Journal of Behavioral Medicine

, Volume 35, Issue 2, pp 167–178 | Cite as

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

  • Heather D. Hadjistavropoulos
  • Jennifer Amy Janzen
  • Melissa D. Kehler
  • Jocelyne A. Leclerc
  • Donald Sharpe
  • Michelle D. Bourgault-Fagnou
Article

Abstract

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.

Keywords

Health anxiety Cognitive-behavioural model Health cognitions 

References

  1. Abramowitz, J. S., Olatunji, B. O., & Deacon, B. J. (2007). Health anxiety, hypochondriasis, and the anxiety disorders. Behavior Therapy, 38, 86–94. doi:10.1016/j.beth.2006.05.001 PubMedCrossRefGoogle Scholar
  2. Arbuckle, J. L. (1996). Full information estimation in the presence of incomplete data. In G. A. Marcoulides & R. E. Schumacker (Eds.), Advanced structural equation modeling: Issues and techniques (pp. 243–278). Mahwah, NJ: Erlbaum.Google Scholar
  3. Bjelland, I., Dahl, A. A., Tangen Hang, T., & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale: An updated literature review. Journal of Psychosomatic Research, 52, 69–77. doi:10.1016/S0022-3999(01)00296-3 PubMedCrossRefGoogle Scholar
  4. Bleichhardt, G., & Hiller, W. (2007). Hypochondriasis and health anxiety in the German population. British Journal of Health Psychology, 12, 511–523. doi:10.1348/135910706X146034 PubMedCrossRefGoogle Scholar
  5. Byrne, B. M. (2001). Structural equation modeling with AMOS. New York, NY: Lawrence Erlbaum.Google Scholar
  6. Byrne, B. M. (2005). Factor analytic models: Viewing the structure of an assessment instrument from three perspectives. Journal of Personality Assessment, 85, 17–32. doi:10.1207/s15327752jpa8501_02 PubMedCrossRefGoogle Scholar
  7. Byrne, B. M. (2010). Structural equation modeling with AMOS (2nd ed.). New York, NY: Routledge.Google Scholar
  8. Cheung, G. W., & Rensvold, R. B. (2002). Evaluating goodness-of-fit indexes for testing measurement invariance. Structural Equation Modeling, 9, 233–255. doi:10.1207/S15328007SEM0902_5 CrossRefGoogle Scholar
  9. Enders, C. K., & Bandalos, D. L. (2001). The relative performance of full information maximum likelihood estimation for missing data in structural equation models. Structural Equation Modeling, 8, 430–457. doi:10.1207/S15328007SEM0803_5 CrossRefGoogle Scholar
  10. Fabrigar, L. R., Wegener, D. T., MacCallum, R. C., & Strahan, E. J. (1999). Evaluating the use of exploratory factor analysis in psychological research. Psychological Methods, 4, 272–279. doi:10.1037/1082-989X.4.3.272 CrossRefGoogle Scholar
  11. Ferguson, E. (2009). A taxometric analysis of health anxiety. Psychological Medicine, 39, 277–285. doi:10.1017/S0033291708003322 PubMedCrossRefGoogle Scholar
  12. Fink, P., Ørnbøl, E., & Christensen, K. S. (2010). The outcome of health anxiety in primary care. A two-year follow-up study on health care costs and self-rated health. PLoS One, 5, e9873. doi:10.1371/journal.pone.0009873 PubMedCrossRefGoogle Scholar
  13. Hadjistavropoulos, H. D., & Hadjistavropoulos, T. (2003). The relevance of health anxiety to chronic pain: Research findings and recommendations for assessment and treatment. Current Pain and Headache Reports, 7, 98–104. doi:10.1007/s11916-003-0019-z PubMedCrossRefGoogle Scholar
  14. Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55. doi:10.1080/10705519909540118 CrossRefGoogle Scholar
  15. Kehler, M. D., & Hadjistavropoulos, H. D. (2009). Is health anxiety a significant problem for individuals with multiple sclerosis? Journal of Behavioral Medicine, 32, 150–161. doi:10.1007/s10865-008-9186-z PubMedCrossRefGoogle Scholar
  16. Kellner, R. (1987). Abridged manual of the Illness Attitudes Scale. Department of Psychiatry, School of Medicine, University of New Mexico.Google Scholar
  17. Kirby, S. E., & Yardley, L. (2009). The contribution of symptoms of posttraumatic stress disorder, health anxiety and intolerance of uncertainty to distress in Ménière’s disease. The Journal of Nervous and Mental Disease, 197, 324–329. doi:10.1097/NMD.0b013c3181a20866 PubMedCrossRefGoogle Scholar
  18. Kline, R. (2004). Principles and practice of structural equation modeling (2nd ed.). New York: Guildford Press.Google Scholar
  19. Lei, M., & Lomax, R. G. (2005). The effect of varying degrees of nonnormality in structural equation modeling. Structural Equation Modeling, 12, 1–27. doi:10.1207/s15328007sem1201_1 CrossRefGoogle Scholar
  20. Marcus, D. K., Gurley, J. R., Marchi, M. M., & Bauer, C. (2007). Cognitive and perceptual variables in hypochondriasis and health anxiety: A systematic review. Clinical Psychology Review, 27, 127–139. doi:10.1016/j.cpr.2006.09.003 PubMedCrossRefGoogle Scholar
  21. Marcus, D. K., Hughes, K. T., & Arnau, R. C. (2008). Health anxiety, rumination, and negative affect: A meditational analysis. Journal of Psychosomatic Research, 64, 495–501. doi:10.1016/j.jpsychores.2008.02.004 PubMedCrossRefGoogle Scholar
  22. Moorey, S., Greer, S., Watson, M., Gorman, C., Rowden, L., Tunmore, R., et al. (1991). The factor structure and factor stability of the Hospital Anxiety and Depression Scale in patients with cancer. British Journal of Psychiatry, 158, 255–259.PubMedCrossRefGoogle Scholar
  23. O’Connor, B. P. (2000). SPSS and SAS programs for determining the number of components using parallel analysis and Velicer’s MAP test. Behavior Research Methods, Instruments and Computers, 32, 396–402.CrossRefGoogle Scholar
  24. Payne, K. A., Binik, Y. M., Pukall, C. F., Thaler, L., Amsel, R., & Khalifé, S. (2007). Effects of sexual arousal on genital and non-genital sensation: A comparison of women with vulvar vestibulitis syndrome and healthy controls. Archives of Sexual Behavior, 36, 289–300. doi:10.1007/s10508-006-9089-4 PubMedCrossRefGoogle Scholar
  25. Pilowsky, I. (1967). Dimensions of hypochondriasis. British Journal of Psychiatry, 113, 89–93.PubMedCrossRefGoogle Scholar
  26. Ratcliffe, D., MacLeod, A., & Sensky, T. (2006). Anxiety in patients who have had a myocardial infarction: The maintaining role of perceived physical sensations and causal attributions. Behavioural and Cognitive Psychotherapy, 34, 201–217. doi:10.1017/S1352465806002773 CrossRefGoogle Scholar
  27. Raykov, T., & Penev, S. (1998). Nested structural equation models: Noncentrality and power of restriction test. Structural Equation Modeling, 5, 229–246. doi:10.1080/10705519809540103 CrossRefGoogle Scholar
  28. Rode, S., Salkovskis, P., Dowd, H., & Hanna, M. (2006). Health anxiety levels in chronic pain clinic attenders. Journal of Psychosomatic Research, 60, 155–161. doi:10.1016/j.psychores.2005.07.005 PubMedCrossRefGoogle Scholar
  29. Salkovskis, P. M., Rimes, K. A., Warwick, H. M. C., & Clark, D. M. (2002). The Health Anxiety Inventory: Development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine, 32, 843–853. doi:10.1017/S0033291702005822 PubMedCrossRefGoogle Scholar
  30. Salkovskis, P. M., & Warwick, H. M. (2001). Making sense of hypochondriasis: A cognitive model of health anxiety. In G. J. G. Asmundson, S. Taylor, & B. J. Cox (Eds.), Health anxiety: Clinical and research perspectives on hypochondriasis and related conditions (pp. 46–64). New York, NY: Wiley.Google Scholar
  31. Schmitt, N., & Kulijanin, G. (2008). Measurement invariance: Review of practice and implications. Human Resource Management Review, 18, 210–222. doi:10.1016/j.hrmr.2008.03.003 CrossRefGoogle Scholar
  32. Speckens, A. E. M., Spinhoven, P., Van Hemert, A. M., & Bolk, J. H. (2000). The Reassurance Questionnaire (RQ): Psychometric properties of a self-report questionnaire to assess reassurability. Psychological Medicine, 30, 841–847. doi:10.1017/S0033291799002378 PubMedCrossRefGoogle Scholar
  33. Tang, N. K. Y., Salkovskis, P. M., Poplavskaya, E., Wright, K. J., Hanna, M., & Hester, J. (2007). Increased use of safety-seeking behaviors in chronic back pain patients with high health anxiety. Behaviour Research and Therapy, 45, 2821–2835. doi:10.1016/j.brat.2007.05.004 PubMedCrossRefGoogle Scholar
  34. Taylor, S., & Asmundson, G. J. G. (2004). Treating health anxiety: A cognitive-behavioral approach. New York, NY: Guilford Press.Google Scholar
  35. Wang, M., & Russell, S. R. (2005). Measurement equivalence of the Job Descriptive Index across Chinese and American workers: Results from confirmatory factor analysis and item response theory. Educational and Psychological Measurement, 65, 709–732. doi:10.1177/0013164404272494 CrossRefGoogle Scholar
  36. Warwick, H. M. C., & Salkovskis, P. M. (1990). Hypochondriasis. Behaviour Research and Therapy, 28, 105–117. doi:10.1016/0005-7967(90)90023-C PubMedCrossRefGoogle Scholar
  37. Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370. doi:10.1111/j.1600-0447.1983.tb09716.x PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Heather D. Hadjistavropoulos
    • 1
  • Jennifer Amy Janzen
    • 1
  • Melissa D. Kehler
    • 1
  • Jocelyne A. Leclerc
    • 1
  • Donald Sharpe
    • 1
  • Michelle D. Bourgault-Fagnou
    • 1
  1. 1.Department of PsychologyUniversity of ReginaReginaCanada

Personalised recommendations