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1.
Expert Rev Pharmacoecon Outcomes Res ; 19(6): 663-676, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31859542

RESUMO

Introduction: Health anxiety, also known as 'hypochondriasis', is a common, distressing and costly condition that responds to cognitive behavior therapy (CBT) but evidence pertaining to response and remission rates, treatment in routine care, therapist-guided Internet-delivered CBT (ICBT) and health economics has not been systematically reviewed.Areas covered: In this systematic review and meta-analysis we searched PubMed, PsycINFO, and OATD (17/06/2019) for randomized controlled trials (RCTs) comparing CBT to non-CBT controls for health anxiety. Based on 19 RCTs, the pooled between-group effect on health anxiety was moderate to large (g = 0.79; 95% CI: 0.57-1.01; adjusted for publication bias: g = 0.62), with small to moderate effects on secondary symptoms and effects largely sustained 12-18 months after treatment. Moderators were control condition and recruitment path, but not treatment setting. The pooled CBT response rate was 66%, and the remission rate 48%. ICBT had effects comparable to face-to-face CBT. CBT for health anxiety is probably cost-effective, but with limited effect on the quality of life.Expert opinion: CBT is a highly efficacious and probably cost-effective treatment for health anxiety. We recommend that ICBT is implemented more widely, and that health economic outcomes and ways of increasing response and remission rates are explored further.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Hipocondríase/terapia , Terapia Cognitivo-Comportamental/economia , Análise Custo-Benefício , Economia Médica , Humanos , Hipocondríase/economia , Internet , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
2.
Artigo em Russo | MEDLINE | ID: mdl-31089094

RESUMO

AIM: To study neurophysiological features of the cognitive activity in patients with anxiety-depressive and hypochondriacal disorders. MATERIAL AND METHODS: The study included 65 people: 16 with hypochondriacal disorder, 23 with mixed anxiety and depressive disorder, and 26 control subjects. Heart rate variability method and electroencephalography were used. RESULTS AND CONCLUSION: There was a decrease in the beta-1 frequency range in EEG after performing cognitive test in patients with mixed anxiety and depressive disorder. Patients with hypochondriacal disorder had the reduced duration of RR intervals; increased beta-1 frequency range in the resting state; the increase in the dominant beta-2 frequency during the cognitive test, and in the standard deviation of theta-wave frequencies after the cognitive test.


Assuntos
Transtorno Depressivo , Hipocondríase , Ansiedade , Transtornos de Ansiedade , Cognição , Eletroencefalografia , Humanos , Hipocondríase/prevenção & controle , Hipocondríase/terapia
3.
Clin Psychol Psychother ; 26(3): 319-327, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30793415

RESUMO

Although the observation and assessment of psychotherapeutic competences are central to training, supervision, patient care, quality control, and life-long practice, structured instruments are used only occasionally. In the current study, an observation-based tool for the Assessment of Core CBT Skills (ACCS) was translated into German and adapted, and its psychometric properties were pilot evaluated. Competence of therapists-in-training was assessed in a random sample of n = 30 videos on cognitive behavioural therapy including patients diagnosed with hypochondriasis. Two of three raters independently assessed the competences demonstrated in the entire, active treatment sessions (n = 60). In our sample, internal consistency was excellent, and interrater reliability was good. Convergent validity (Cognitive Therapy Scale) and discriminant validity (Helping Alliance Questionnaire) were within the expected ranges. The ACCS total score did not significantly predict the reduction of symptoms of hypochondriasis, and a one-factorial structure of the instrument was found. By providing multiple opportunities for feedback, self-reflection, and supervision, the ACCS may complement current tools for the assessment of psychotherapeutic competences and importantly support competence-based training and supervision.


Assuntos
Competência Clínica , Terapia Cognitivo-Comportamental/educação , Terapia Cognitivo-Comportamental/normas , Avaliação Educacional/métodos , Hipocondríase/terapia , Psicometria/normas , Adulto , Feminino , Humanos , Masculino , Psicometria/estatística & dados numéricos , Reprodutibilidade dos Testes , Tradução
4.
Curr Psychiatry Rep ; 20(7): 49, 2018 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-29931576

RESUMO

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.


Assuntos
Ansiedade/psicologia , Ansiedade/terapia , Hipocondríase/psicologia , Hipocondríase/terapia , Antidepressivos/uso terapêutico , Ansiedade/complicações , Ansiedade/mortalidade , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/mortalidade , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental , Humanos , Hipocondríase/complicações , Hipocondríase/mortalidade , Internet/estatística & dados numéricos , Atenção Plena , Prevalência , Estresse Psicológico/prevenção & controle , Estresse Psicológico/psicologia , Estresse Psicológico/terapia
5.
Georgian Med News ; (274): 70-73, 2018 Jan.
Artigo em Russo | MEDLINE | ID: mdl-29461230

RESUMO

The features of clinical symptoms, neurotic disorders and the level of subjective control were studied in patients with fibromyalgia. The analysis of relationship between the level of subjective control and neurotic symptoms (asthenia, depression, anxiety, hypochondria) depending the severity of main clinical manifestations of the disease was carried out. It was found that high intensity of fatigue, muscle pain, stiffness, insomnia, and an increase in the number of diagnostic tender points contribute to the formation of inverse correlation between the level of subjective control and neurotic disturbances. Thus, the increase of the externality of the level of subjective control allows indicating to the formation of patients' passivity in relation to their disease, the lack of adherence to prescribed course of treatment (low compliance). Although drug therapy is the main component of complex treatment of fibromyalgia patients, patients require significantly more - successful treatment requires active involvement of patients in the therapy process, as well as changes in their attitudes and lifestyle, which can be achieved by training in so-called "schools" for patients, use of psychotherapeutic methods.


Assuntos
Ansiedade/psicologia , Astenia/psicologia , Depressão/psicologia , Síndrome de Fadiga Crônica/psicologia , Fibromialgia/psicologia , Hipocondríase/psicologia , Adulto , Analgésicos/uso terapêutico , Ansiedade/diagnóstico , Ansiedade/fisiopatologia , Ansiedade/terapia , Astenia/diagnóstico , Astenia/fisiopatologia , Astenia/terapia , Treinamento Autógeno/métodos , Estudos de Coortes , Depressão/diagnóstico , Depressão/fisiopatologia , Depressão/terapia , Síndrome de Fadiga Crônica/diagnóstico , Síndrome de Fadiga Crônica/fisiopatologia , Síndrome de Fadiga Crônica/terapia , Feminino , Fibromialgia/diagnóstico , Fibromialgia/fisiopatologia , Fibromialgia/terapia , Humanos , Hipnose/métodos , Hipocondríase/diagnóstico , Hipocondríase/fisiopatologia , Hipocondríase/terapia , Pessoa de Meia-Idade , Projetos de Pesquisa , Índice de Gravidade de Doença
6.
Dent Update ; 44(1): 8-12, 15-20, 23-4, 26-8, 30-2, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29172307

RESUMO

Phantom bite syndrome was first described by Marbach over 40 years ago as a mono-symptomatic hypochondriacal psychosis. He used the term to describe a prolonged syndrome in which patients report that their 'bite is wrong' or that 'their dental occlusion is abnormal' with this causing them great difficulties. This strong belief about 'their bite' being the source of their problems leads to them demanding, and subsequently getting, various types of dentistry carried out by multiple dentists and 'specialists'. Sadly, even after exhaustive, painstaking, careful treatment, none of the dental treatments manages to solve their perceived 'bite problems'. This is because they suffer from a psychiatric illness involving a delusion into which they continue to lack insight, in spite of the failures of often sophisticated dental treatments.1,2,3 In summary, dental practitioners, or other specialists, who suspect that they might be dealing with such a problem should refer these patients early on for specialist management by an appropriate specialist within the secondary care settings, preferably before they get trapped into the time-consuming quagmire of their management. A 'Phantom Bite Questionnaire', which is available to download free, might help. Clinical relevance: This article aims to provide professionals in various fields with guidelines on detecting, diagnosing and managing patients with Phantom Bite Syndrome (PBS). This is desirable in order to prevent extensive, or unnecessarily destructive, or unstable dental treatment being undertaken on such patients in a vain attempt to solve their problems with 'dentistry' when, in fact, these are really due to underlying mental health issues.


Assuntos
Hipocondríase , Má Oclusão , Parestesia , Transtornos Psicóticos , Adulto , Feminino , Humanos , Hipocondríase/diagnóstico , Hipocondríase/terapia , Má Oclusão/diagnóstico , Má Oclusão/psicologia , Parestesia/diagnóstico , Parestesia/psicologia , Parestesia/terapia , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/terapia , Síndrome
7.
Health Technol Assess ; 21(50): 1-58, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28877841

RESUMO

BACKGROUND: Health anxiety is an under-recognised but frequent cause of distress that is potentially treatable, but there are few studies in secondary care. OBJECTIVE: To determine the clinical effectiveness and cost-effectiveness of a modified form of cognitive-behaviour therapy (CBT) for health anxiety (CBT-HA) compared with standard care in medical outpatients. DESIGN: Randomised controlled trial. SETTING: Five general hospitals in London, Middlesex and Nottinghamshire. PARTICIPANTS: A total of 444 patients aged 16-75 years seen in cardiology, endocrinology, gastroenterology, neurology and respiratory medicine clinics who scored ≥ 20 points on the Health Anxiety Inventory (HAI) and satisfied diagnostic requirements for hypochondriasis. Those with current psychiatric disorders were excluded, but those with concurrent medical illnesses were not. INTERVENTIONS: Cognitive-behaviour therapy for health anxiety - between 4 and 10 1-hour sessions of CBT-HA from a health professional or psychologist trained in the treatment. Standard care was normal practice in primary and secondary care. MAIN OUTCOME MEASURES: Primary - researchers masked to allocation assessed patients at baseline, 3, 6, 12, 24 months and 5 years. The primary outcome was change in the HAI score between baseline and 12 months. Main secondary outcomes - costs of care in the two groups after 24 and 60 months, change in health anxiety (HAI), generalised anxiety and depression [Hospital Anxiety and Depression Scale (HADS)] scores, social functioning using the Social Functioning Questionnaire and quality of life using the EuroQol-5 Dimensions (EQ-5D), at 6, 12, 24 and 60 months, and deaths over 5 years. RESULTS: Of the 28,991 patients screened over 21 months, 5769 had HAI scores of ≥ 20 points. Improvement in HAI scores at 3 months was significantly greater in the CBT-HA group (mean number of sessions = 6) than in the standard care, and this was maintained over the 5-year period (overall p < 0.0001), with no loss of efficacy between 2 and 5 years. Differences in the generalised anxiety (p = 0.0018) and depression scores (p = 0.0065) on the HADS were similar in both groups over the 5-year period. Gastroenterology and cardiology patients showed the greatest CBT gains. The outcomes for nurses were superior to those of other therapists. Deaths (n = 24) were similar in both groups; those in standard care died earlier than those in CBT-HA. Patients with mild personality disturbance and higher dependence levels had the best outcome with CBT-HA. Total costs were similar in both groups over the 5-year period (£12,590.58 for CBT-HA; £13,334.94 for standard care). CBT-HA was not cost-effective in terms of quality-adjusted life-years, as measured using the EQ-5D, but was cost-effective in terms of HAI outcomes, and offset the cost of treatment. LIMITATIONS: Many eligible patients were not randomised and the population treated may not be representative. CONCLUSIONS: CBT-HA is a highly effective treatment for pathological health anxiety with lasting benefit over 5 years. It also improves generalised anxiety and depressive symptoms more than standard care. The presence of personality abnormality is not a bar to successful outcome. CBT-HA may also be cost-effective, but the high costs of concurrent medical illnesses obscure potential savings. This treatment deserves further research in medical settings. TRIAL REGISTRATION: Current Controlled Trials ISRCTN14565822. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 50. See the NIHR Journals Library website for further project information.


Assuntos
Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Hipocondríase/terapia , Adolescente , Adulto , Idoso , Instituições de Assistência Ambulatorial , Escalas de Graduação Psiquiátrica Breve , Terapia Cognitivo-Comportamental/economia , Análise Custo-Benefício , Feminino , Humanos , Hipocondríase/economia , Estudos Longitudinais , Masculino , Resultado do Tratamento
9.
J Consult Clin Psychol ; 85(10): 1012-1017, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28956951

RESUMO

OBJECTIVE: Cognitive-behavioral therapy (CBT) has been shown to be effective in treating hypochondriasis. However, there are doubts regarding the long-term effectiveness of CBT for hypochondriasis, in particular for follow-up periods longer than 1 year. The aim of the present study was to evaluate the long-term effectiveness of cognitive therapy (CT) and exposure therapy (ET) for the treatment of hypochondriasis. METHOD: Seventy-five patients with a diagnosis of hypochondriasis who were previously treated with CT or ET were contacted 3 years after treatment. Fifty (67%) patients participated and were interviewed by an independent and blinded diagnostician using standardized interviews. RESULTS: We found further improvements after therapy in primary outcome measures (d = .37), general functioning (d = .38), and reduced doctor visits (d = .30) during the naturalistic follow-up period. At the 3-year follow-up, 72% of the patients no longer fulfilled the diagnosis of hypochondriasis. Based on the main outcome measure, we found response rates of 76% and remission rates of 68%. At follow-up, only 4% of patients were taking antidepressant medication. Additional psychological treatment was utilized by 18% of the patients during the follow-up period (only 8% because of health anxiety). We found no overall differences between CT and ET. Only a trend for a greater deterioration rate in CT (13%) in comparison to ET (0%) was found. CONCLUSIONS: Our results suggest that ⅔ of the patients with hypochondriasis were remitted in the long term. Thus, remission rates after CBT were twice as high as in untreated samples. (PsycINFO Database Record


Assuntos
Terapia Cognitivo-Comportamental/métodos , Hipocondríase/terapia , Terapia Implosiva/métodos , Adulto , Feminino , Seguimentos , Humanos , Hipocondríase/psicologia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
10.
Am J Psychiatry ; 174(8): 756-764, 2017 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-28659038

RESUMO

OBJECTIVE: Prior studies of hypochondriasis demonstrated benefits for pharmacotherapy and for cognitive-behavioral therapy (CBT). This study examined whether joint treatment offers additional benefit. METHOD: Patients with DSM-IV hypochondriasis (N=195) were randomly assigned to one of four treatments-placebo, CBT, fluoxetine, or joint treatment with both fluoxetine and CBT. Evaluations assessed hypochondriasis, other psychopathology, adverse events, functional status, and quality of life. The primary analysis assessed outcome at week 24 among the intent-to-treat sample, with responders defined as having a 25% or greater improvement over baseline on both the Whiteley Index and a modified version of the Yale-Brown Obsessive Compulsive Scale for hypochondriasis (H-YBOCS-M). The Cochran-Armitage trend test assessed the hypothesized pattern of response: joint treatment > CBT or fluoxetine treatment > placebo treatment. RESULTS: The predicted pattern of response was statistically significant, as shown by the following responder rates: joint treatment group, 47.2%; single active treatment group, 41.8%; and placebo group, 29.6%. Responder rates for each active treatment were not significantly different from the rate for placebo. Secondary analyses of the Whiteley Index as a continuous measure revealed that, compared with placebo, fluoxetine (but not CBT) was significantly more effective at week 24 in reducing hypochondriasis and had a significantly faster rate of improvement over 24 weeks. Fluoxetine also resulted in significantly less anxiety and better quality of life than placebo. Dropout rates did not differ between groups, and treatment-emergent adverse events were evenly distributed. CONCLUSIONS: This study supports the safety, tolerance, and efficacy of fluoxetine for hypochondriasis. Joint treatment provided a small incremental benefit. Because approximately 50% of patients did not respond to the study treatments, new or more intensive approaches are needed.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Fluoxetina/uso terapêutico , Hipocondríase/terapia , Adulto , Idoso , Terapia Combinada , Feminino , Fluoxetina/efeitos adversos , Humanos , Hipocondríase/diagnóstico , Masculino , Pessoa de Meia-Idade , Qualidade de Vida/psicologia , Adulto Jovem
12.
Behav Cogn Psychother ; 45(2): 110-123, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28229805

RESUMO

BACKGROUND: Health anxiety (HA), or hypochondriasis, is a psychological problem characterized by a preoccupation with the belief that one is physically unwell. A 2007 Cochrane review (Thomson and Page, 2007) found cognitive behavioural therapy (CBT) to be an effective intervention for individuals with HA. Similar findings were reported in a recent meta-analysis (Olatunji et al., 2014), which did not employ a systematic search strategy. The current review aimed to investigate the efficacy of CBT for HA, and to update the existing reviews. METHOD: A systematic search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance, including randomized controlled trials that compared CBT with a control condition for people with HA. Five hundred and sixty-seven studies were found in the original search, of which 14 were included in the meta-analysis. RESULTS: Meta-analysis was conducted on 21 comparisons and a large effect size for CBT compared with a control condition was found at post therapy d = 1.01 (95% confidence interval 0.77-1.25), as well as at 6- and 12-month follow-up. CONCLUSIONS: This systematic review and meta-analysis provides support for the hypothesis that CBT is an effective intervention for HA when compared with a variety of control conditions, e.g. treatment-as-usual, waiting list, medication, and other psychological therapies.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Hipocondríase/psicologia , Hipocondríase/terapia , Ansiedade , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Humanos , Psicoterapia/métodos
13.
J Clin Psychol ; 73(6): 612-625, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27532367

RESUMO

OBJECTIVE: Psychotherapy for hypochondriasis has greatly improved over the last decades and cognitive-behavioral treatments are most promising. However, research on predictors of treatment outcome for hypochondriasis is rare. Possible predictors of treatment outcome in cognitive therapy (CT) and exposure therapy (ET) for hypochondriasis were investigated. METHOD: Characteristics and behaviors of 75 patients were considered as possible predictors: sociodemographic variables (sex, age, and cohabitation); psychopathology (pretreatment hypochondriacal symptoms, comorbid mental disorders, and levels of depression, anxiety, and somatic symptoms); and patient in-session interpersonal behavior. RESULTS: Severity of pretreatment hypochondriacal symptoms, comorbid mental disorders, and patient in-session interpersonal behavior were significant predictors in multiple hierarchical regression analyses. Interactions between the predictors and the treatment (CT or ET) were not found. CONCLUSIONS: In-session interpersonal behavior is an important predictor of outcome. Furthermore, there are no specific contraindications to treating hypochondriasis with CT or ET.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Hipocondríase/terapia , Terapia Implosiva/métodos , Adulto , Feminino , Humanos , Hipocondríase/psicologia , Masculino , Valor Preditivo dos Testes , Prognóstico , Resultado do Tratamento
14.
Br J Psychiatry ; 209(5): 407-413, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27491531

RESUMO

BACKGROUND: In DSM-5 two new diagnoses, somatic symptom disorder (SSD) and illness anxiety disorder (IAD), have replaced DSM-IV hypochondriasis. There are no previous treatment studies for these disorders. Cognitive-behavioural therapy (CBT) delivered as therapist-guided or unguided internet treatment or as unguided bibliotherapy could be used to increase treatment accessibility. AIMS: To investigate the effect of CBT delivered as guided internet treatment (ICBT), unguided internet treatment (U-ICBT) and as unguided bibliotherapy. METHOD: A randomised controlled trial (RCT) where participants (n = 132) with a diagnosis of SSD or IAD were randomised to ICBT, U-ICBT, bibliotherapy or to a control condition on a waiting list (trial registration: Clinicaltrials.gov identifier NCT01966705). RESULTS: Compared with the control condition, all three treatment groups made large and significant improvements on the primary outcome Health Anxiety Inventory (between-group d at post-treatment was 0.80-1.27). CONCLUSIONS: ICBT, U-ICBT and bibliotherapy can be highly effective in the treatment of SSD and IAD. This is the first study showing that these new DSM-5 disorders can be effectively treated.


Assuntos
Biblioterapia/métodos , Terapia Cognitivo-Comportamental/métodos , Seguimentos , Terapia Implosiva/métodos , Transtornos Psicofisiológicos/terapia , Transtornos Somatoformes/terapia , Adulto , Idoso , Feminino , Humanos , Hipocondríase/terapia , Internet , Masculino , Pessoa de Meia-Idade , Adulto Jovem
15.
Br J Psychiatry ; 209(3): 244-50, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27445356

RESUMO

BACKGROUND: Health anxiety, hypochondriasis and personality disturbance commonly coexist. The impact of personality status was assessed in a secondary analysis of a randomised controlled trial (RCT). AIMS: To test the impact of personality status using ICD-11 criteria on the clinical and cost outcomes of treatment with cognitive-behavioural therapy for health anxiety (CBT-HA) and standard care over 2 years. METHOD: Personality dysfunction was assessed at baseline in 444 patients before randomisation and independent assessment of costs and outcomes made on four occasions over 2 years. RESULTS: In total, 381 patients (86%) had some personality dysfunction with 184 (41%) satisfying the ICD criteria for personality disorder. Those with no personality dysfunction showed no treatment differences (P = 0.90) and worse social function with CBT-HA compared with standard care (P<0.03) whereas all other personality groups showed greater improvement with CBT-HA maintained over 2 years (P<0.001). Less benefit was shown in those with more severe personality disorder (P<0.05). Costs were less with CBT-HA except for non-significant greater differences in those with moderate or severe personality disorder. CONCLUSIONS: The results contradict the hypothesis that personality disorder impairs response to CBT in health anxiety in both the short and medium term.


Assuntos
Terapia Cognitivo-Comportamental/economia , Hipocondríase/epidemiologia , Hipocondríase/terapia , Transtornos da Personalidade/epidemiologia , Transtornos da Personalidade/terapia , Adolescente , Adulto , Idoso , Comorbidade , Inglaterra/epidemiologia , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
16.
Behav Cogn Psychother ; 44(5): 601-14, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27126076

RESUMO

BACKGROUND: Cognitive-behavioural therapy can change dysfunctional symptom attributions in patients with hypochondriasis. Past research has used forced-choice answer formats, such as questionnaires, to assess these misattributions; however, with this approach, idiosyncratic attributions cannot be assessed. Free associations are an important complement to existing approaches that assess symptom attributions. AIMS: With this study, we contribute to the current literature by using an open-response instrument to investigate changes in freely associated attributions after exposure therapy (ET) and cognitive therapy (CT) compared with a wait list (WL). METHOD: The current study is a re-examination of a formerly published randomized controlled trial (Weck, Neng, Richtberg, Jakob and Stangier, 2015) that investigated the effectiveness of CT and ET. Seventy-three patients with hypochondriasis were randomly assigned to CT, ET or a WL, and completed a 12-week treatment (or waiting period). Before and after the treatment or waiting period, patients completed an Attribution task in which they had to spontaneously attribute nine common bodily sensations to possible causes in an open-response format. RESULTS: Compared with the WL, both CT and ET reduced the frequency of somatic attributions regarding severe diseases (CT: Hedges's g = 1.12; ET: Hedges's g = 1.03) and increased the frequency of normalizing attributions (CT: Hedges's g = 1.17; ET: Hedges's g = 1.24). Only CT changed the attributions regarding moderate diseases (Hedges's g = 0.69). Changes in somatic attributions regarding mild diseases and psychological attributions were not observed. CONCLUSIONS: Both CT and ET are effective for treating freely associated misattributions in patients with hypochondriasis. This study supplements research that used a forced-choice assessment.


Assuntos
Hipocondríase/terapia , Entrevista Psicológica/métodos , Adulto , Terapia Cognitivo-Comportamental/métodos , Feminino , Associação Livre , Humanos , Hipocondríase/psicologia , Terapia Implosiva/métodos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Resultado do Tratamento
17.
Ann Ist Super Sanita ; 52(1): 4-5, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27033610

RESUMO

Fifteen years after the publication of G. Braddock's paper "Epicureanism, death, and the good life" in Philosophical inquiry the time has come to think of what actually prevents Epicureanism from taking root in Western societies, thereby facilitating our relationship with disease and care: hypochondria. In this commentary I analyse the philosophical problem of hypochondria overturning Heidegger's idea that awareness of death is positive and calling for medical therapies that, through the help of psychology, would act on the causes and elimination of hypochondria.


Assuntos
Morte , Hipocondríase/psicologia , Humanos , Hipocondríase/terapia , Filosofia
19.
Psychother Res ; 26(1): 106-19, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-25180697

RESUMO

OBJECTIVE: Patient in-session interpersonal behavior, as part of the therapeutic alliance, is an important aspect of the psychotherapy process and impacts treatment outcome. In the present study, the development and validation of a rating scale of patient in-session interpersonal behavior is described. METHOD: A 10-item rating scale, the Assessment Form of Patient Interpersonal Behavior (AFPIB), was developed using an inductive procedure. The AFPIB was then validated in a sample of patients with hypochondriasis (N = 30), by having two independent raters assess patients' interpersonal behaviors shown in videotaped psychotherapy sessions (N = 60). RESULTS: The AFPIB demonstrated good reliability and validity. CONCLUSIONS: Thus, the AFPIB seems to be a promising rating scale for the assessment of patient interpersonal behavior shown in psychotherapy sessions.


Assuntos
Hipocondríase/terapia , Relações Profissional-Paciente , Psicometria/instrumentação , Psicoterapia/métodos , Inquéritos e Questionários/normas , Adulto , Humanos
20.
J Behav Ther Exp Psychiatry ; 50: 139-46, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26204567

RESUMO

BACKGROUND AND OBJECTIVES: Previous studies using modified versions of the Affect Misattribution Procedure (AMP; Payne, Cheng, Govorun, & Stewart, 2005) have revealed that there is an implicit negative evaluation bias of illness-related information in patients with hypochondriasis (HYP), which might be a maintaining feature of HYP. However, there is no evidence on whether this bias might be targeted successfully by effective treatments, such as exposure therapy (ET) or cognitive therapy (CT). This is the first study to examine the change in negative implicit evaluations in a randomized controlled trial, including individual CT and ET, compared to a wait-list control group for HYP. METHODS: An AMP with illness, symptom and neutral primes was used in 70 patients with HYP before and after treatment (wait-list respectively). RESULTS: There was no significant change in negative implicit affective evaluations in both CT and ET, compared to wait-list. However, comparisons between the two active treatments revealed an interaction effect, that only for CT were the affective reactions on illness-as well as symptom-related prime trials (but not neutral primes) significantly more positive at post-compared to pre-treatment. In CT but not in ET, the reduction of implicit negative evaluation bias regarding symptom-related primes was significantly related to the reduction of self-reported health anxiety. LIMITATIONS: The small subsample sizes for CT and ET, in comparison to wait-list, prohibit the detection of smaller effects. CONCLUSIONS: Formal cognitive restructuring is necessary for reducing implicit negative evaluation bias in HYP, but the latter is not a prerequisite for reducing health anxiety. Thus, the importance of the negative implicit evaluation bias for the maintenance of HYP remains questionable.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Hipocondríase/terapia , Terapia Implosiva/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
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