Class 6

Question 1

Understanding Health Anxiety

Answer 1

• Core Concept: The human body is naturally “noisy,” meaning it produces various sensations and changes. Health anxiety arises when these normal bodily sensations are misinterpreted as signs of a serious illness.
• Facets of Health Anxiety: The experience of health anxiety has two main components:
  
  • Cognitive: This involves holding dysfunctional or inaccurate beliefs that you have, or are at risk of developing, a serious medical condition.
  • Behavioural: This involves engaging in coping or “safety-seeking” behaviours, such as excessively checking symptoms, seeking reassurance from family or the internet, and avoiding places like hospitals.
• Measurement: Health anxiety can be measured using tools like the Short Health Anxiety Inventory (SHAI), a 16-item questionnaire. Studies show that individuals with a history of hypochondriasis score significantly higher on this scale compared to anxious individuals or students.

Question 2

Diagnosis and Classification: From DSM-IV to DSM-5

Answer 2

The diagnostic classification of health anxiety has evolved significantly.

• DSM-IV: Hypochondriasis: This was defined as a preoccupation with fears of having a serious disease based on the misinterpretation of bodily symptoms.
• DSM-5: A New Approach: The DSM-5 replaced Hypochondriasis with two more reliable diagnoses, primarily differing in severity.
  
  1. Somatic Symptom Disorder (SSD): This diagnosis is given when a person has excessive thoughts, feelings, or behaviors related to their physical symptoms, such as disproportionate and persistent thoughts, persistently high anxiety, or excessive time and energy devoted to health concerns. Patients with SSD tend to have more severe health anxiety.
  2. Illness Anxiety Disorder (IAD): This is characterized by a preoccupation with having or acquiring a serious illness, even in the absence of significant physical symptoms. It has two specifiers: the Care-Seeking Type (frequently using medical care) and the Care-Avoidant Type. Many patients with IAD fluctuate between these two types.

Question 3

Models for Understanding Health Anxiety

Answer 3

The sources present two key models that explain how health anxiety develops and is maintained.

1. The Common-Sense Model of Illness
2. The Cognitive Behavioural Model of Health Anxiety

Question 4

1. The Common-Sense Model of Illness

Answer 4

This model explains how people form mental models to make sense of their health and symptoms.

• Representations and Prototypes: Our past experiences with illness create prototypes, which are memory structures that influence our expectations. When we experience a deviation from our usual self, a mental representation is activated.
• Dimensions of Illness Representations: We conceptualize our health along five key dimensions, which can be measured by the Illness Perception Questionnaire:
  
  • Identity: The label we give our signs and symptoms.
  • Cause: Our beliefs about what caused the symptoms.
  • Consequences: The perceived impact of the symptoms on our lives.
  • Timeline: How long we believe the symptoms will last.
  • Controllability: Our belief in our ability to control the symptoms.
• Determinants of Representations: These beliefs are shaped by physical stimuli, personal experiences, and mental shortcuts or heuristics. Key heuristics include:
  
  • Symmetry Rule: Believing you are sick if you have symptoms and healthy if you don’t.
  • Stress-Illness Rule: Attributing symptoms that appear during stressful times to stress rather than illness.
  • Age-Illness Rule: Viewing mild, gradual symptoms as a normal part of aging.
• The Process: A physical sensation (e.g., back pain) triggers a cognitive and emotional representation based on context and past experiences. This representation determines the coping strategy (e.g., going to the doctor). The outcome of this coping and the appraisal of one’s resources can lead to either relief or worsened anxiety and physical symptoms.

Question 5

2. The Cognitive Behavioural Model of Health Anxiety

Answer 5

This model focuses on the role of dysfunctional thoughts, cognitive biases, and behaviors in maintaining health anxiety.

• Triggering Beliefs: The model posits that dysfunctional thoughts, based on past experiences, trigger anxiety. These thoughts often involve believing that a feared disease is catastrophic, that one is vulnerable to it, that one cannot cope with it, and that medical resources are inadequate.
• Cognitive Biases: Individuals with severe health anxiety often display cognitive biases that maintain their fear:
  
  • Confirmatory Bias: Focusing on information that confirms fears while ignoring information that disconfirms them.
  • Thought-Action-Fusion Bias: Believing that thinking a negative thought makes it more likely to come true.
  • Ex-consequentia Reasoning: Believing that feeling anxious is proof that danger must be present.
• Safety Behaviours: People with health anxiety engage in safety behaviours like information-seeking, reassurance-seeking, body monitoring, and avoidance. These behaviours are counterproductive because they reinforce the belief that danger is present and that fear is the appropriate response.

Question 6

Treatment for Health Anxiety

Answer 6

• Cognitive Behavioural Therapy (CBT): CBT is considered the treatment of choice for health anxiety due to the greatest empirical support. It is a patient-centered and collaborative approach.
• Core Features of CBT: Treatment typically involves about 12 sessions and includes psycho-education, homework, identifying and challenging thoughts and behaviors that trigger anxiety, and exposure with response prevention (confronting feared situations).
• Adjunctive Strategies: CBT can be supplemented with stress management techniques, fear reduction exercises (e.g., fear of dying), a focus on general life satisfaction, and mindfulness.
• Barriers to Treatment: Several factors can make treatment more difficult, including having severe or long-term health anxiety, holding strongly-held beliefs, having a co-morbid personality disorder or medical condition, experiencing stressful life events, or benefiting in some way (e.g., financially) from the health anxiety.
• Efficacy: There is considerable evidence supporting the efficacy of CBT, including in group therapy and internet-delivered formats.