Abramowitz / Braddock Hypochondriasis and Health Anxiety

1. Auflage 2011
ISBN: 978-1-61676-325-1
Verlag: Hogrefe Publishing
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 104 Seiten

Reihe: Advances in Psychotherapy - Evidence-Based Practice

An essential resource for anyone providing services for individuals with somatoform or anxiety disorders
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.

Autoren/Hrsg.

Abramowitz, Jonathan S.

Braddock, Autumn E.

Braddock, Autumn

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizin, Gesundheitswesen Allgemeinmedizin, Familienmedizin
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Psychiatrie, Sozialpsychiatrie, Suchttherapie
• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie

Inhaltsverzeichnis

1;Table of Contents;10
2;Preface;8
3;1 Description of Health Anxiety;12
4;2 Theories and Models of Health Anxiety;21
5;3 Diagnosis and Treatment Indications;28
6;4 Treatment;38
7;5 Case Vignette;74
8;6 Further Reading;78
9;7 References;79
10;8 Appendices: Tools and Resources;81

Leseproben

1.7.3 Self-Report Inventories

The Short Health Anxiety Inventory (SHAI; Salkovskis, Rimes, Warwick, & Clark, 2002) is an 18-item questionnaire that assesses health anxiety independent of physical health status. For each item the respondent chooses from a series of four statements (ranging in severity from 0 [least severe] to 3 [most severe]) that best reflects his or her feelings over the past several months. Items address the following aspects of health anxiety: worry about health, awareness of bodily sensations and changes, and feared consequences of having an illness. The SHAI contains two factors: (a) the feared likelihood of becoming ill and (b) the feared negative consequences of becoming ill. The measure has good reliability and validity in clinical and nonclinical samples and can also be used to assess health anxiety within other psychological disorders (e.g., anxiety disorders). The full SHAI is reprinted in an article by Salkovskis and colleagues (2002).

The Illness Attitudes Scale (IAS; Kellner, 1986; 1987) is a 29-item questionnaire that measures (a) fear of illness/disease/pain/death, (b) symptoms’ interference with lifestyle, (c) treatment experience, and (d) disease conviction (Hadjistavropoulos, Frombach, & Asmundson, 1999). Respondents are asked how often a list of thoughts and behaviors occur, with responses ranging from “never” to “most of the time”. Overall, the measure has good reliability and validity. This scale is reproduced in Kellner (1987). The Cognitions about Body and Health Questionnaire (CBHQ; Rief, Hiller, & Margraf, 1998) is a 31-item measure developed to help differentiate individuals with severe health anxiety from those with somatization disorder. It measures catastrophic interpretations of (a) bodily complaints, (b) autonomic sensations, (c) bodily weakness, (d) bodily complaints, and (e) health habits. Items assess agreement with catastrophic interpretations of bodily complaints and are rated on a 4-point scale ranging from “completely wrong” to “completely right.” Overall, the psychometric properties of the CBHQ are adequate. The CBHQ is reprinted in an article by Rief and colleagues (1998).

1.7.4 Documenting Changes in Symptom Levels

Continual assessment of health anxiety and related symptoms throughout the course of psychological treatment assists the clinician in evaluating treatment response. It is not enough to simply assume that “he seems to be less preoccupied,” or “it looks like she has cut down on her reassurance-seeking,” or even for the patient to report that he or she “feels better.” Periodic re-assessment, using the aforementioned diagnostic tools and comparison with baseline symptom levels, should be conducted to objectively clarify whether and in which ways treatment has been helpful, and to identify problems that may require further treatment.

2 Theories and Models of Health Anxiety

This chapter outlines a well-studied biopsychosocial theory of the development and maintenance of health anxiety. The treatment implications of this model are also discussed.

2.1 Development of Health Anxiety

According to the biopsychosocial model, health anxiety arises from normal physiological, psychological, and environmental processes. When people acquire certain maladaptive beliefs about health and illness, they begin routinely misinterpreting benign bodily sensations as indicative of serious illness.

2.1.1 The Human Body Is “Noisy”

The biopsychosocial model of health anxiety begins with the reality that the human body is ever-changing, that it is receptive and responsive to a myriad of external and internal stimuli, and that it has many interrelated systems that constantly influence one another. We may occasionally notice this “body noise,” especially if we “listen” carefully enough (e.g., stomach grumbling, a “pulled” muscle). People with health anxiety, however, habitually listen to their bodies and therefore become exquisitely sensitive to even very subtle bodily variations that most people would ignore or not even detect. It is this hypervigilance to the near steady stream of more or less benign body cues and sensations that sets the stage for health anxiety. Table 4 lists common sources of benign bodily sensations, perturbations, and variations that are frequently misinterpreted as signs of serious illness.

2.1.2 Beliefs and Interpretations Lead to Health Anxiety

Following from Beck’s (1976) cognitive model of emotion, health anxiety results when benign bodily sensations are misinterpreted as signs that a serious medical condition is present (e.g., “This pain in my groin means I have prostate cancer”). Once this happens, the innocuous bodily sensations (e.g., body noise) become the target of preoccupation (hypervigilance), and the person tries to avoid or reduce the perceived threat. This sequence is depicted in Figure 1. .