Abramowitz / Braddock Psychological Treatment of Health Anxiety and Hypochondriasis

A Biopsychosocial Approach
1. Auflage 2008
ISBN: 978-1-61676-347-3
Verlag: Hogrefe Publishing
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 344 Seiten

Between 25% and 50% of visits to primary care clinics are for somatic complaints with no identifiable organic pathology. While most people are reassured when told they are not ill, a certain percentage is convinced the doctor has missed something serious. For centuries, hypochondriasis and persistent somatic complaints have baffled physicians and mental health professionals alike. Recent decades, however, have seen advances in the understanding and treatment of this problem when it is considered a form of “health anxiety.” 

In this highly practical and accessible book, Jonathan Abramowitz and Autumn Braddock present a model of health anxiety and hypochondriasis grounded in the most up-to-date clinical science and that incorporates physiological, cognitive, and behavioral processes. They also offer a step-by-step guide to assessment, conceptualization, and psychological treatment that is derived from this model and integrates strategies for psychoeducation, cognitive therapy, behavioral therapy (exposure and response prevention), and dealing with resistance to treatment. 

The book is packed with illustrative clinical examples and therapist-patient dialogues. Sample forms and handouts are also provided. This volume, which also addresses motivational problems and other common obstacles in treating individuals with health anxiety, is an essential resource for students and researchers in behavioral medicine and health psychology, and for anyone working with patients in hospitals, primary care settings, academic medical centers, and freestanding mental health clinics.

Autoren/Hrsg.

Abramowitz, Jonathan S.

Braddock, Autumn E.

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Psychiatrie, Sozialpsychiatrie, Suchttherapie
• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie
• Sozialwissenschaften Psychologie Allgemeine Psychologie Biologische Psychologie, Neuropsychologie

Inhaltsverzeichnis

1;About the Authors;6
2;Table of Contents;8
3;Preface;10
4;Acknowledgments;13
5;PART 1 What Do We Know About Health Anxiety?;14
5.1;The Clinical Picture: Health Anxiety in Their Own Words;16
5.1.1;Background;16
5.1.2;The Physician’s Perspective;21
5.1.3;The Psychologist’s Perspective;22
5.2;The Nature of Health Anxiety;26
5.2.1;Defining Health Anxiety;26
5.2.2;Essential Features of Health Anxiety: Form and Function;31
5.2.3;Clinical Conditions Characterized by Health Anxiety;41
5.2.4;Associated Features of Health Anxiety;51
5.3;Causes of Health Anxiety: Nature, Notion, and Nurture;54
5.3.1;Somatosensory Amplification;54
5.3.2;Genetics and Heritability of Health Anxiety;55
5.3.3;A Biopsychosocial Model of the Etiology of Health Anxiety;59
5.3.4;Nature: Our “Noisy Bodies”;59
5.3.5;Notions: Beliefs and Interpretations that Lead to Health Anxiety;65
5.3.6;Nurture: The Origin of Dysfunctional Health Beliefs;73
5.3.7;Implications of the Biopsychosocial Model;78
5.4;The Persistence of Health Anxiety;80
5.4.1;Maintenance Factors;81
5.4.2;Treatment Implications of the Biopsychosocial Model;96
5.5;Treating Health Anxiety: Overview and Evidence;98
5.5.1;Psychological Treatments;98
5.5.2;Pharmacologic Treatments;109
5.5.3;The Treatment Program in Part 2 of this Book;113
6;PART 2 Effective Assessment and Treatment of Health Anxiety;114
6.1;Initial Assessment and Diagnosis;116
6.1.1;Developing a Therapeutic Relationship;116
6.1.2;Importance of Ongoing Assessment;117
6.1.3;Aims of Assessment;117
6.1.4;Prior to the Clinical Interview;118
6.1.5;The Clinical Interview;123
6.1.6;Structured Diagnostic Interviews;129
6.1.7;Collateral and Release of Information;130
6.1.8;Measuring Symptom Severity;130
6.1.9;Providing Feedback to the Patient;132
6.1.10;Referrals;133
6.1.11;Cultural Issues in Assessment;133
6.1.12;Obstacles in Assessment;134
6.2;Enhancing Motivation and Communication;136
6.2.1;General Communication Strategies;138
6.2.2;Discussing the Biopsychosocial Model;144
6.2.3;Providing a Rationale for Psychological Treatment;154
6.3;Functional Assessment;158
6.3.1;Overview of Functional Assessment;158
6.3.2;Review of Recent Episodes;163
6.3.3;Historical Factors Potentially Giving Rise to Dysfunctional Beliefs;164
6.3.4;Identifying Triggers;165
6.3.5;Identifying Dysfunctional Attitudes, Beliefs, and Misinterpretations;167
6.3.6;Identifying Maladaptive Behaviors;171
6.3.7;Self-Monitoring;177
6.3.8;Practical Issues;179
6.4;Case Formulation and Treatment Planning;180
6.4.1;Overview of Case Formulation;180
6.4.2;Biopsychosocial Case Formulation;181
6.4.3;Components of Case Formulation;183
6.4.4;Treatment Planning;189
6.5;Psychoeducation;194
6.5.1;Gauging The Patient’s Perspective;194
6.5.2;Module 1: Threatening Thinking;196
6.5.3;Module 2: The Fight-or-Flight Response;198
6.5.4;Module 3: Safety Behavior;203
6.5.5;Module 4: Body Noise and Body Vigilance;207
6.5.6;Providing the Rationale for Treatment;212
6.5.7;Using Psychoeducation During Treatment;214
6.6;Cognitive Therapy;216
6.6.1;Stylistic Issues;217
6.6.2;Identifying Cognitive Errors;219
6.6.3;General Strategies for Correcting Cognitive Errors;220
6.6.4;Applying Cognitive Strategies to Particular Thinking Errors;226
6.6.5;When to Use Cognitive Techniques;244
6.6.6;Challenges and Obstacles;244
6.7;Exposure Therapy and Response Prevention;246
6.7.1;Is Exposure a Cognitive, Behavioral, or Cognitive-Behavioral Treatment?;246
6.7.2;Introducing Exposure Therapy to the Patient;247
6.7.3;Situational Exposure;251
6.7.4;Imaginal Exposure;255
6.7.5;Interoceptive Exposure;260
6.7.6;Stylistic Considerations During Exposure Sessions;263
6.7.7;Response Prevention;264
6.7.8;Employing a Support Person;267
6.7.9;Integrating Cognitive Therapy;268
6.7.10;Programmed and Lifestyle Exposure: Encouraging Independence;268
6.8;Overcoming Common Obstacles and Maintaining Treatment Gains;270
6.8.1;Overcoming Common Obstacles;270
6.8.2;After Treatment Ends;280
6.8.3;Maintaining Improvement;281
6.8.4;Some Concluding Thoughts;286
7;References;288
8;Appendix;302
8.1;Handout 7.1. Change Plan Worksheet;304
8.2;Handout 8.1. Self-Monitoring of Body Symptoms;305
8.3;Handout 8.2. Daily Monitoring Form;306
8.4;Handout 8.3. Health Concerns Log;307
8.5;Handout 10.1. Body Symptom Monitoring Form;308
8.6;Handout 10.2. The Fight-or-Flight Response;309
8.7;Handout 10.3. Your Noisy Body;314
8.8;Handout 11.1. Common Thinking Patterns in Health Anxiety;320
8.9;Handout 11.2. Thought Challenging Form;322
8.10;Handout 11.3. Helpful Comments;323
8.11;Handout 12.1. The 10 Commandments for Successful Exposure;324
8.12;Yale-Brown Obsessive Compulsive Severity Scale (Y-BOCS) Adapted for Health Anxiety;325
8.13;Brown Assessment of Beliefs Scale;327
9;Index;330

Leseproben

Psychological consultation entails obtaining a thorough assessment of a patient’s problem and then providing education, information, and the necessary recommendations to that individual and the patient’s family or support network (Brown, Pryzwansky, &, Schulte, 2001). Effective consultation depends on the consultant’s own education, training, and experience as well as on one’s knowledge of the relevant scientific literature. This chapter provides a detailed description of how to conduct a diagnostic interview, how to assess the nature and severity of health-anxiety symptoms, how to and present treatment recommendations. Collection and discussion of this information constitutes the initial consultation that should precede any therapy. Chapter 7 provides the reader with additional strategies for communicating impressions and recommendations to health-anxious patients who often reject mental-health services.

Assessment is an ongoing and conceptually driven pursuit whereby theories of the causes, maintenance, and treatment of health anxiety determine what is important to evaluate. Initial assessment begins with a clinical interview to determine a diagnosis, rule out organic illnesses, identify possible comorbid conditions, and exclude any problems that may be mistaken for health anxiety.

Next, the nature and intensity of the individual’s health concerns and safetyseeking behaviors are determined. The presentation of such symptoms, the range of comorbid psychopathology, and the impact of the disorder on the individual’s functioning vary widely from patient to patient, so that assessment should also encompass the individual’s level of functioning and support network. Understanding the problem within this broad context helps the clinician to identify factors that might exacerbate or ameliorate health-anxious symptoms or impact adherence to treatment recommendations. It also helps one to recognize additional forms of psychopathology that warrant clinical attention, or that might influence treatment planning.

Developing a Therapeutic Relationship
Careful assessment provides an excellent opportunity to begin developing an alliance with the patient and engaging the patient in the process of goal-setting. Many health-anxious individuals come to their initial psychological consultation feeling distraught and cast off by physicians. They might feel the need to prove to the consultant that theirs is a medical and not a psychological problem, and thus present as angry, irritable, and defensive. It can help if the therapist points out that the aim of the evaluation is not to determine whether the problem is medical or psychological, but rather simply to assess the patient’s experience. The patient will have the opportunity to describe his or her complaints to someone who will listen and validate them, rather than tell them there is "nothing wrong." Thus, assessment begins the process of encouraging collaboration and cooperation.

Importance of Ongoing Assessment
Continually assessing the nature and severity of health anxiety and related symptoms throughout the course of treatment assists the therapist in evaluating whether, and in what ways, the patient is responding. This is consistent with the emphasis on objective measurement of treatment effectiveness within evidencebased practice. It is not sufficient for the clinician simply to think, "He seems to be less worried about his tonsils", or "It sounds like she has cut down on her reassurance-seeking," or even for the patient (or a relative) to report that he or she "is doing better.