Seniors have been consistently under-represented in the health anxiety treatment literature. The aim of this study was to test the efficacy of a six-session enhanced cognitive behaviour therapy (ECBT) programme for subclinical health anxiety in seniors, and to examine whether the programme fostered therapeutic alliance and motivation for psychotherapy as compared to a standard cognitive behavioural therapy (SCBT) programme and wait-list control (WLC). Fifty-seven seniors with subclinical health anxiety were randomly assigned to six weeks of SCBT, ECBT, or WLC. At pre-treatment, post-treatment, and three-month follow-up, participants completed questionnaires on health anxiety and its dimensions, and other related psychological constructs. Therapeutic alliance and motivation measures were completed after Sessions 1, 3, and 6. At post-treatment, participants in the SCBT and ECBT groups showed significantly lower health anxiety when compared to WLC, with reductions on the subscale measuring disease fear/phobia. Significantly, more participants in the SCBT (66.7%) and ECBT (55.6%) conditions demonstrated clinically significant change on health anxiety compared to the WLC condition (11%). Gains were maintained at three months. There were minimal differences found between the SCBT and ECBT groups on therapeutic alliance and motivation. The findings indicated that both forms of CBT were efficacious for reducing some of the health anxious thoughts and beliefs in seniors.