiety sensitivity, and somatosensory amplification when compared to the wait-listed control group. Conclusions: This study suggests that video-based cognitive-behavioral interventions can be an affordable, feasible, and effective method to reduce anxiety during a large-scale pandemic.


COVID‑19, video-based psychotherapy, cognitive-behavioral therapy, anxiety


1. Rachman S. Health anxiety disorders: a cognitive construal. Behav Res Ther. 2012;50:502-12.

2. Thompson RR, Garfin DR, Holman EA, Silver RC. Distress, worry, and functioning following a global health crisis: a national study of Americans’ responses to Ebola. Clin Psychol Sci. 2017;5:513-21.

3. Roy D, Tripathy S, Kar SK, Sharma N, Verma SK, Kaushal V. Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID‑19 pandemic. Asian J Psychiatr. 2020;51:102083.

4. Shabahang R, Aruguete MS, McCutcheon, LE. Online health information utilization and online news exposure as predictors of COVID‑19 anxiety. N Am J Psychol. 2020;22:469-82.

5. Cooper K, Gregory JD, Walker I, Lambe S, Salkovskis PM. Cognitive behaviour therapy for health anxiety: a systematic review and meta-analysis. Behav Cogn Psychother. 2017;45:110-23.

6. Abramowitz JS, Olatunji BO, Deacon BJ. Health anxiety, hypochondriasis, and the anxiety disorders. Behav Ther. 2007;38:86-94.

7. Barsky AJ, Orav EJ, Bates DW. Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry. 2005;62:903-10.

8. Terluin B, van Rhenen W, Anema JR, Taris TW. Psychological symptoms and subsequent sickness absence. Int Arch Occup Environ Health. 2011;84:825.

9. Leonidou C, Panayiotou G, Bati A, Karekla M. Coping with psychosomatic symptoms: the buffering role of psychological flexibility and impact on quality of life. J Health Psych. 2019;24:175-87.

10. Kim HS, Sherman DK, Updegraff JA. Fear of Ebola: the influence of collectivism on xenophobic threat responses. Psychol Sci. 2016;27:935-44.

11. American Psychiatric Association (APA). New poll: COVID‑19 impacting mental well-being: Americans feeling anxious, especially for loved ones; older adults are less anxious [Internet]. 2020 Mar 25 [cited 2021 Mar 26]. news-releases/new-poll-COVID‑19-impacting-mental-wellbeing-americans-feeling-anxious-especially-for-loved-onesolder-adults-are-less-anxious

12. Fergus TA, Bardeen JR. Anxiety sensitivity and intolerance of uncertainty: evidence of incremental specificity in relation to health anxiety. Pers Individ Dif. 2013;55:640-4.

13. Martínez MP, Belloch A, Botella C. Somatosensory amplification in hypochondriasis and panic disorder. Clin Psychol Psychother 1999;6:46-53.

14. Taylor S, Zvolensky MJ, Cox BJ, Deacon B, Heimberg RG, Ledley DR, et al. Robust dimensions of anxiety sensitivity: development and initial validation of the anxiety sensitivity index-3. Psychol Assess. 2007;19:176.

15. Barsky AJ, Goodson JD, Lane RS, Cleary PD. The amplification of somatic symptoms. Psychosom Med. 1988;50:510-9.

16. McKay D, Yang H, Elhai J, Asmundson GJ. Anxiety regarding contracting COVID‑19 related to interoceptive anxiety sensations: the moderating role of disgust propensity and sensitivity. J Anxiety Disord. 2020;73:102233.

17. Tian F, Li H, Tian S, Yang J, Shao J, Tian C. Psychological symptoms of ordinary Chinese citizens based on SCL-90 during the level I emergency response to COVID‑19. Psychiatry Res. 2020;288:112992.

18. Colizzi M, Bortoletto R, Silvestri M, Mondini, F, Puttini, E, Cainelli C, et al. Medically unexplained symptoms in the times of COVID‑19 pandemic: a case-report. Brain Behav Immun Health. 2020;5:100073.

19. Leonidou C, Panayiotou G. How do illness-anxious individuals process health-threatening information? A systematic review of evidence for the cognitive-behavioral model. J Psychosom Res. 2018;111:100-15.

20. Olatunji BO, Cisler JM, Deacon BJ. Efficacy of cognitive behavioral therapy for anxiety disorders: a review of meta-analytic findings. Psychiatr Clin. 2010;33:557-77.

21. Olatunji BO, Kauffman BY, Meltzer S, Davis ML, Smits JA, Powers MB. Cognitive-behavioral therapy for hypochondriasis/health anxiety: a meta-analysis of treatment outcome and moderators. Behav Res Ther. 2014;58:65-74.

22. Adam F, De Sutter P, Day J, Grimm E. A randomized study comparing video-based mindfulness-based cognitive therapy with video-based traditional cognitive behavioral therapy in a sample of women struggling to achieve orgasm. J Sex Med. 2020;17:312-24.

23. Savard J, Ivers H, Savard MH, Morin CM. Is a video-based cognitive behavioral therapy for insomnia as efficacious as a professionally administered treatment in breast cancer? Results of a randomized controlled trial. Sleep. 2014;37:1305-14.

24. Hedman E, Lindefors N, Andersson G, Andersson E, Lekander M, Rück C, et al. Predictors of outcome in Internet-based cognitive behavior therapy for severe health anxiety. Behav Res Ther. 2013;51:711-7.

25. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Arlington: American Psychiatric Publishing; 2013.

26. Salkovskis PM, Rimes KA, Warwick HM, Clark DM. The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychol Med. 2002;32:843-53.

27. Taylor S, Zvolensky MJ, Cox BJ, Deacon B, Heimberg RG, Ledley DR, et al. Robust dimensions of anxiety sensitivity: development and initial validation of the anxiety sensitivity index-3. Psychol Assess. 2007;19:176.

28. Barsky AJ, Wyshak G, Klerman GL. The somatosensory amplification scale and its relationship to hypochondriasis. J Psychiatr Res. 1990;24:323-34.

29. Hartmann T, Goldhoorn C. Horton and Wohl revisited: exploring viewers‘ experience of parasocial interaction. J Commun. 2011;61:1104-21.

30. Ohanian R. Communication and validation of a scale to measure celebrity endorser’s perceived attractiveness and design to influence. J Advert. 1990;19:39-52.

31. Wheaton MG, Abramowitz JS, Berman NC, Fabricant LE, Olatunji BO. Psychological predictors of anxiety in response to the H1N1 (swine flu) pandemic. Cog Ther Res. 2012;36:210-8.

32. Lawshe CH. A quantitative approach to content validity 1. Pers Psychol. 1975;28:563-75.

33. Waltz, CF, Bausell RB. Nursing research: design, statistics, and computer analysis. Philadelphia: Davis Co; 1981.

34. Abramowitz JS, Deacon BJ, Valentiner DP. The short health anxiety inventory in an undergraduate sample: Implications for a cognitive-behavioral model of hypochondriasis. Cog Ther Res. 2007;31:871-83.

35. Alberts NM, Hadjistavropoulos HD, Jones SL, Sharpe D. The short health anxiety inventory: a systematic review and meta-analysis. J Anxiety Disord. 2013;27:68-78.

36. Petrocchi N, Tenore K, Couyoumdjian A, Gragnani A. The anxiety sensitivity index-3: factor structure and psychometric properties in Italian clinical and non-clinical samples. BPA-Appl Psychol Bull. 2014;62:53-64.

37. Nakao M, Kumano H, Kuboki T, Barsky AJ. Reliability and validity of the Japanese version of somatosensory amplification scale: clinical application to psychosomatic illness. Jpn J Psychosom Med. 2001;41:539-47.

38. Guelec H, Sayar K. Reliability and validity of the Turkish form of the Somatosensory Amplification Scale. Psychiatry Clin Neurosci. 2007;61:25-30.

39. Aghayousefi A, Oraki M, Mohammadi N, Farzad V, Daghaghzadeh H. Reliability and validity of the Farsi version of the somatosensory amplification scale. Iran J Psychiatry Behav Sci. 2015 Sep;9:e233.

40. Shabahang R, Besharat M, Mokhtari Chirani B, Rezaei S, Nikoogoftar M, Bagheri Sheykhangafshe F. Investigation of psychometric attributes of the experience of Parasocial Interaction Scale in Iranian students sample. Soc Psychol Res. 2019;8:17-44.

41. French JR, Raven B, Cartwright D. The bases of social power. Class Org Theory. 1959;7:311-20.

42. Sweller J. Element interactivity and intrinsic, extraneous, and germane cognitive load. Educ Psychol Rev. 2010;22:123-38.

43. De Koning BB, Tabbers HK, Rikers RM, Paas F. Towards a framework for attention cueing in instructional animations: Guidelines for research and design. Educ Psychol Rev. 2009;21:113-40.

44. Sørensen P, Birket-Smith M, Wattar U, Buemann I, Salkovskis P. A randomized clinical trial of cognitive behavioural therapy versus short-term psychodynamic psychotherapy versus no intervention for patients with hypochondriasis. Psychol Med. 2011;41:431-41.

45. Greeven A, van Balkom AJ, Visser S, Merkelbach JW, van Rood YR, van Dyck R, et al. Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a randomized controlled trial. Am J Psychiatry. 2007;164:91-9.

46. Tyrer P, Cooper S, Tyrer H, Salkovskis P, Crawford M, Green J, et al. CHAMP: cognitive behaviour therapy for health anxiety in medical patients, a randomised controlled trial. BMC Psychiatry. 2011;11:99.

47. Salkovskis PM, Warwick HM, Deale AC. Cognitive-behavioral treatment for severe and persistent health anxiety (Hypochondriasis). Brief Treat Crisis Interv. 2003;3:353-67.

48. Barsky AJ, Ahern DK. Cognitive behavior therapy for hypochondriasis: a randomized controlled trial. JAMA. 2004;291:1464-70.

49. Hedman E, Axelsson E, Andersson E, Lekander M, Ljotsson B. Exposure-based cognitive–behavioural therapy via the internet and as bibliotherapy for somatic symptom disorder and illness anxiety disorder: randomised controlled trial. Br J Psychiatry. 2016;209:407-13.

50. Surawy C, McManus F, Muse K, Williams JM. Mindfulness-based cognitive therapy (MBCT) for health anxiety (hypochondriasis): rationale, implementation and case illustration. Mindfulness. 2015;6:382-92.

51. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Erlbaum; 1988.

52. Abramowitz JS, Schwartz SA, Whiteside SP. A contemporary conceptual model of hypochondriasis. Mayo Clinic Proc. 2002;77:1323-30.

53. Leventhal H. Symptom reporting: a focus on process. In: McHugh S, Vallis TM, eds. Illness behavior: a multidisciplinary model. New York: Plenum Press; 1986. p. 219-37.

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