A cognitive model of Health Anxiety. Stuart Mead Clinical Lead for the West Dorset Steps to Wellbeing service/cbt therapist.

Transcription

1 A cognitive model of Health Anxiety Stuart Mead Clinical Lead for the West Dorset Steps to Wellbeing service/cbt therapist.

2 Contents What is Health Anxiety Disorder? What are the features/symptoms of Health Anxiety Disorder? Engagement issues The aims of Cognitive Behavioural Therapy A cognitive model

3 What are the features/ symptoms of Health Anxiety Disorder? Anxiety Disorder. Tend to centre on conditions such as cancer, HIV, AIDs, etc. Harmless physical symptoms are indicators of serious disease or severe medical conditions. Second, third and fourth opinions from other doctors. Often the symptoms are referred to as medically unexplained symptoms.

4 What is Health Anxiety Disorder? DSM V Hypochondriasis Preoccupation with fears of, or idea one has, serious disease, based in misinterpretation of bodily sensations or changes Persists despite appropriate medical evaluation and reassurance Belief is not delusional, BDD, depression, panic, GAD, OCD, etc Causes significant distress or impairment Duration at least six months

5 Salkovskis The preoccupation with health is based on the person's misinterpretation of bodily sensations. That is, the diagnosis is a cognitive one. The problem persists despite medical examination and reassurance. Alternatively: The problem persists because of medical examination and reassurance?

6 Appropriate medical evaluation and reassurance A Health Anxiety diagnosis rests upon a judgment about: What is appropriate? How do the rest of us decide to be reassured? What prevents health anxious people being reassured?

7 Examples of unhelpful beliefs. Bodily changes are always a sign that something is wrong. If I don t worry about my health, something will go wrong. Detailed tests are the only way to really rule out an illness. If the doctor sends me for any tests, he or she is convinced that there is something wrong.

8 Engagement issues Client may not have overt psychological diagnosis and may not have requested referral. Anger: client feels denied appropriate diagnosis, Are you saying it s all in my mind? May be determined to prove therapy will not help in order to prove illness. May just not want to take the risk it s not physical, due to perceived consequences if it is.

9 Aids to engagement in therapy Timing of therapy (not while physical investigation ongoing). Follow the identical non anxious twin rule (conduct identical tests, based on same history, symptoms & previous investigations). No lose contract e.g. worry and stress are distressing and can cause many physical symptoms; therapy may be able to help with worry and stress & benefit body. Long, careful, collaborative assessment: aim to have a shared understanding and clear goals at the end.

10 Establishing a collaborative relationship Take a neutral, collaborative, open minded stance. As therapists we need demonstrable proof that only anxiety and known physical factors are at work. or patient may drop dead. Listen to the symptoms. Listen to any anger the client may have. Avoid loaded terms: just anxiety, right or wrong. Normalise worries about health.

11 The aims of Cognitive Behavioural Therapy Engagement in the psychological approach. Formulate as a combination of physical, cognitive, emotional & behavioural factors. Offer alternative explanations of symptoms. Deal with maintaining factors: checking, reassurance seeking, disaster scenario, internet research. Work with assumptions & beliefs.

12 CBT maintenance model for Health Anxiety

13 Scanning/focus exercise.

14 Longitudinal factors Early experiences of illness, death, loss, medical mishaps, family health attitudes. Personal rules/beliefs I am someone who must be fit and strong. Ill people are weak/repulsive/pathetic. My body is fragile. I will go to hell for my sins. Critical incidents illness/medical mishap to self or peer.

15 Examples of cognitive distortions Jumping to conclusions I m sweating more than I should in this hot spell. I must be ill. Catastrophising This must be cancer Nobody is ever really cured of cancer Superstitious thinking If I think I m well, I will tempt fate

16 Examples of cognitive distortions All or nothing thinking Unless I am entirely free from symptoms, then I must be unwell I must always know I am completely well Selective attention and memory The doctor said he might arrange for another test in a few months time he must think there is something wrong (ignoring the fact that he had said there was no abnormality on the test)

17 Effective treatment. Understanding the history of why client distrusts reassurance may be crucial. Essential to demonstrate empathy and facilitate effective engagement, so the person feels properly understood at last.

18 Essential to construct a health anxiety explanation of the client s experience, incorporating the roots of the personal meaning of present symptoms and of the underlying assumptions about illness, medical consultation, investigation and treatment, which made them vulnerable to misinterpreting bodily sensations. Gives vivid examples

19 Summary Anxiety disorder. Maintenance factors: Reassurance Scanning Catastrophising Collaborative approach.