Psychosomatics 50:303-304, May-June 2009
doi: 10.1176/appi.psy.50.3.303
© 2009 Academy of Psychosomatic Medicine
Psychological Treatment of Health Anxiety and Hypochondriasis: A Biopsychosocial Approach
By Jonathan S. Abramowitz, Autumn E. Braddock, Hogrefe & Huber, 2008, 332 pages, ISBN-13: 978-0889373471, $55.00
Sanjeev Sockalingam, M.D., FRCP(C)
Maladaptive health anxiety, a term used synonymously with hypochondriasis, is characterized by excessive health worries, increased medical utilization, and increased healthcare costs. Patients with health anxiety are commonly managed in primary-care clinics since many of these patients are reluctant to be assessed by psychiatrists or psychologists and continue to suffer from this chronic condition.
Existing pharmacological trials for hypochondriasis have yielded modest results. More recent data suggest that cognitive-behavioral therapy (CBT) and CBT variants are efficacious in treating health anxiety.1 On the basis of these studies, there is a need for practical approaches using cognitive-behavioral principles to improve treatment outcomes in this patient population.
The authors of this book address this need by introducing a biopsychosocial model to health anxiety and use this model as the foundation for their proposed psychological treatment. The approach utilizes psychoeducational, CBT, and exposure and response prevention (ERP) techniques, supported by evidence of their efficacy in other anxiety disorders associated with hypochondriasis.2 Using this model, patients develop skills to promote acceptance of health uncertainty, as opposed to receiving simple reassurance about their overall health. Moreover, this book contains practical interventions that can be easily utilized by healthcare providers from various disciplines.
The book is divided into two parts. Part I provides the reader with an understanding of health anxiety, using case examples to illustrate the complex relationships between patients with medically unexplained symptoms and their healthcare providers. The remaining chapters in Part I highlight common features of health anxiety—its etiology, the biopsychosocial underpinnings of this construct, and maintenance factors resulting in persistent health anxiety symptoms.
In Part II of the book, the authors discuss the assessment of health anxiety, identify specific interviewing strategies, and encourage the use of standardized health-anxiety scales. The authors also identify the importance of developing an early therapeutic alliance during the assessment, which can facilitate patient acceptance of the proposed model. Moreover, the authors build on the importance of working collaboratively with patients suffering from health anxiety by utilizing a motivational interviewing framework.
Once the patient is engaged in pursuing psychological treatment, the authors recommend using a functional assessment to further enhance the case formulation. The remaining chapters on the psychological treatments for health anxiety are well organized, easy to read, and clinically relevant. Each chapter achieves a balance between theory and practical techniques. For example, the authors delineate four psychoeducational modules consisting of threatening thinking, fight-or-flight response, safety behavior, and body noise and vigilance. Again, the authors provide clear psychoeducational tools that can be beneficial to a variety of healthcare professionals at all levels of training.
Chapter 11 provides a brief summary of CBT principles before summarizing CBT interventions specific to patients with health anxiety. Also, the chapter prepares readers for potential difficulties in using CBT for health anxiety, including the fine balance between confrontation and building a therapeutic alliance during treatment. In Chapter 12, the authors introduce ERP, a cognitive and behavioral intervention that can also target symptoms of health anxiety. The last chapter highlights common pitfalls and obstacles associated with this treatment model, providing readers with strategies to manage such situations. Each treatment chapter includes specific CBT templates, such as thought-challenging forms, behavioral-experiment sheets, and a summary of interoceptive exposure techniques specific to health anxiety. The appendix includes additional therapy worksheets and psychoeducational materials, which are a valuable resource for clinicians.
Overall, the book is a practical reference for the multitude of healthcare professionals involved in the treatment of patients with health anxiety. This book aims to ease the bewilderment of clinicians treating patients with health anxiety by clearly outlining the biopsychosocial factors linked to health anxiety. The authors acknowledge that patients may be resistant to this biopsychosocial model, which may limit its effectiveness in some patients. Nonetheless, this is a very good book that provides a solid theoretical framework for understanding and managing health anxiety symptoms.
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FOOTNOTES
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Dr. Sockalingam is Psychiatrist, Program in Medical Psychiatry, Toronto General Hospital, University Health Network, and Assistant Professor, Faculty of Medicine, University of Toronto, Toronto, Canada.
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REFERENCES
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- Thomson AB, Page LA: Psychotherapies for hypochondriasis. Cochrane Database Syst Rev 2007; 4:CD006520
- Abramowitz JS, Olatunji BO, Deacon BJ: Health anxiety, hypochondriasis, and the anxiety disorders. Behav Ther 2007; 38:86–94[CrossRef][Medline]
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