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Hypochondriasis and Health Anxiety (Advances in Psychotherapy


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Table of Contents

Dedication... v Preface ... vii Acknowledgments... viii 1 Description of Health Anxiety 1.1 Terminology... 1 1.2 Definition ... 1 1.3 Epidemiology ... 3 1.4 Course and Prognosis... 4 1.5 Differential Diagnoses ... 4 1.5.1 Somatization Disorder ... 5 1.5.2 Somatic Delusions ... 5 1.5.3 Illness or Disease Phobia... 5 1.5.4 Panic Disorder ... 6 1.5.5 Obsessive-Compulsive Disorder ... 6 1.5.6 Generalized Anxiety Disorder ... 6 1.5.7 Pain Disorder ... 7 1.6 Comorbidity ... 7 1.7 Diagnostic Procedures and Documentation... 7 1.7.1 Structured Diagnostic Interviews... 7 1.7.2 Semi-Structured Symptom Interviews... 8 1.7.3 Self-Report Inventories... 9 1.7.4 Documenting Changes in Symptom Levels... 9 2 Theories and Models of Health Anxiety 2.1 Development of Health Anxiety... 10 2.1.1 The Human Body Is NoisyA" ... 10 2.1.2 Beliefs and Interpretations Lead to Health Anxiety... 10 2.1.3 Origins of Dysfunctional Core Beliefs ... 12 2.2 Maintenance of Health Anxiety... 12 2.2.1 Physiological Maintenance Factors ... 13 2.2.2 Cognitive Maintenance Factors ... 14 2.2.3 Behavioral Maintenance Factors ... 15 2.3 Treatment Implications of the Model... 16 3 Diagnosis and Treatment Indications 3.1 Review of Medical Records... 17 3.2 Self-Report Inventories... 17 3.3 The Clinical Interview ... 18 3.3.1 Chief Complaint and History ... 18 3.3.2 Mood... 18 3.3.3 Social Functioning ... 19 3.3.4 History and Previous Treatment... 19 3.3.5 Family Issues ... 19 x Advances in Psychotherapy: Hypochondriasis and Health Anxiety 3.4 Identifying the Appropriate Treatment... 20 3.4.1 Medications... 20 3.4.2 Cognitive Behavior Therapy (CBT)... 21 3.5 Factors that Influence Treatment Decisions ... 21 3.6 Presenting the Recommendation for CBT... 22 3.6.1 Getting a Foot in the Door... 22 3.6.2 The Mind-Body Connection... 23 3.6.3 Body Vigilance and Body Noise ... 23 3.6.4 Effects of Behavioral Responses ... 23 3.6.5 Presenting the Treatment Rationale... 23 3.6.6 Eliciting Change TalkA"... 24 4 Treatment 4.1 Methods of Treatment... 27 4.1.1 Functional Assessment... 28 4.1.2 Self Monitoring... 32 4.1.3 Psychoeducation... 33 4.1.4 Cognitive Therapy Techniques... 39 4.1.5 Exposure and Response Prevention... 47 4.1.6 Implementing Appropriate Self-Care Behaviors ... 58 4.2 Mechanisms of Action ... 58 4.3 Efficacy and Prognosis... 59 4.4 Variants of the Treatment Procedures... 59 4.5 Problems in Carrying Out Treatment... 60 4.5.1 Nonadherence... 60 4.5.2 Arguments... 61 4.5.3 Unbearable Anxiety Levels During Exposure... 62 4.6 Multicultural Issues ... 62 5 Case Vignette... 63 6 Further Reading... 67 7 References... 68 8 Appendices: Tools and Resources... 70

About the Author

Jonathan S. Abramowitz, PhD, ABPP is Associate Professor and Associate Chair of Psychology as well as Research Associate Professor of Psychiatry, at the University of North Carolina (UNC) at Chapel Hill. He also serves as Director of the Anxiety and Stress Disorders Clinic at UNC. From 2000 to 2006 he was Director of the OCD/Anxiety Disorders Treatment and Research Programat the Mayo Clinic in Rochester, Minnesota. Dr. Abramowitz conducts research on the psychopathology and treatment of anxiety disorders and has authored or edited 5 books and over 100 peer-reviewed research articles and book chapters on these topics. He currently serves as Associate Editor of two professional journals, Behavior Research and Therapy and Journal of Cognitive Psychotherapy, as well as serving on the editorial boards of a number of other professional journals. Dr. Abramowitz is a member of the Obsessive Compulsive Foundation's Scientific Advisory Board and a member of the Anxiety Disorders Association of America's Clinical Advisory Board. In 2005 he was elected to the Board of Directors of the Association for Behavioral and Cognitive Therapies (formerly AABT). He also served on the DSM-IV-TR Anxiety Disorders Work Group. In 2003, Dr. Abramowitz received the Outstanding Contributions to Research Award from the Mayo Clinic Department of Psychiatry and Psychology, and in 2004 he received the David Shakow Early Career Award for Outstanding Contributions to Clinical Psychology from Division 12 (Clinical Psychology) of the American Psychological Association. He currently lives in Chapel Hill, North Carolina with his wife, Stacy, and their daughters Emily and Miriam. 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. She is the former Codirector of the Anxiety Disorders Clinic at Mayo Clinic (2006-2008), where she served as a staff clinical health psychologist in the Department of Psychiatry and Psychology and an Instructor in the Mayo Medical School. Dr. Braddock received her B.A. in Psychology from Yale University and her Ph.D. in Clinical Psychology with a minor in Sport Psychology from UCLA. She completed an APA-Accredited internship at the VA Greater Los Angeles Healthcare System (West Los Angeles) and a 2-year APA-Accredited postdoctoral fellowship in Clinical Health Psychology at Mayo Clinic. She has received numerous awards and grants including the Howard R. Rome Fellow Grand Rounds Award at Mayo Clinic, Distinguished Teaching Award at UCLA, and the Mead Prize for Leadership and Character at Yale University. Dr. Braddock has presented her research,primarily addressing anxiety within medical populations, at national and international conferences. She enjoys visiting with her loving parents and brothers in Colorado. Currently, she lives in Santa Maria, California with her partner and best friend, Eric.


"Chapter 8 is "Appendices: Tools and Resources." The appendix is one of my favorite aspects of this work, and is well worth the modest price of this book. The authors include worksheets for assessment, self-monitoring of body symptoms form, a symptom record, exposure hierarchy form, and an exposure practice form. Handouts for the palient include information on "our noisy bodies," the fight-or-flight response, common thinking patterns in health anxiety and tips for successfull exposure. These handouts are invaluable for clinicians to use in a busy practice. [...] In summary, I thought this book was very easy to understand for clinicians [and] in a very concise, easily digested format." Mary Jo Fitz-Gerald, MD, in Psychosomatics, Vol. 53 (2), 2012 "This volume in the Advances in Psychotherapy series is a practical guide to cognitive-behavioral therapy for hypochondriasis and health anxiety complete with illustrative case vignettes.[...] The authors provide a surprisingly in-depth look into the state of the field. The books in this series are great supplemental tools, references, and primers. All mental health professionals will find this book worthwhile, and primary care physicians may find it especially helpful if they have patients with health anxiety. The series is well regarded for both its academic and clinical applications." Nicholas Greco IV, MS, BCETS, CATSM(Abbott Laboratories), 2011 "Health Anxiety by Jonathan Abramowitz and Autumn Braddock is a concise, informative, up-to-date and immensely useful clinical guide to understanding and treating people suffering from worries and catastrophic fears of illness. The authors provide a focused review of how health anxiety is manifested in various disorders and how differential diagnosis can be made (e.g., somatization disorder, OCD, generalized anxiety disorder, etc.). I particularly liked the description of assurance-seeking, body checking, safety signals and avoidance that help perpetuate this often refractory condition. The reader will find several useful self-report forms, recommendations for medication (and the downside of medication), clinical pointers in diagnosis and conceptualization, an excellent sophisticated cognitive-behavioral model of health anxiety, and a detailed case example. Throughout this concise and clearly written book the reader will find user-friendly tables that quickly summarize the "go-to" approach that CBT allows. I highly recommend this book and will use it in training therapists in dealing with this often intransigent problem." Robert L. Leahy, PhD, Director, American Institute for Cognitive Therapy, New York, NY, Associate Editor, International Journal of Cognitive Therapy, Clinical Professor of Psychology, Department of Psychiatry, Weill-Cornell University Medical College, New York Presbyterian Hospital, New York, NY "In this much needed volume, Abramowitz and Braddock share their masterful knowledge of health anxiety using an easily accessible yet exquisitely elegant framework. State-of-the-art essentials of providing empirically-based treatment for this often difficult to treat condition are covered in a clear and concise manner that is certain to facilitate positive outcomes. Clearly an invaluable resource for all clinicians providing care to those struggling with excessive anxiety regarding their health." Gordon J. G. Asmundson, PhD, RD Psych, FRSC, Professor of Psychology, Department of Psychology, University of Regina, Saskatchewan, Canada, Editor-in-Chief, Cognitive Behaviour Therapy

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