Abstract
Hypochondriasis is a debilitating condition which can have profound psychological and functional effects. The most effective psychological treatments are cognitive and behavioural therapies. However, the degree of improvement across these treatments is variable, often with modest recovery and a high dropout rate. The aim of this study was to provide a preliminary investigation of effects associated with metacognitive therapy (MCT) applied to DSM-IV hypochondriasis. Four consecutively referred patients were treated using established A–B single case series methodology. Following MCT all patients demonstrated large and clinically meaningful improvements in specific hypochondriacal symptoms and more general negative affect measures. Treatment gains were maintained at 6-month follow-up. Substantial changes were also observed in metacognitive beliefs. Overall this case series provides preliminary evidence that MCT can be applied to hypochondriasis and it supports a move towards a more definitive evaluation of the treatment in this group.
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References
Agostinis, A., Morley, S. J., & Dowzer, C. N. (2008). The Leeds Reliable Change Index Calculator (Software). http://www.leeds.ac.uk/lihs/psychiatry/dclin/rcic.html.
Bailey, R., & Wells, A. (2013). Does metacognition make a unique contribution to health anxiety in addition to neuroticism, illness cognition and somatosensory amplification? Journal of Cognitive Psychotherapy, 27, 327–337.
Barsky, A. J. (1992). Amplification, somatization, and the somatoform disorders. Psychosomatics, 33, 28–34.
Barsky, A. J., & Ahern, D. K. (2004). Cognitive behaviour therapy for hypochondriasis: A randomized controlled trial. The Journal of the American Medical Association, 291, 1464–1470.
Barsky, A. J., Goodson, J. D., Lane, R. S., & Cleary, P. D. (1988). The amplification of somatic symptoms. Psychosomatic Medicine, 50, 510–519.
Barsky, A. J., & Klerman, G. L. (1983). Overview: Hypochondriasis, bodily complaints and somatic styles. American Journal of Psychiatry, 140, 273–283.
Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: Penguin Books.
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893–897.
Beck, A. T., & Steer, R. A. (1990). Manual for the Beck Anxiety Inventory. San Antonio, TX: Psychological Corporation.
Beck, A. T., Steer, R. A., & Brown, G. (1996). Beck Depression Inventory (2nd ed.). San Antonio, TX: Harcourt.
Bergin, A. E., & Strupp, H. H. (1970). New directions in psychotherapy research. Journal of Abnormal Psychology, 76, 13–26.
Borden, J. W., Peterson, D. R., & Jackson, E. A. (1991). The Beck Anxiety Inventory in nonclinical samples: Initial psychometric properties. Journal of Psychopathology and Behavioral Assessment, 13, 345–356.
Bouman, T. K., & Meijer, K. J. (1999). A preliminary study of worry and metacognitions in hypochondriasis. Clinical Psychology and Psychotherapy, 6, 96–101.
Brosschot, J. F., Gerin, W., & Thayer, J. F. (2006). Worry and health: The perseverative cognition hypothesis. Journal of Psychosomatic Research, 60, 113–124.
Brosschot, J. F., Pieper, S., & Thayer, J. F. (2005). Expanding stress theory: Prolonged activation and perseverative cognition. Psychoneuroendocrinology, 30, 1043–1049.
Brosschot, J. F., & Van Der Doef, M. P. (2006). Daily worrying increases somatic complaints; a simple worry reduction intervention helps. Psychology and Health, 21, 19–31.
Buwalda, F. M., Bouman, T. K., & Van Duijn, M. A. J. (2008). The effect of a psychoeducational course on hypochondriacal metacognition. Cognitive Research and Therapy, 32, 689–701.
Chambless, D. L., & Ollendick, T. H. (2001). Empirically supported psychological interventions: Controversies and Evidence. Annual Review of Psychology, 52, 685–716.
Clark, D. M., Salkovskis, P. M., Hackmann, A., Wells, A., Fennell, M., Ludgate, J., et al. (1998). Two psychological treatments for hypochondriasis: A randomised controlled trial. British Journal of Psychiatry, 173, 218–225.
Creamer, M., Foran, J., & Bell, R. (1995). The Beck Anxiety Inventory in a nonclinical sample. Behaviour Research and Therapy, 33, 477–485.
Creed, F., & Barsky, A. (2004). A systematic review of the epidemiology of somatisation disorder and hypochondriasis. Journal of Psychosomatic Research, 56, 391–408.
Deacon, B., & Abramowitz, J. (2008). Is hypochondriasis related to obsessive–compulsive disorder, panic disorder, or both? An empirical evaluation. Journal of Cognitive Psychotherapy, 22, 115–127.
Fergus, T. A. (2013). Repetitive thought and health anxiety: Tests of specificity. Journal of Psychopathology and Behavioral Assessment. Retrieved from http://link.springer.com/journal/volumesAndIssues/10862.
Fink, P., Ewald, H., Jensen, J., Sørensen, L., Engberg, M., Holm, M., et al. (1999). Screening for somatization and hypochondriasis in primary care and neurological in-patients: A seven-item scale for hypochondriasis and somatization. Journal of Psychosomatic Research, 46, 261–273.
Fink, P., Ornbel, E., Toft, T., Sparle, K. C., Frostholm, L., & Olesen, F. (2004). A new empirically established hypochondriasis diagnosis. American Journal of Psychiatry, 161, 1680–1691.
Fydrich, T., Dowdall, D., & Chambless, D. L. (1992). Reliability and validity of the Beck Anxiety Inventory. Journal of Anxiety Disorders, 6, 55–61.
Gerdes, T. T., Noyes, R., Kathol, R. G., Phillips, B. M., Fisher, M., Morcuende, M., et al. (1996). Physician recognition of hypochondriacal patients. General Hospital Psychiatry, 18, 106–112.
Greeven, A., van Balkom, A. J., Visser, S., Merkelbach, J. W., vanRood, Y. R., van Dyck, R., et al. (2007). Cognitive behaviour therapy and paroxetine in the treatment of hypochondriasis: A randomized controlled trial. American Journal of Psychiatry, 164, 91–99.
Hedman, E., Andersson, G., Andersson, E., Ljotsson, B., et al. (2011). Internet-based cognitive-behavioural therapy for severe health anxiety: Randomised controlled trial. British Journal of Psychiatry, 198, 230–236.
Jacobson, N. S., Follette, W. C., & Revenstorf, D. (1986). Toward a standard definition of clinically significant change. Behavior Therapy, 15, 309–311.
Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.
Kaur, A., Butow, P. N., & Sharpe, L. (2013). Health threat increases attentional bias for negative stimuli. Journal of Behavior Therapy and Experimental Psychiatry, 44, 469–476.
Kaur, A., Butow, P., & Thewes, B. (2011). Do metacognitions predict attentional bias in health anxiety? Cognitive Therapy and Research, 35, 575–580.
Kazdin, A. E. (1992). Research design in clinical psychology (2nd ed.). Boston: Allyn & Bacon.
Levin, J. R., O’Donnell, A. M., & Kratochwill, T. R. (2003). Educational/psychological intervention research. In I. B. Weiner (Series Ed.), W. M. Reynolds, & G. E. Miller (Vol. Eds.), Handbook of psychology: Vol. 7. Educational psychology (pp. 557–581). New York, NY: Wiley.
Lovas, D. A., & Barsky, A. J. (2010). Mindfulness-based cognitive therapy for hypochondriasis, or severe health anxiety: A pilot study. Journal of Anxiety Disorders, 24, 931–935.
Lucock, M. P., & Morley, S. (1996). The Health Anxiety Questionnaire. British Journal of Health Psychology, 1, 137–150.
Lucock, M. P., White, C., Peake, M. D., & Morley, S. (1998). Biased perception and recall of reassurance in medical patients. British Journal of Health Psychology, 3, 237–243.
Lyubomirsky, S., Kasri, F., Chang, O., & Chung, I. (2006). Ruminative response styles and delay of seeking diagnosis for breast cancer symptoms. Journal of Social and Clinical Psychology, 25, 276–304.
Marcus, D. K., Hughes, K. T., & Arnau, R. C. (2008). Health anxiety, rumination, and negative affect: A mediational analysis. Journal of Psychosomatic Research, 64, 495–501.
McManus, F., Grey, N., & Shafran, R. (2008). Cognitive therapy for anxiety disorders: Current status and future directions. Behavioural and Cognitive Psychotherapy, 36, 695–704.
McManus, F., Surawy, C., Muse, K., Vazquez-Montes, M., & Williams, J. M. (2012). A randomized clinical trial of mindfulness-based cognitive therapy versus unrestricted services for health anxiety (hypochondriasis). Journal of Consulting and Clinical Psychology, 80, 817–828.
Meechan, G. T., Collins, J. P., Moss-Morris, R. E., & Petrie, K. J. (2005). Who is not reassured following benign diagnosis of breast symptoms? Psychooncology, 14, 239–246.
Morgan, D. L., & Morgan, R. K. (2001). Single-participant research design: Bringing science to managed care. American Psychologist, 56, 119–127.
Myers, S., & Wells, A. (2005). Obsessive–compulsive symptoms: The contribution of metacognitions and responsibility. Journal of Anxiety Disorders, 19, 806–817.
Noyes, R., Happel, R. L., & Yagla, S. J. (1999). Correlates of hypochondriasis in a nonclinical population. Psychosomatics, 40, 461–469.
Noyes, R., Kathol, R. G., Fisher, M. M., Phillips, B. M., Suelzer, M. T., & Holt, C. S. (1993). The validity of DSM-III-R hypochondriasis. Archives of General Psychiatry, 50, 961–970.
Noyes, R., Stuart, S. P., Langbehn, D. R., Happel, R. L., Longley, S. L., Muller, B. A., et al. (2003). Test of an interpersonal model of hypochondriasis. Psychosomatic Medicine, 65, 292–300.
Olde Hartman, T. C., Borghuis, M. S., Lucassena, P. L. B. J., van de Laara, F. A., Speckens, A. E., & van Weela, C. (2009). Medically unexplained symptoms, somatisation disorder and hypochondriasis: Course and prognosis. A systematic review. Journal of Psychosomatic Research, 66, 363–377.
Osman, A., Barrios, F. X., Aukes, D., Osman, J. R., & Markway, K. (1993). The Beck Anxiety Inventory: Psychometric properties in a community population. Journal of Psychopathology and Behavioral Assessment, 15, 287–297.
Osman, A., Barrios, F. X., Gutierrez, P. M., Williams, J. E., & Bailey, J. (2008). Psychometric properties of the Beck Depression Inventory-II in nonclinical adolescent samples. Journal of Clinical Psychology, 64, 83–102.
Owens, K. B., Asmundson, G. J. G., Hadjistavropoulos, T., & Owens, T. J. (2004). Attentional bias toward illness threat in individuals with elevated health anxiety. Cognitive Therapy and Research, 28, 57–66.
Papageorgiou, C., & Wells, A. (1998). Effects of attention training on hypochondriasis: A brief case series. Psychological Medicine, 28, 193–200.
Parsonson, B. S., & Baer, D. M. (1992). The visual analysis of data, and current research into the stimuli controlling it. In T. R. Kratochwill & J. R. Levin (Eds.), Single-case research design and analysis (pp. 15–40). Hillsdale, NJ: Erlbaum.
Pieper, S., & Brosschot, J. F. (2005). Prolonged stress-related cardiovascular activation: Is there any? Annals of Behavioral Medicine, 30, 91–103.
Pilowsky, I. (1967). Dimension of hypochondriasis. British Journal of Psychiatry, 113, 89–93.
Rector, N. A., & Roger, D. (1996). Cognitive style and well-being: A prospective examination. Personality and Individual Differences, 21, 663–667.
Richards, S., Taylor, R., Ramasamy, R., & Richards, R. (1999). Single subject research: Applications in educational and clinical settings. San Diego: Singular.
Rief, W., Hiller, W., & Margraf, J. (1998). Cognitive aspects of hypochondriasis and the somatization syndrome. Journal of Abnormal Psychology, 107, 587–595.
Robbins, J. M., & Kirmayer, L. J. (1996). Transient and persistent hypochondrical worry in primary care. Psychological Medicine, 26, 575–589.
Salkovskis, P. M. (1989). Somatic problems. In K. Hawton, P. M. Salkovskis, J. Kirk, & D. M. Clark (Eds.), Cognitive behaviour therapy for psychiatric problems. A practical guide. Oxford: Oxford Medical Publications.
Salkovskis, P. M. (1996). The cognitive approach to anxiety: Threat beliefs, safety seeking behaviour, and the special case of health anxiety and obsessions. In P. M. Salkovskis (Ed.), Frontiers of cognitive therapy (pp. 48–74). Guilford: New York.
Salkovskis, P. M., & Warwick, H. M. (1986). Morbid preoccupations, health anxiety and reassurance: A cognitive-behavioural approach to hypochondriasis. Behaviour Research and Therapy, 24, 597–602.
Spada, M. M., Georgiou, G., & Wells, A. (2010). The relationship among metacognitions, attentional control and state anxiety. Cognitive Behaviour Therapy, 39, 64–71.
Speckens, A. E. M. (2001). Assessment of hypochondriasis. In V. Starcevic & D. R. Lipsitt (Eds.), Hypochondriasis: Modern perspectives on an ancient malady (pp. 61–88). New York: Oxford University Press.
Thomson, A. B., & Page, L. A. (2007). Psychotherapies for hypochondriasis. Cochrane Database of Systematic Reviews, 4, 1–43.
Visser, S., & Bouman, T. K. (2001). The treatment of hypochondriasis: Exposure plus response prevention vs. cognitive therapy. Behaviour Research and Therapy, 39, 423–442.
Warwick, H. M. C., Clark, D. M., Cobb, A. M., & Salkovskis, P. M. (1996). A controlled study of cognitive-behavioural treatment of hypochondriasis. British Journal of Psychiatry, 169, 189–195.
Warwick, H. M. C., & Salkovskis, P. M. (1990). Hypochondriasis. Behaviour Research and Therapy, 28, 105–117.
Weck, F., Neng, J. M. B., & Stangier, U. (2012). The effects of attention training on the perception of bodily sensations in patients with hypochondriasis: A randomized controlled pilot trial. Cognitive Therapy and Research, 37, 514–520.
Welch, P. G., Carleton, R. N., & Asmundson, G. J. G. (2009). Measuring health anxiety: Moving past the dichotomous response option of the original Whitely Index. Journal of Anxiety Disorders, 23, 1002–1007.
Wells, A. (1995). Meta-cognition and worry: A cognitive model of generalized anxiety disorder. Behavioural and Cognitive Psychotherapy, 23, 301–320.
Wells, A. (1997). Cognitive therapy of anxiety disorders a practice manual and conceptual guide. Chichester: Wiley.
Wells, A. (2000). Emotional disorders and metacognition: Innovative cognitive therapy. Chichester: Wiley.
Wells, A. (2009). Metacognitive therapy for anxiety and depression. New York: Guilford Press.
Wells, A., & Cartwright-Hatton, S. (2004). A short form of the Metacognitions Questionnaire: Properties of the MCQ-30. Behaviour Research and Therapy, 42, 385–396.
Wells, A., & Matthews, G. (1994). Attentions and emotion: A clinical perspective. Hove: Erlbaum.
Wells, A., & Matthews, G. (1996). Modelling cognition in emotional disorder: The S-REF model. Behaviour Research and Therapy, 34, 881–888.
Wells, A., & Papageorgiou, C. (1998). Social phobia: Effects of external attention on anxiety, negative beliefs, and perspective taking. Behavior Therapy, 29, 357–370.
Wells, A., & Papageorgiou, C. (2001). Brief cognitive therapy for social phobia: A case series. Behaviour Research and Therapy, 39, 713–720.
Wells, A., & Papageorgiou, C. (2004). Metacognitive therapy for depressive rumination. In C. Papageorgiou & A. Wells (Eds.), Depressive rumination: Nature, theory and treatment. Chichester: Wiley.
Wells, A., & Sembi, S. (2004). Metacognitive therapy for PTSD: A preliminary investigation of a new brief treatment. Journal of Behavior Therapy and Experimental Psychiatry, 35, 307–318.
Westen, D., & Bradley, R. (2005). Empirically supported complexity. Current Directions in Psychological Science, 14, 266–271.
Williams, P. G. (2004). The psychopathology of self-assessed health: A cognitive approach to health anxiety and hypochondriasis [Special Issue: Cognition, Emotion, & Illness]. Cognitive Therapy and Research, 28, 629–644.
Acknowledgments
The data have been presented at the 2nd International Conference of Metacognitive Therapy, Manchester, UK, 2013. The study did not receive external funding.
Conflict of Interest
Robin Bailey and Adrian Wells declare that they have no conflict of interest.
Informed Consent
Informed consent was obtained from all patients for being included in the study.
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No animal studies were carried out by the authors for this article.
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Bailey, R., Wells, A. Metacognitive Therapy in the Treatment of Hypochondriasis: A Systematic Case Series. Cogn Ther Res 38, 541–550 (2014). https://doi.org/10.1007/s10608-014-9615-y
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DOI: https://doi.org/10.1007/s10608-014-9615-y
Keywords
- Hypochondriasis
- Metacognitive therapy
- Case series