JMIR Publications

ABSTRACT

Background:

Health anxiety, commonly diagnosed in the DSM-5 as illness anxiety disorder (IAD) or somatic symptom disorder, is an increasingly prevalent condition that imposes a substantial burden on healthcare systems. Digital mental health interventions (DMHIs), owing to their scalability and cost-effectiveness, have been proposed as promising approaches for managing health anxiety. However, the overall effectiveness of digital behavioral interventions for alleviating health anxiety has not yet been comprehensively evaluated through systematic review and meta-analysis.

Objective:

To systematically evaluate the clinical effectiveness of digital behavioral interventions for reducing health anxiety in adults and to examine effects on related psychological outcomes.

Methods:

This systematic review and meta-analysis adhered to the PRISMA 2020 statement and Cochrane guidelines. We systematically searched PubMed, Embase, Web of Science, and ScienceDirect from database inception to 1 November 2025. Eligible studies included randomized controlled trials (RCTs), quasi-experimental studies, and cohort studies involving adults with health anxiety. The primary outcome was health anxiety severity assessed using validated instruments. Meta-analyses employed random-effects models to estimate standardized mean differences (SMDs) with 95% confidence intervals (CIs). Study quality was appraised using JBI guidelines, and risk of bias for RCTs was assessed with the Cochrane ROB 2 tool.

Results:

This systematic review included 16 studies (2014–2025; N=2,481), primarily evaluating internet-delivered behavioral therapies, particularly iCBT. RoB 2 assessments of nine RCTs indicated generally low risk for randomization and deviations from intended interventions, with some concerns regarding missing outcome data, outcome measurement, and selective reporting. Meta-analysis showed significant reductions in core health anxiety symptoms: HAI (3 studies) SMD=−0.96 (95% CI −1.78 to −0.12) and SHAI (4 studies) SMD=−0.81 (95% CI −1.45 to −0.16). Digital interventions also showed potential benefits for comorbid general anxiety (BAI) and depressive symptoms (MADRS-S). Heterogeneity was high across outcomes (I²>80%), likely reflecting differences in samples, protocols, and measures; sensitivity analyses supported the robustness of effects on core health anxiety.

Conclusions:

Digitally assisted cognitive and behavioral therapies represent a well-established and effective approach for alleviating health anxiety, with intervention effects delivered via smart devices comparable to the quality of face-to-face behavioral treatments. Internet-based platforms offer a feasible means of enhancing patient engagement and have demonstrated significant short-term efficacy in reducing core health anxiety symptoms, along with potential for sustained improvement. Future research should prioritize direct comparisons between internet-based and face-to-face CBT and explore the integration of embodied interaction modalities, such as visualization and voice-based interaction, to optimize therapeutic outcomes Clinical Trial: Prospero Registration Number: CRD420251238746