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Brief Treatment and Crisis Intervention 3:353-368 (2003)
© 2003 Oxford University Press

Cognitive-Behavioral Treatment for Severe and Persistent Health Anxiety (Hypochondriasis)

   Paul M. Salkovskis, PhD
   Hilary M. C. Warwick, PhD
   Alicia C. Deale, PhD

From the Department of Psychology, Institute of Psychiatry, Kings College, London (Salkovskis and Deale); from the Department of Psychiatry, St.George's Hospital Medical School, London (Warwick).

Contact information: Paul Salkovskis, PhD, Department of Psychology, Institute of Psychiatry, Kings College, London, SE5 8AF, UK. E-mail: p.salkovskis{at}iop.kcl.ac.uk.

Hypochondriasis is presently classified as a somatoform disorder. However, in terms of phenomenology and cognitive processes, it is probably best considered as a form of severe and persistent anxiety focused on health. This reconceptualization allows the application of Beck's general cognitive theory of anxiety (1985) to the understanding and treatment of hypochondriasis. In this paper, the classification and phenomenology of health anxiety is explained in terms of a specific cognitive-behavioral conceptualization. The way this conceptualization has been successfully applied to the treatment of health anxiety and hypochodriasis is described. The all-important task of engagement is accomplished as part of the cognitive assessment, which helps the patient develop and evaluate an alternative understanding of their problems. This understanding focuses on how misinterpretations of health-related information (mainly bodily variations and medical information) leads to a pattern of responses including anxiety, distorted patterns of attention, safety-seeking behaviors, and physiological arousal. These responses in turn account for the patient's pattern of symptoms and functional impairment. Treatment progresses by helping the patient actively explore the validity of the alternative account of their problems arising from the shared understanding. This objective is accomplished through two avenues: one, discussion, which has the purpose of making sense of the person's experience; and two, active evaluation of the mechanisms involved, through collaboratively designed and implemented behavioral experiments. Evidence from randomized controlled trials strongly suggests that cognitive treatments are effective and that the effects are specific to the treatment techniques used. Development of this work will likely branch into medical problems, where a prominent component of health anxiety exists.

KEY WORDS: hypochondriasis, somatoform disorders, cognitive behavioral therapy






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