Behavior Therapy and Cognitive Behavior Therapy are types of treatment that are based firmly on research findings. These approaches aid people in achieving specific changes or goals.
Changes or goals might involve:
A way of acting: like smoking less or being more outgoing;
A way of feeling: like helping a person to be less scared, less depressed, or less anxious;
A way of thinking: like learning to problem-solve or get rid of self-defeating thoughts;
A way of dealing with physical or medical problems: like lessening back pain or helping a person stick to a doctor’s suggestions.
Behavior Therapists and Cognitive Behavior Therapists usually focus more on the current situation and its solution, rather than the past.
They concentrate on a person’s views and beliefs about their life, not on personality traits.
Behavior Therapists and Cognitive Behavior Therapists treat individuals, parents, children, couples, and families.
Replacing ways of living that do not work well with ways of living that work, and giving people more control over their lives, are common goals of behavior and cognitive behavior therapy.
HOW TO GET HELP:
If you are looking for help, either for yourself or someone else, you may be tempted to call someone who advertises in a local publication or who comes up from a search of the Internet.
You may, or may not, find a competent therapist in this manner.
It is wise to check on the credentials of a psychotherapist.
It is expected that competent therapists hold advanced academic degrees.
They should be listed as members of professional organizations, such as the Association for Behavioral and Cognitive Therapies or the American Psychological Association.
Of course, they should be licensed to practice in your state.
You can find competent specialists who are affiliated with local universities or mental health facilities or who are listed on the websites of professional organizations.
You may, of course, visit our website (www.abct.org) and click on "Find a CBT Therapist"
The Association for Behavioral and Cognitive Therapies (ABCT) is an interdisciplinary organization committed to the advancement of a scientific approach to the understanding and amelioration of problems of the human condition.
These aims are achieved through the investigation and application of behavioral, cognitive, and other evidence-based principles to assessment, prevention, and treatment.
Health Anxiety: What Is It?
Anxiety is the body’s natural response to the perception of threat. Because most
people consider their physical health to be of great importance, it is not surprising
that most people experience anxiety about their health from time to time.
Most people’s health anxiety is fleeting, in that reassurance from a medical professional
alleviates any distress and worry.
Other people, however, experience anxiety about their health that is intensely
distressing, frequent, and persistent. Such “clinical health anxiety” is especially
common for people with psychological disorders such as illness anxiety disorder
(IAD), obsessive-compulsive disorder (OCD), generalized anxiety disorder
(GAD), panic disorder, or somatic symptom disorder (i.e., hypochondriasis, pain
disorder). In health anxiety (which is not an official diagnosis itself), the person
experiences excessive, unreasonable fears of, and a preoccupation with, having
or acquiring a serious illness such as heart disease, cancer, or some other physical
malady. The fear and anxiety is usually based on a misinterpretation of a
harmless (or minor) bodily sensation (e.g., heart fluttering, dizziness, headache)
and it persists in spite of appropriate medical evaluation and determination that
no medical problem is present.
People with health anxiety typically engage in a number of behaviors to try
to reduce their distress. Examples include frequently visiting doctors, excessively
researching diseases and their symptoms on the Internet, repeatedly seeking
reassurance from loved ones, and excessively checking and inspecting aspects of
their body (e.g., lumps, moles) and its by-products (e.g., smell or color of excrement).
Although medical reassurance and checking may temporarily reduce the
health-related concerns, these behaviors do not usually quell the anxiety in the
An alternative fear-reduction strategy used by some people with health anxiety
is to avoid information related to illnesses (e.g., news segments about global
pandemics) because of the intense distress that such information causes. They
may also avoid hospitals and other important aspects of medical care (e.g., giving
self-breast exams) out of fears of catching a disease or confirming their worst
fears that a disease is present.
Health anxiety is not the same as “faking,” nor are those with health anxiety
necessarily “crying wolf” to seek attention. Health anxiety exists on a continuum
from mild to extremely severe. In the most severe instances, people with health
anxiety cannot hold a job or sustain meaningful relationships. They might relocate
to live close to medical centers, fearing that a serious illness or death could
befall them at any point.
As mentioned above, health anxiety might be related to a number of psychological
or medical conditions, including:
• GAD. People with GAD struggle with worries about many aspects of their
life, often seeking reassurance to make life more bearable. Health is one of the
possible areas of concern in this condition.
• OCD. OCD may include fears of contamination and illnesses similar to
health anxiety. The two problems might also overlap in terms of checking
and reassurance-seeking rituals.
• Panic disorder. People with panic disorder suffer panic attacks and
thereafter have a tendency to misinterpret physical sensations (e.g., racing
heart) as the symptoms of a serious medical problem (e.g., heart attack). The
fears in panic disorder are usually of acute, immediate bodily sensations
associated with physiological arousal, whereas worries in health anxiety tend
to include a broader range of bodily sensations and diseases.
• Conversion disorder. People with conversion disorder usually
report a loss of physical functioning (e.g., loss of movement and/or feeling in
a limb) and other unexplained physical symptoms that can lead to fears
regarding health status.
• Delusional disorder, somatic type. People with health anxiety
may express strong conviction that they have medical maladies (even despite
medical reassurance to the contrary), but at other times are able to consider
the possibility that they are mistaken. People with delusional disorder, however,
are more convinced that their health-related fears are realistic and are
unable to consider alternatives. Somatic delusions, which are those focused
on the body and its functions, also tend to be more bizarre (e.g., believing the
body is infested with parasites) than the typical concerns in health anxiety.
• Depression. Some people with depression worry about their health
and experience unexplained physical symptoms. These health concerns most
often occur when depressive episodes are at their worst.
• Underlying medical condition. Just because someone has severe
health anxiety does not automatically mean that they do not have any medical
illnesses. Consequently, health care professionals should assess for
underlying medical conditions (e.g., neurological or endocrine disorders)
that may be causing the distressing physical symptoms. However, no more
than routine medical assessment is necessary. Care should be taken not to
fall into the trap of excessive medical reassurance seeking (and reassurance
giving) as mentioned above.
Who Is Affected by Health Anxiety?
Lifetime prevalence rates of clinically severe health anxiety in the general
population vary widely, ranging from .02% to 7.7%. This wide range is the
result of the fact that estimates come from different types of samples.
Prevalence rates are highest in primary care settings and among those who
already have a bona fide medical condition (e.g., Crohn’s disease). Clinical
levels of health anxiety affect men and women about equally and generally
have an onset sometime in adulthood.
What Are Its Effects on the Sufferers and Their Loved Ones?
As mentioned, health anxiety causes significant distress and impairment
in social, occupational, and other daily functioning. Those with overwhelming
preoccupations about health status might frequently visit doctors to perform
laboratory tests (e.g., echocardiogram) or seek medical reassurance
(i.e., have the doctor tell them they are healthy), which can be quite costly
over time. Significant others of those with health anxiety, such as friends,
romantic partners, and family members, may also be affected. For instance,
they may have to leave work in the middle of the day to take loved ones to
medical appointments, contribute personal income to medical expenses, or
experience relationship distress related to accommodating health-related
requests (e.g., constantly providing reassurance, assisting with excessive
decontamination rituals in the home).
Who Can Diagnose Health Anxiety?
It is important to consider health anxiety as a diagnosis when frequent
and intense preoccupation with unexplained physical symptoms persists
despite a thorough medical examination that fails to identify any disease or
abnormality. In these instances, general practitioners may recommend seeing
a psychiatrist, psychologist, or other mental health professional. These
individuals will conduct a diagnostic assessment that may include certain
questionnaires or an interview as well as a review of one’s medical records.
Although many people referred for psychological assessment may understandably
become frustrated, or even upset, that their doctor believes the
problem is “all in their head,” it is important to remember that health anxiety
is a valid—and treatable—condition.
What Treatment Options Exist for Health Anxiety?
Certain antidepressant medications can be helpful in reducing health
anxiety symptoms, but the reasons that these medications work are presently
not clear. Advantages of medication treatment include general safety and
ease of use, as well as minimal time required for follow-up (i.e., one only
needs to coordinate with prescribers for refills). Disadvantages of medication
include limited expectations for improvement, the need to remain on these
agents continuously, incurred financial costs over the long run, and possible
short- and long-term side effects.
The first-line psychological treatment for health anxiety is cognitivebehavioral
therapy (CBT). CBT is a skills-based approach that helps people
learn to adopt different ways of thinking and behaving in response to health
anxieties. CBT may involve education about how the body works, how diseases
and illnesses affect the body, and how behaviors—such as checking,
avoidance, and reassurance seeking—are not solutions to the problem. CBT
also helps people with health anxiety to identify and challenge misinterpretations
of benign bodily sensations as well as more deeply held maladaptive
beliefs about health, illness, and medicine more generally. Exposure—a technique
commonly used in CBT for health anxiety—also helps people to reintroduce
feared or avoided stimuli (e.g., body sensations, places) and refrain
from engaging in maladaptive health-related behaviors (e.g., body checking).
In essence, CBT teaches the person to better manage their fear, which often
leads to long-term fear reduction and improvement in life functioning.
Advantages of CBT include its general long-term effectiveness and relatively
brief duration (usually 12 to 20 sessions). This treatment has been well
studied and shown to improve health anxiety in the majority of people
(although not all) who receive it. The main disadvantage of CBT is that it
requires more effort than taking a medication. CBT asks clients to learn and
practice alternative ways of thinking and behaving in response to their health
anxiety, which takes some level of motivation and effort. A qualified mental
health professional should be able to describe the advantages and disadvantages
of each treatment approach in greater detail.
For more information or to find a therapist:
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