A randomized trial of two forms of cognitive behaviour therapy for an older adult population with subclinical health anxiety.

Seniors have been consistently under-represented in the health anxiety treatment literature. The aim of this study was to test the efficacy of a six-session enhanced cognitive behaviour therapy (ECBT) programme for subclinical health anxiety in seniors, and to examine whether the programme fostered therapeutic alliance and motivation for psychotherapy as compared to a standard cognitive behavioural therapy (SCBT) programme and wait-list control (WLC). Fifty-seven seniors with subclinical health anxiety were randomly assigned to six weeks of SCBT, ECBT, or WLC. At pre-treatment, post-treatment, and three-month follow-up, participants completed questionnaires on health anxiety and its dimensions, and other related psychological constructs. Therapeutic alliance and motivation measures were completed after Sessions 1, 3, and 6. At post-treatment, participants in the SCBT and ECBT groups showed significantly lower health anxiety when compared to WLC, with reductions on the subscale measuring disease fear/phobia. Significantly, more participants in the SCBT (66.7%) and ECBT (55.6%) conditions demonstrated clinically significant change on health anxiety compared to the WLC condition (11%). Gains were maintained at three months. There were minimal differences found between the SCBT and ECBT groups on therapeutic alliance and motivation. The findings indicated that both forms of CBT were efficacious for reducing some of the health anxious thoughts and beliefs in seniors.

Core cognitions related to health anxiety in self-reported medical and non-medical samples.

The cognitive-behavioural model of health anxiety hypothesizes that the degree of health threat experienced by an individual is a function of the perceived: (1) likelihood of illness; (2) awfulness of illness; (3) difficulty coping with illness; and (4) inadequacy of medical services. While research has examined cognitions in health anxiety, it is not known whether these cognitions predict health anxiety in individuals who do or do not report medical conditions and whether these cognitions are uniquely related to health anxiety. After developing the Health Cognitions Questionnaire to assess these specific cognitions, we examined the extent to which the cognitions predicted health anxiety and poor response to reassurance in a healthy community sample (n = 273) and a sample who self-reported various medical conditions (n = 208). Supporting the cognitive-behavioural model, these cognitions predicted health anxiety and poor response to reassurance in both samples, with some differences observed between those who did or did not report medical conditions. The cognitions were uniquely related to health anxiety even after controlling for depression and general anxiety. Clinical and theoretical implications are discussed. Overall, the Health Cognitions Questionnaire has potential to facilitate further research on the development, maintenance, and treatment of health anxiety.

Understanding health anxiety among community dwelling seniors with varying degrees of frailty.

OBJECTIVE: In this study, we attempted to disentangle the extent to which older age vs physical health problems contribute to health anxiety. Thus, we compared the levels of health anxiety among younger adults and seniors, with either low or high levels of frailty. Predictors of health anxiety in seniors were explored. METHODS: Forty-nine seniors with high levels of frailty were compared with 63 seniors with low levels of frailty and 130 younger adults. Comparisons were made on the Illness Attitudes Scale (IAS) and on a Medically Adjusted Illness Attitudes Scale, an adapted version ensuring scores reflect health anxiety, and not greater illness. Seniors also completed measures of frailty, pain, depression, trait anxiety and coping. RESULTS: Results varied depending on the health anxiety measure. Using the traditional IAS, seniors with high frailty experienced greater levels of health anxiety than seniors with low-frailty and younger adults. Using the medically adjusted version, seniors with high frailty experienced similar levels of heath anxiety compared with younger adults; seniors with low frailty had the lowest levels of health anxiety. Using multiple regression analysis, emotional preoccupation and trait anxiety uniquely predicted health anxiety among seniors. CONCLUSIONS: Researchers and clinicians should ensure that health anxiety measures actually assess health anxiety and not physical illness. Using an appropriate health anxiety measure, the results suggest seniors with relatively fewer health problems may experience reduced health anxiety compared with other older adults and younger adults. The results are considered in the context of research on aging and anxiety. Implications for clinical practice and future research are discussed.