Can't stop, won't stop - understanding anxiety's role in cyberchondria among pregnant women.

Online health research is common during pregnancy, especially if women are facing complications. Given the unpleasant emotions women experience after research, it is surprising that cyberchondria, excessive and repeated online health research caused by anxiety that intensifies such anxiety, has not been studied in pregnant women. Therefore, the aim of this study was to examine the predictors of cyberchondria among women with and without pregnancy complications, accounting for health anxiety (a worry regarding personal health) and pregnancy-specific anxiety (concerns related to pregnancy and childbirth). A total of 360 pregnant women completed a questionnaire consisted of Short Health Anxiety Inventory, Pregnancy Concerns Scale and Short Cyberchondria Scale. The results of one-way MANOVA showed that women who had medically complicated pregnancy had higher levels of health anxiety, pregnancy-specific anxiety and cyberchondria compared to those without complications. A hierarchical multiple regression analysis showed that health anxiety and pregnancy-specific anxiety were predictors of cyberchondria but had different roles depending on complications. Pregnancy-specific anxiety predicted cyberchondria in both groups above health anxiety. Health anxiety predicted cyberchondria only in women without complications. In conclusion, women with complications have a higher chance of experiencing cyberchondria. Pregnancy-specific and health anxiety are risk factors for cyberchondria in pregnant women.

Relationship between mental health and climacteric adjustment in middle aged women: a confirmatory analysis.

BACKGROUND: Climacteric changes in women are associated with an increased probability of psychological symptoms. Identifying the relationship between adjustment to this period and mental health helps to plan for middle-aged women's health improvement. Therefore, the present study aimed to investigate the relationship between climacteric adjustment (CA) and mental health in middle aged women. METHOD: This cross-sectional study was conducted on 190 women aged 40 to 53 years. Mental health symptoms (including hypochondriasis, anxiety, depression, and social impairment) and CA were assessed using 28-item general health questionnaire and the CA questionnaire, respectively, as a self-report. Data were analyzed using linear and stepwise regression methods, and the fitting of the resulting conceptual model was assessed using AMOS software. RESULTS: The results showed that hypochondriasis score and social impairment, anxiety level and CA in the perfection dimension, and social impairment score and CA in perfection, decline in beauty, and sexual silence dimensions had an inverse relationship. Moreover, the relationship between anxiety score and CA in the reaction to end of menstruation and the relationship between social impairment and decline of femininity were positive and significant. Factor analysis of the conceptual model obtained from the study results demonstrated a good model fit (CMIN /DF = 0.807, P = .671). CONCLUSION: The results showed a relationship between CA and psychological symptoms in middle-aged women. In other words, the level of hypochondriasis, anxiety, and social impairment symptoms decreased with increasing CA in sexual silence, perfection, and decline in beauty.

Climacteric changes in women are associated with increased psychological symptoms. Identifying the relationship between adjustment to this period and mental health helps to plan for middle-aged women's health improvement. Therefore, the present study aimed to investigate the relationship between climacteric adjustment (CA) and mental health in middle aged women. This cross-sectional study was conducted on 190 women aged 40 to 53 years. Mental health symptoms (including hypochondriasis, anxiety, depression, and social impairment) and CA were assessed using 28-item general health questionnaire and the CA questionnaire, respectively, as a self-report. The results showed that hypochondriasis score and social impairment, anxiety level and CA in the perfection dimension, and social impairment score and CA in perfection, decline in beauty, and sexual silence dimensions had an inverse relationship. Moreover, the relationship between anxiety score and CA in the reaction to end of menstruation and the relationship between social impairment and decline of femininity were positive and significant. The results showed a relationship between CA and psychological symptoms in middle-aged. In other words, the level of hypochondriasis, anxiety, and social impairment symptoms decreased with increasing CA in sexual silence, perfection, and decline in beauty.

Cyberchondria among information technology professionals of Bhubaneswar by using cyberchondria severity scale (CSS-15).

Background: Internet can act as an excellent resource for gaining valuable health related information. However, excessive online research and investigation about health-related issues may impose a negative impact. The term cyberchondria is used to describe a clinical condition in which frequent internet searches for health-related information leads to exaggerated anxieties about physical well-being. Objectives: To determine the prevalence of cyberchondria and associated factors among the information technology professionals of Bhubaneswar in India. Materials and methods: A cross-sectional study was carried out among 243 software professionals in Bhubaneswar using a previously validated Cyberchondria Severity Scale (CSS-15) questionnaire. Descriptive statistics in terms of number, percentage, mean and standard deviation were presented. Independent t-test and one-way analysis of variance was applied to compare the cyberchondria score between two and more than two independent variables respectively. Results: From 243 individuals 130 (53.5%) were males and 113 (46.5%) were females with mean age 29.82±6.67 years. The prevalence of cyberchondria severity was found to be 46.5%. The mean cyberchondria score of all study subjects was 43.80±10.62. It was significantly higher among those who spend more than 1 hour in the internet during night, feel fear and anxiety in visiting the doctor or dentist, interested in gaining the health-related information from other resources and agreed that gaining health related information has increased after COVID-19 pandemic (p˂0.05). Conclusion: Cyberchondria is a growing issue with regard to mental health in developing countries and has the ability to cause anxiety and distress. Appropriate actions must be taken to prevent it on a societal level.

Hypochondriasis and Personality Traits of Patients with Chronic Plaque Psoriasis.

BACKGROUND: Plaque psoriasis has been associated with anxiety, depression, suicidal ideation and various personality traits. However, studies on hypochondriasis, i.e. the belief of serious illness despite having no or only mild symptoms, are currently scarce. OBJECTIVE: The aim of this study was to assess hypochondriasis and personality traits in psoriasis patients using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). METHODS: We conducted an observational study on patients with plaque psoriasis who underwent MMPI-2 testing. Demographic and clinical data, including comorbidities, alcohol consumption, and smoking, were collected. RESULTS: A total of 136 consecutive psoriatic patients were included. The mean age (±SD) was 53.7 (±13.5), mean PASI (Psoriasis Area Severity Index) was 12.4 (±9.9), and mean disease duration was 23.3 (±15.7) years. Pathologically elevated scores in the Hypochondriasis scale were observed in 27.9% of patients. Furthermore, in a few other MMPI-2 scales (Anxiety, Fears and Negative Treatment Indicators) ≥25% of patients obtained pathologically elevated scores. Conversely, the scales that had the highest proportion of low scorers were Ego Strength and Dominance. At regression analysis, higher psoriasis severity and female gender were associated with higher scores in the Hypochondriasis scale (p = 0.03 and 0.001). Finally, 72.8% reported any alcohol consumption and 8.1% heavy alcohol consumption. CONCLUSION: About one third of patients with psoriasis have high scores in the MMPI-2 hypochondriasis evaluation scale. Poor individual coping resources also appeared to be distinctive psychological features in a significant proportion of psoriatic patients.

Insights into the antecedents of cyberchondria: a perspective from the USA.

This study establishes a theoretical framework for assessing antecedents of cyberchondria, which is a process of amplified anxiety about one's health because of excessive online health information seeking. We examined the framework through partial least squares structural equation modeling after collecting data through a cross-sectional online survey. This research contributes to the literature by (i) evaluating the roles of health anxiety (HA) and affective responses (AR) on cyberchondria; (ii) equipping health strategists with understanding about ways to tailor their educational and communication strategies to specific segments by importance-performance map analysis and necessary condition analysis. Finally, by (iii) providing strategic tactics to curb cyberchondria so that it becomes possible to attain a better patient outcome. Findings suggest that the existing association between intolerance of uncertainty and cyberchondria is serially mediated by HA and AR. For healthcare educators and practitioners, the findings of this research deliver a blueprint for effectively controlling cyberchondria.

Sustained benefit of cognitive behaviour therapy for health anxiety in medical patients (CHAMP) over 8 years: a randomised-controlled trial.

BACKGROUND: Health anxiety is an under-recognised but a frequent cause of distress. It is particularly common in general hospitals. METHODS: We carried out an 8-year follow-up of medical out-patients with health anxiety (hypochondriasis) enrolled in a randomised-controlled trial in five general hospitals in London, Middlesex and Nottinghamshire. Randomisation was to a mean of six sessions of cognitive behaviour therapy adapted for health anxiety (CBT-HA) or to standard care in the clinics. The primary outcome was a change in score on the Short Health Anxiety Inventory, with generalised anxiety and depression as secondary outcomes. Of 444 patients aged 16-75 years seen in cardiology, endocrinology, gastroenterology, neurology and respiratory medicine clinics, 306 (68.9%) were followed-up 8 years after randomisation, including 36 who had died. The study is registered with controlled-trials.com, ISRCTN14565822. RESULTS: There was a significant difference in the HAI score in favour of CBT-HA over standard care after 8 years [1.83, 95% confidence interval (CI) 0.25-3.40, p = 0.023], between group differences in generalised anxiety were less (0.54, 95% CI -0.29 to 1.36), p = 0.20, ns), but those for depression were greater at 8 years (1.22, 95% CI 0.42-2.01, p < 0.003) in CBT-HA than in standard care, most in standard care satisfying the criteria for clinical depression. Those seen by nurse therapists and in cardiology and gastrointestinal clinics achieved the greatest gains with CBT-HA, with greater improvement in both symptoms and social function. CONCLUSIONS: CBT-HA is a highly long-term effective treatment for pathological health anxiety with long-term benefits. Standard care for health anxiety in medical clinics promotes depression. Nurse therapists are effective practitioners.

Abnormal Body Phenomena in Persons with Major Depressive Disorder.

BACKGROUND: Depressive disorders, despite being classified as mood or affective disorders, are known to include disturbances in the experience of body, space, time, and intersubjectivity. However, current diagnostic manuals largely ignore these aspects of depressive experience. In this article, we use phenomenological accounts of embodiment as a theoretical foundation for a qualitative study of abnormal body phenomena (ABP) in depressive disorders. METHODS: 550 patients affected by schizophrenic and affective disorders were interviewed in a clinical setting. Interviews sought to uncover the qualitative features of experiences through self-descriptions. Clinical files were subsequently digitized and re-examined using consensual qualitative research. RESULTS: Ninety-nine out of 100 patients with MDD reported at least one ABP. From cross-analysis of the MDD sample, we obtained 4 general categories of ABP, 3 of which had additional subcategories. The 4 categories include slowed embodied temporality (N = 90), anomalous vital rhythms (N = 82), worries about one's body (N = 22), and body deformation (N = 47). CONCLUSIONS: The results provide empirical evidence in support of theoretical discussions of embodiment in MDD found in the work of classical and contemporary phenomenologists. The findings also provide nuanced insight into the experience of persons living with MDD. Some categories of ABP, like slowed embodied temporality, can help to finely characterize psychomotor retardation or the so-called "medically unexplained symptoms" (MUS). This fine-tuned characterization can help to connect MUS to neuropsychological and neurobiological (e.g., alterations of interoceptive processes linked to anomalies of the brain resting-state hypothesis) and inflammatory (e.g., studies linking environmental stressors, inflammation mediators, and neurovegetative and affective symptoms) models of MDD. Our results can also support a pathogenic model of MDD, which posits, on the phenomenal level, ABP as the point of departure for the development of secondary symptoms including cognitive elaborations of these, namely, delusions about the body. Moreover, some of the categories, when contrasted with phenomenological qualitative studies of other disorders, provide conceptual resources of differential diagnosis and of identifying a "depressive core syndrome." For example, findings within category 4, deformation of the body, provide resources for using ABP to distinguish between MDD and schizophrenia.

Is cyberchondria a new transdiagnostic digital compulsive syndrome? A systematic review of the evidence.

BACKGROUND: Cyberchondria (CYB) has been described relatively recently as a behaviour characterized by excessive online searching for medical information that is associated with increasing levels of health anxiety. Although CYB has received some attention from researchers, there is no consensus about many of its aspects. AIMS: We describe one of the first reported cases of a treatment-seeking patient with CYB. We review the published literature on the definition of CYB, its assessment, epidemiology, cost and burden, psychological models and mechanisms associated with CYB, relationships between CYB and mental disorders and prevention and treatment strategies. METHODS: Systematic review of all peer-reviewed papers published within the PubMed, PsycINFO, and Cochrane Library databases. RESULTS: 61 articles were selected. Nearly all the studies were descriptive and cross-sectional recruiting sample mainly from the general/university student population and collecting self-report data via online surveys. Data on epidemiology, clinical features, course, comorbidity and therapeutic interventions were scarce. CYB showed a self-reported association with health anxiety, hypochondriasis and obsessive-compulsive disorder (OCD) as well as other forms of problematic usage of the internet (PUI) The psychological mechanisms associated with CYB include low self-esteem, anxiety sensitivity, intolerance of uncertainty, pain catastrophizing and certain meta-cognitive beliefs. CONCLUSION: A working definition of CYB includes excessive online health searches that are compulsive and may serve the purpose of seeking reassurance, whilst leading to a worsening of anxiety or distress and further negative consequences. CYB represents a clinically relevant transdiagnostic compulsive behavioural syndrome, closely related to PUI and usually presenting in association with health anxiety, hypochondriasis and/or OCD. CYB is clearly in need of further study and we identify key areas for future research.

DSM-5 Personality Disorders and Traits in Patients With Severe Health Anxiety.

Severe health anxiety (SHA)/hypochondriasis (HY) is often associated with personality pathology; however, studies report inconsistent results. In general populations, 12% have a personality disorder (PD). We assessed physician-referred psychiatric outpatients with SHA enrolled for a treatment study (n = 84) with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) axis II (SCID-II), Personality Inventory for DSM-5 (PID-5), Whiteley Index 7, and Short Health Anxiety Inventory, and the healthy controls (n = 84) with PID-5 only. There were 71.4% of the patients who met criteria for PDs: avoidant (22.6%), obsessive-compulsive (16.7%), depressive (16.7%), dependent (7.1%), paranoid (3.6%), borderline (2.4%), and not otherwise specified (32.1%). Severity of personality pathology was associated with severity of health anxiety. In group comparisons, PID-5 trait domains of negative affectivity, detachment, low antagonism, and low disinhibition, and facets of anxiousness, separation insecurity, and low attention seeking emerged as unique predictors of SHA. Personality pathology is common among individuals with SHA/HY. Further research is needed to understand the nature of the relationship between health anxiety and personality pathology and to determine whether treatments that target both SHA/HY and personality pathology will improve short- and long-term outcomes.

Psychological characteristics and associations between living kidney transplantation recipients and biologically related or unrelated donors.

BACKGROUND: Although recipients and donors in living kidney transplantation experience psychological distress-including depression and anxiety-during the pre-operative period, very few studies have evaluated the related psychological reactions. This study aimed to determine the characteristics and correlations of the mood states and personality of recipients and donors (genetically related and unrelated) of living kidney transplantations. METHODS: A total of 66 pairs of living donors and recipients were enrolled from April 2008 to June 2019 in this study, of whom 53 eligible pairs of living donors and recipients were included in the retrospective analysis of their psychological assessments in the pre-transplantation states. While participants' personality patterns were assessed using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), mood states were evaluated via both the State-Trait Anxiety Inventory (STAI) and The Center for Epidemiologic Studies Depression Scale (CES-D). Statistical analysis was performed using paired t-tests and Spearman's correlation analyses. RESULTS: The recipient group showed significantly higher scores for Hypochondriasis (t = - 4.49, p = .0001), Depression (t = - 3.36, p = .0015), and Hysteria (t = - 3.30, p = .0018) of MMPI-2 and CES-D (t = - 3.93, p = .0003) than the donor group. The biologically unrelated recipient group reported higher scores of Hypochondriasis (t = - 3.37, p = .003) and Depression (t = - 2.86, p = 0.0098) than the unrelated donor group. Higher scores for Hypochondriasis (t = - 3.00, p = 0.0054) and CES-D (t = - 3.53, p = .0014) were found in the related recipient group. A positive association was found for Hypomania (r = .40, p = .003) of MMPI-2, STAI-S (r = .36, p = .009), and CES-D (r = .36, p = .008) between the recipient and donor groups. CONCLUSIONS: Recipients suffered from a higher level of depression and somatic concerns than donors before living kidney transplantation. Psychological problems like depression and anxiety can occur in both living kidney transplantation donors and recipients. This study suggests that clinicians must pay attention to mood states not only in recipients but also in donors because of emotional contagion.

Testing the Italian version of the Cyberchondria Severity Scale and a metacognitive model of cyberchondria.

Cyberchondria refers to the tendency to excessively and compulsively search for online medical information despite the distress experienced, with consequent impairment of daily-life activities. The current two studies sought to explore (i) the factor structure of the Italian version of the Cyberchondria Severity Scale (CSS) and (ii) a metacognitive model of cyberchondria. Participants were Italian community adults who reported using the Internet to search for health-related information (Study 1: N = 374, Study 2: N = 717). Results from Study 1 supported the Italian version of the CSS exhibiting a five-factor structure, with the resulting scales demonstrating good internal consistency, 5-week test-retest reliability, and generally strong correlations with indices of health anxiety. In Study 2, results of a path analysis showed that the negative metacognitive belief domain ("thoughts are uncontrollable") shared the strongest direct association with each of the five dimensions of cyberchondria, followed by beliefs about rituals. Consistently, the strongest indirect associations were found between "thoughts are uncontrollable" and all the five cyberchondria dimensions via beliefs about rituals. These results provide support for an Italian version of the CSS and the metacognitive conceptualization of cyberchondria.

Exploring cyberchondria and worry about health among individuals with no diagnosed medical condition.

OBJECTIVE: To study the phenomenon of cyberchondria and related worries about health among individuals without any diagnosed medical condition. . METHODS: The survey-based, cross-sectional study was conducted from January to July 2018 in the twin cities of Rawalpindi and Islamabad, Pakistan, and comprised graduates of either gender aged at least 35 years with access to internet and means of use, and with no current diagnosed medical condition. The self-reporting Cyberchondria Severity Scale was used data-collection along with a demographic sheet. SPSS 21 was used for data analysis. RESULTS: Of the 150 subjects, 90(60%) were men and 60(40%) were women. A total of 40(26.6%) subjects had low level of cyberchondria, while 35(23.3%) experienced a higher level of it. Mean scores of men on total CSS were slightly higher than those of women (p>0.05). Men also scored higher on compulsion, distress, excessiveness and reassurance subsclaes (p>0.05 each), whereas women scored slightly higherthan men on 'mistrust of medical profession' subscale (p>0.05). No significant gender differences werefound on cyberchondria and its subscales (p>0.05 each). CONCLUSIONS: Doctors / health professionals may benefit from the findings by focussing on their patients who use internet as a major source of medical information.

Use of Web-Based Health Services in Individuals With and Without Symptoms of Hypochondria: Survey Study.

BACKGROUND: An increasing number of people consult physicians because of distressing information found online. Cyberchondria refers to the phenomenon of health anxiety because of online health information. OBJECTIVE: This study aimed to examine online health research of individuals with and without symptoms of hypochondria and their impact on health anxiety as well as behavior. METHODS: An online survey was conducted. Demographic data, health-related internet use, and general health behavior were assessed. The illness attitude scale was used to record symptoms of hypochondria. RESULTS: The final sample consisted of N=471 participants. More than 40% (188/471) of participants showed at least some symptoms of hypochondria. Participants with symptoms of hypochondria used the internet more frequently for health-related purposes and also frequented more online services than individuals without symptoms. Most online health services were rated as more reliable by individuals with symptoms of hypochondria. Changes to behavior such as doctor hopping or ordering nonprescribed medicine online were considered more likely by individuals with symptoms of hypochondria. CONCLUSIONS: Results show that individuals with symptoms of hypochondria do not turn to online research as a result of lacking alternatives but rather consult health services on- as well as offline.

The role of pain catastrophizing in cyberchondria among emerging adults.

Chronic pain is a prevalent and debilitating health problem that often persists in the absence of an identifiable biomedical cause. Uncertainty regarding the origins of a pain problem may lead to pain catastrophizing and unfruitful healthcare seeking behaviors. Individuals with chronic pain often turn to the internet to identify possible causes or sources of their pain symptoms, thus affirming their pain experience. Despite evidence that pain catastrophizing amplifies distress about pain complaints, no studies have investigated whether it is associated with escalations in health anxiety that result from searching for online health information (i.e., cyberchondria). The aim of the present study was to investigate whether pain catastrophizing predicted variance in cyberchondria above and beyond health anxiety. Undergraduate students (N = 221, 70.6% female) completed questionnaires assessing pain catastrophizing, health anxiety, and cyberchondria. Results from hierarchical regression models indicated that pain catastrophizing predicted unique variance in four dimensions of cyberchondria: compulsion, distress, excessiveness, and reassurance. Findings are consistent with research highlighting the consequences of pain catastrophizing on myriad psychological outcomes. Individuals who catastrophize about pain experiences may be vulnerable to developing severe health anxiety from searching the internet for health information. Implications for research among individuals with chronic pain are discussed.

The Role of Disease Conviction: Exploring Its Effects on Chest Pain and Anxiety-Related Models of Non-cardiac Chest Pain.

The aim of this study was to investigate the role of disease conviction in the chest pain and life interference of patients with non-cardiac chest pain (NCCP), after controlling for anxiety sensitivity and body vigilance. While all three psychological constructs are theoretically implicated and empirically associated with the experience of NCCP, no research has examined the influence of disease conviction in the context of other relevant constructs. The sample included 229 participants with NCCP who were recruited after a medical evaluation failed to elicit an organic explanation for their chest pain. Hierarchical regression analyses revealed that while anxiety sensitivity significantly predicted chest pain severity and interference, only body vigilance contributed significant additional variance to chest pain severity, and only disease conviction contributed significant additional variance to chest pain interference. While anxiety sensitivity, body vigilance, and disease conviction all appear to affect those with NCCP, it seems that their impact is manifest in different domains (i.e., pain perception vs. psychosocial impairment).

The assessment of cognitive-behavioral therapy skills in patients diagnosed with health anxiety: Development and pilot study on an observer-based rating scale.

Cognitive-behavioral therapy is a highly effective treatment of health anxiety, but it remains unclear through which mechanisms treatment effects prevail. Some evidence suggests that patients acquire skills-understood as techniques helping them reach therapy goals-through psychotherapy. In the current study, an observer-based rating scale for the skills assessment of patients with health anxiety (SAPH) was developed and validated in a pilot study. Based on 177 videotapes, four independent raters evaluated the frequency of skills acquired during cognitive and exposure therapy among 66 patients diagnosed with health anxiety with the SAPH. Predictive validity was evaluated by the Yale-Brown Obsessive-Compulsive Scale for Hypochondriasis. The SAPH demonstrated good interrater reliability (ICC(1,2)  = .88, p < .001, 95% CI [.81, .92]) and internal consistency (α = .94). Although patient skills did not significantly increase during three sessions, they significantly predicted a reduction in health anxiety symptoms at the end of treatment (R2  = .35). Patients' skills are highly important within the treatment of health anxiety. By providing external ratings of patients' skills with good psychometric properties, our pilot data suggest that the SAPH may complement current tools for the assessment of skills, specifically in targeting health anxiety.

Cyberchondria and its Relationships with Related Constructs: a Network Analysis.

Cyberchondria denotes repeated online searches for health information that are associated with increasing levels of health anxiety. The aims of this study were to apply network analysis to investigate the extent to which cyberchondria is a distinct construct, ascertain which of the related constructs have the strongest relationships with cyberchondria and investigate whether some of the symptoms of cyberchondria are more central to the construct of cyberchondria. Questionnaires assessing the severity of cyberchondria, health anxiety, obsessive-compulsive disorder symptoms, intolerance of uncertainty, problematic Internet use, anxiety, depression and somatic symptoms were administered to 751 participants who searched for health information online during a previous 3-month period and were recruited from an online crowdsourcing platform. Network analyses were used to compute the networks, perform community detection tests and calculate centrality indices. Results suggest that cyberchondria is a relatively specific syndrome-like construct, distinct from all related constructs and consisting of interrelated symptoms. It has the strongest relationships with problematic Internet use and health anxiety. No symptom of cyberchondria emerged clearly as more central to the construct of cyberchondria. Future research should aim to deepen our understanding of cyberchondria and its links with psychopathology, especially its close relationship with problematic Internet use.

Recent Advances in the Understanding and Treatment of Health Anxiety.

PURPOSE OF REVIEW: To examine the diagnosis of health anxiety, its prevalence in different settings, public health significance, treatment, and outcome. RECENT FINDINGS: Health anxiety is similar to hypochondriasis but is characterized by fear of, rather than conviction of, illness. Lifetime prevalence rates are 6% in the population and as high as 20% in hospital out-patients, leading to greater costs to health services through unnecessary medical contacts. Its prevalence may be increasing because of excessive internet browsing (cyberchondria). Drug treatment with antidepressants has some efficacy but is not well-liked, but psychological treatments, including cognitive behavior therapy, stress management, mindfulness training, and acceptance and commitment therapy, given either individually, in groups, or over the Internet, have all proved efficacious in both the short and longer term. Untreated health anxiety leads to premature mortality. Health anxiety has become an increasing clinical and public health issue at a time when people are being formally asked to take more responsibility in monitoring their own health. More attention by health services is needed.

Outcome of day treatment for older adults with affective disorders: An observational pre-post design of two transdiagnostic approaches.

OBJECTIVE: First, to evaluate the outcome of 2 transdiagnostic day treatment programs. A 20-week psychotherapeutic day treatment (PDT) and an activating day treatment (ADT) program delivered in blocks of 4 weeks with a maximum of 24 weeks with respect to depression, anxiety, and hypochondriasis. Second, to explore the impact of cognitive impairment and personality pathology on treatment outcome. METHODS: The course of depression (Inventory of Depressive Symptoms), anxiety (Geriatric Anxiety Inventory), and hypochondriasis (Whitley Index) were evaluated by linear mixed models adjusted for age, sex, level of education, and alcohol usage among 49 patients (mean age 65 years, 67% females) receiving PDT and among 61 patients (mean age 67.1, 61% females) receiving ADT. Pre-post effect-sizes were expressed as Cohen's d. Subsequently, cognitive impairment (no, suspected, established) and personality pathology (DSM-IV criteria as well as the Big Five personality traits) were examined as potential moderators of treatment outcome. RESULTS: Among patients receiving PDT, large improvements were found for depression (d = 1.1) and anxiety (d = 1.2) but not for hypochondriasis (d = 0.0). Patients receiving ADT showed moderate treatment effects for depression (d = 0.6), anxiety (d = 0.6), as well as hypochondriasis (d = 0.6). Personality pathology moderates treatment outcome of neither PDT nor ADT. Cognitive impairment negatively interfered with the course of depressive symptoms among patients receiving PDT. CONCLUSIONS: Transdiagnostic day treatment is promising for older adults with affective disorders with high feasibility.

Hypochondriac concerns and correlates of personality styles and affective states in bipolar I and II disorders.

BACKGROUND: Hypochondriac concerns are associated with the treatment-difficulty of bipolar disorder, which might be due to the personality styles and affective states. METHODS: We invited outpatients with bipolar I disorder (BD I, n = 87), bipolar II disorder (BD II, n = 92) and healthy volunteers (n = 129) to undergo the Illness Attitude Scales and Parker Personality Measure tests, and measurements of concurrent affective states. RESULTS: Compared to healthy volunteers, BD I and BD II patients scored significantly higher on mania, hypomania and depression. BD I and BD II patients also scored significantly higher on Symptom Effect and Treatment Seeking, and BD II patients scored higher on Patho-thanatophobia and Hypochondriacal Belief. BD II in addition scored higher on Patho-thanatophobia than BD I did. In controls, the Dependent style predicted Patho-thanatophobia and Symptom Effect, Schizoid with Hypochondriacal Belief; in BD I, Narcissistic (-) with Hypochondriacal Belief, Histrionic with Patho-thanatophobia and Hypochondriacal Belief, depression with Hypochondriacal Belief, and hypomania with Symptom Effect and Hypochondriacal Belief; in BD II, depression with Symptom Effect and Hypochondriacal Belief, mania with Symptom Effect. CONCLUSIONS: Bipolar disorder, especially BD II, is associated with greater hypochondriac concerns, which relates to personality disorder functioning styles and concurrent affective states.