Download Hypochondriasis and Health Anxiety

Jonathan S. Abramowitz & Autumn E. Braddock
Hypochondriasis and Health Anxiety
In the series: Advances in Psychotherapy – Evidence-Based Practice: Volume 19
2010, ca. 90 pages, softcover
US $29.80 / € 24.95 / £ 19.90 (Series Standing Order: US $24.80 / € 19.95 / £ 15.90)
ISBN: 978-0-88937-333-4
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An essential resource for anyone providing services for individuals with somatoform or anxiety disorders
!
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Cognitive-behavioral therapy is now the treatment of choice for
individuals with health anxiety and related problems. The latest
research shows that it results in reductions in health-related
worries, reassurance-seeking behavior, and phobic avoidance, as
well as increases in life satisfaction and everyday functioning.
This compact, easy to understand book by experts Jonathan S.
Abramowitz and Autumn E. Braddock opens with an overview
of the diagnostic issues and assessment of health anxiety, and
delineates a research-based conceptual framework for understanding the development, maintenance, and treatment of this
problem.
The focus of the book is a highly practical guide to implementing
treatment, packed with helpful clinical pearls, therapist-patient
dialogues, illustrative case vignettes, and sample forms and
handouts. Readers are equipped with skills for engaging reluctant patients in treatment and tailoring educational, cognitive,
and behavioral techniques for health-related anxiety. The book,
which also addresses common obstacles in treatment, represents an essential resource for anyone providing services for
individuals with somatoform or anxiety disorders.
About the Authors
1
Exposure
Description of Health Anxiety
Anxiety level (0-100)
48
ssful
Advances in Psychother
in advance what
apy: Hypochondriasis and
predictable. Decide
Health Anxiety
, structured, and
you will complete
s should be planned
Plan in advance when
does not work
1. Exposure practice
long you will stay.
situation and how
plan in case the original
90
you will do in the
e. Have a back-up
Terminology
1.1
put it in your schedul
80
your practice and
the
to
s,
response
behavioral
and
out.
practice emotional, physiological,
70
a cognitive,
Anxiety
spacedisthe
more closely
the same
inthreat.
one doubts his or her ability to cope
d frequently. The
when
occurs
being
It
of
repeate
perception
the
practice
be
60
to
s should
a good idea
to experience. It is
2. Exposure practice
Session 1
with the perceived threat. Health anxiety refers to inappropriate or excessive
50
n that you are likely
and
more fear reductio
health-related fears based on misperceptions of innocuous bodily cues
Session 2
until it becomes easier.
40
situation repeatedly
thing youofcan
a serious medical problem. Moreover, the individual
as indicative
most difficult
Session 3
must do the sensations
the him or herself as unable to cope with or prevent
30
difficult
not assume that you
perceives
anxiety
The more
ing. health
challengwith
Session 4
can be gradual. Do
s
practices that are
20
3. Exposure pace
in this case the presence of a serious medical illness.
threat,practice
Try to choose
able.perceived
but be sure to choose
more comfortthe
be
to
learn
imagine right away,
will
10
e them.
, the quicker you
items that you practice
that you will not complet
0
but not so difficult
s.
that are challenging
initial exposure practice
0 5 10 15 20 25
to feel awful during
30 35 40 45 50
repeated practices,
is perfectly normal
1.2
ds. With Definition
uncomfortable. It
tired and anxious afterwar
4. Expect to feel
situation. Rather,
Time (minutes)
s may leave you feeling not be judged by how you felt in the
Definition of
Also, these practice
feeling awful.
response which prepares us to take action when con- Figure
is an adaptive
Anxietydespite
. Success should
situation
4 anxiety
the
decrease
in
health
will
stay
to
of Expected
these feelings
you were able
fronted with possible danger (i.e., the fight or flight response). Some degree
Pattern of Within-sess
andhypochondriasis
judged by whether
ion and Between-sessions
person
anxious
a
motivates
it
if
success should be
your
constructive
be
Repeated
ng
therefore
may
Habituation During
anxiety
Exposure
health-related
of increasi
the effect
will feel or seek proper medical attention. For example,
the anxiety will have
is that youmeasures
take appropriate
your fear. Fighting
is likely totohappen
lead
5. Try not to fight
The worst thing that
apprehension concerning shortness of breath in a person with asthma can
declines as time passes.
just let it happen.
reAt the second session, the
feelings. Instead,
to prompt administration of inhalant bronchodilator medication to prevent
discomfort subsides
ortable.
more quickly because learning
the by suffocation. Clinical health anxiety, on the
temporarily uncomf
sorwithout
has occurred. After several
death
even
practice
fatigue
the
spiratory
te
als, the initial distress level
exposure trie. Comple
is lower and it subsides
early, andinother
es during exposur
relation to the actual degree of threat (if any threat
is extreme
leaving
otherg,hand,
even more quickly.
avoidance strategi
With repeated practice, the
nce, checkin
feared situations no longer
asking for reassura
6. Do not use subtle
even exists). It causes distress and interferes with various domains of function- • This pattern
provoke anxiety.
medications, alcohol,
only occurs if the exposure
use of distraction,
exercise is carefully designed
ing, including interpersonal relationships, self-care, work or school, and leisure.
s.
and if the patient remains
your
such escape strategie
exposed for an extended
is classified as a somatoform disorder in
Hypochondriasis
ences of facing
Hypochondriasis.
consequ
the
period of time
without
about
escaping
the
or seeking reassurance (i.e.,
during
Psychiatric Association [APA], 2000) and characternegative predictions
(American
might happen
DSM-IV-TR
the patient must “invest
anxiety now in order to
practices to test
on.
what you are afraid
serious
a
has,
predicti
one
have
that
yourself
idea
the
or
a
calmer
7. Use exposure
having,
ask
of
fearful
fears
e,
with
future”).
a preoccupation
ized
y ofbyyour
g an exposur
• Two kinds of exposure
to
compare
are used in the treatment
fear. Before beginnin the exposure practice to test the accurac
how it such
as as chronic, life threatening or life-altering sickness
condition
medical
ce and
of health anxiety:
experien
Situational (or in vivo)
of
practice. Then conduct the evidence you gained from your
exposure involves facing
(see Table 1). This “disease conviction” is (a) based on a misinterpretation
the actual feared
situations. Interoceptive
about
spite
Afterwards, think
exposure involves purposely
harmless or minor bodily sensations or perturbations and (b) persists in
prediction.
inducing feared
body sensations so the
atten- and reassurance of good health.
patient may systematic
to pay
your original fearful
evaluation
medical
of
can be helpful
ally confront them in
s itappropriate
therapy.
down
During exposure practice your
go up and
might concern specific bodily functions •
preoccupation
health-related
scale from 0 to 100.
The
make Theanxiety
on
therapist
that
s
fear
and
your
patient
variable
sensathe
will construct a list of exposure
8. Rate
such as peristalsis or heart beat; slight benign abnormalities, signs, and
feeling and to notice
ordered from the least to
stimuli to be
most anxiety-provoking.
tion to how you are
pulled muscle, mole, or bruise on the skin;•
cough,
occasional
an
as
such
tions
.
Continue such as “a hollow head” or “weak spine;” All exposure exercises will be planned ahead
during the practice
in anxiety. complaints
on ambiguous
and
vague
of
time
reducti
(collabora
to
ant
avoid
tively)
surprises.
signific
A good body parts (e.g., prostate gland), or diseases
takes.kidneys),
enough for a
time it (e.g.,
specific
or
much organs
how
• The therapist will provide
s should last long
goes down, no matter (e.g., rabies,
support and coaching during
9. Exposure practice
on the 0-100 scale
rating cancer).
until your anxiety
task, but will not force the
each exposure
until your anxiety
each exposure practice
patient into exposure tasks.
health anxiety often fixate on the cause, meaning, and choose
exposure practice
clinical
with
an
Patients
continue
The
to
patient
exposure instead of avoidance
must
rule of thumb is
if it peaked at 80).
and instead of the use of
authenticity of their complaints. Common expressions of this fixation include reduction strategies.
half (e.g., below 40
anxietysettings
decreases by at least
e practices in multiple expo• The patient must prepare
. Conducting exposur
to “tough it out” when the
to conduct
in a variety of settings
going gets rough.
It is often helpful
This may be challenging
in the beginning, but it will
conduct some
10. If possible, practice a more broad decrease in your anxiety.
also be helpful to
get easier.
other settings. It can
will help bring about
feel artificially
t, at home, and in
Situational Exposure
people can make us
sures with your therapis
the presence of other
Situation or in vivo
es
sometim
Building the situational
because
hierarchy. Compose two
exposure means
exposures by yourself
lists, based on the results
the functional assessmen
confronting real life
of
t, and with the patient’s
safe.
g
assistance. Include the situations in the first list and
use.
© 2011 Hogrefe Publishin
stimuli
the bodily sensations that
purchaser for clinical
reproduced by the
ndHealthAnxiety
trigger excessive health
concerns, or that the patient
This page may be
: Hypochondriasisa
avoids, in the second. Record
itz & A. E. Braddock
sensations on the Exposure
these situations and
From: J. S. Abramow
Hierarchy Form (Appendix
9). The following are
10 Tips for Succe
Jonathan S. Abramowitz, Ph.D, ABPP, is Professor and
Associate Chair of Psychology at the University of North
Carolina at Chapel Hill. He is an international expert on
the treatment of anxiety disorders, having published over
150 research articles, book chapters, and books. He regularly presents workshops for clinicians on the treatment of
anxiety disorders.
Autumn E. Braddock, PhD, is a primary care psychologist
within the Veterans Affairs Greater Los Angeles Healthcare System, specializing in behavioral medicine and
cognitive-behavioral therapy for anxiety disorders. She
has presented her research, primarily addressing anxiety
within medical populations, at national and international conferences.
The Series
Advances in Psychotherapy – Evidence-Based Practice
Developed and edited with the support of the Society of Clinical Psychology (APA Division 12)
Series Editor: Danny Wedding
Associate Editors: Larry Beutler, Kenneth E. Freedland, Linda Carter Sobell, David A. Wolfe
Current & Forthcoming Volumes at a Glance:
• Vol. 1: Bipolar Disorder by R.P. Reiser, L.W. Thompson (July 2005)
• Vol. 2: H
eart Disease by J.A. Skala, K.E. Freedland, R.M. Carney
(August 2005)
• Vol. 3: O
bsessive-Compulsive Disorder by J.S. Abramowitz (January 2006)
• Vol. 4: C hildhood Maltreatment by C. Wekerle, A. L. Miller, D.A. Wolfe,
C.B. Spindel (July 2006)
• Vol. 5: S chizophrenia by S.M. Silverstein, W.D. Spaulding, A.A. Menditto
(August 2006)
• Vol. 6: T reating Victims of Mass Disaster and Terrorism by J.Housley,
L.E. Beutler (October 2006)
• Vol. 7: A ttention-Deficit/Hyperactivity Disorder in Children and Adults
by A.U. Rickel, R.T. Brown (April 2007)
• Vol. 8: P roblem and Pathological Gambling by J.P. Whelan,
T.A. Steenbergh, A.W. Meyers (July 2007)
• Vol. 9: C hronic Illness in Children and Adolescents by R.T. Brown,
B.P. Daly, A.U. Rickel (August 2007)
• Vol. 10: Alcohol Use Disorders by S.A. Maisto, G.J. Connors, R.L. Dearing
(October 2007)
• Vol. 11: Chronic Pain by B.J. Field, R.A. Swarm (January 2008)
• Vol. 12: Social Anxiety Disorder by M.M. Antony, K. Rowa (February 2008)
• Vol. 13: Eating Disorders by S.W. Touyz, J. Polivy, P. Hay (May 2008)
• Vol. 14: Suicidal Behavior by R. McKeon (February 2009)
• Vol. 15: Substance Use Problems by M. Earleywine (June 2009)
• Vol. 16: Elimination Disorders in Children and Adolescents
by E.R. Christophersen, P.C. Friman (January 2010)
• Vol. 17: Sexual Violence by W.R. Holcomb (March 2010)
• Vol. 18: Depression by L.P. Rehm (June 2010)
• Vol. 19: Hypochondriasis and Health Anxiety by J.S. Abramowitz,
A. Braddock (due August 2010)
• Vol. 20: P ublic Health Tools for Practicing Psychologists by J.A. Tucker,
D.M. Grimbley (due October 2010)
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