Metacognitive Therapy in the Treatment of Hypochondriasis: A Systematic Case Series
- 915 Downloads
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.
KeywordsHypochondriasis Metacognitive therapy Case series
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 was obtained from all patients for being included in the study.
No animal studies were carried out by the authors for this article.
- 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.
- Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: Penguin Books.Google Scholar
- Beck, A. T., & Steer, R. A. (1990). Manual for the Beck Anxiety Inventory. San Antonio, TX: Psychological Corporation.Google Scholar
- Beck, A. T., Steer, R. A., & Brown, G. (1996). Beck Depression Inventory (2nd ed.). San Antonio, TX: Harcourt.Google Scholar
- 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.PubMedCrossRefGoogle Scholar
- Jacobson, N. S., Follette, W. C., & Revenstorf, D. (1986). Toward a standard definition of clinically significant change. Behavior Therapy, 15, 309–311.Google Scholar
- Kazdin, A. E. (1992). Research design in clinical psychology (2nd ed.). Boston: Allyn & Bacon.Google Scholar
- 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.Google Scholar
- 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.PubMedCrossRefPubMedCentralGoogle Scholar
- 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.PubMedCrossRefGoogle Scholar
- 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.Google Scholar
- Richards, S., Taylor, R., Ramasamy, R., & Richards, R. (1999). Single subject research: Applications in educational and clinical settings. San Diego: Singular.Google Scholar
- 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.Google Scholar
- 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.Google Scholar
- 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.Google Scholar
- Thomson, A. B., & Page, L. A. (2007). Psychotherapies for hypochondriasis. Cochrane Database of Systematic Reviews, 4, 1–43.Google Scholar
- Wells, A. (1997). Cognitive therapy of anxiety disorders a practice manual and conceptual guide. Chichester: Wiley.Google Scholar
- Wells, A. (2000). Emotional disorders and metacognition: Innovative cognitive therapy. Chichester: Wiley.Google Scholar
- Wells, A. (2009). Metacognitive therapy for anxiety and depression. New York: Guilford Press.Google Scholar
- Wells, A., & Matthews, G. (1994). Attentions and emotion: A clinical perspective. Hove: Erlbaum.Google Scholar
- Wells, A., & Papageorgiou, C. (2004). Metacognitive therapy for depressive rumination. In C. Papageorgiou & A. Wells (Eds.), Depressive rumination: Nature, theory and treatment. Chichester: Wiley.Google Scholar