Maintaining Mechanisms of Health Anxiety: Current State of Knowledge

  • Chrysanthi LeonidouEmail author
  • Georgia Panayiotou


Severe health anxiety is the preoccupation that one has or will acquire a severe medical disease and impairs individual’s functioning in the psychological, social, professional, and other domains of daily life. This chapter briefly describes this category of symptomatology in terms of epidemiology, predispositional factors, and impact, and it focuses on reviewing the mechanisms that were linked to the maintenance of health anxiety, which stem from the cognitive-behavioral conceptualization and existing empirical evidence. In addition, this chapter introduces a mechanism that potentially buffers the impact of health anxiety on individual’s functioning and provides an overview of behavioral and cognitive approaches in therapy. Directions for future research in areas that warrant further investigation are also provided.


Health anxiety Illness anxiety Cognitive-behavioral model Maintenance mechanisms Cognitive biases Interoceptive awareness Somatosensory amplification Emotion regulation Behavioral avoidance 


  1. Abramowitz, J. S., & Moore, E. L. (2007). An experimental analysis of hypochondriasis. Behaviour Research and Therapy, 45(3), 413–424. CrossRefGoogle Scholar
  2. Alberts, N. M., & Hadjistavropoulos, H. D. (2014). Parental illness, attachment dimensions, and health beliefs: Testing the cognitive-behavioural and interpersonal models of health anxiety. Anxiety, Stress, and Coping, 27(2), 216–228. CrossRefPubMedGoogle Scholar
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5) (5th ed.). Washington, DC: American Psychiatric Publishing. CrossRefGoogle Scholar
  4. Asmundson, G., Taylor, S., & Cox, B. (2001). Health anxiety: Clinical and research perspectives on hypochondriasis and related conditions. New York: Wiley. CrossRefGoogle Scholar
  5. Asmundson, G. J. G., Abramowitz, J. S., Richter, A. A., & Whedon, M. (2010). Health anxiety: Current perspectives and future directions. Current Psychiatry Reports, 12(4), 306–312. CrossRefPubMedGoogle Scholar
  6. Bailey, R., & Wells, A. (2015). Metacognitive beliefs moderate the relationship between catastrophic misinterpretation and health anxiety. Journal of Anxiety Disorders, 34, 8–14. CrossRefPubMedGoogle Scholar
  7. Bailey, R., & Wells, A. (2016). Is metacognition a causal moderator of the relationship between catastrophic misinterpretation and health anxiety? A prospective study. Behaviour Research and Therapy, 78, 43–50. CrossRefPubMedGoogle Scholar
  8. Bardeen, J. R., & Fergus, T. A. (2014). An examination of the incremental contribution of emotion regulation difficulties to health anxiety beyond specific emotion regulation strategies. Journal of Anxiety Disorders, 28(4), 394–401. CrossRefPubMedGoogle Scholar
  9. Barsky, A. J., Frank, C. B., Cleary, P. D., Wyshak, G., & Klerman, G. L. (1991). The relation between hypochondriasis and age. The American Journal of Psychiatry, 148(7), 923–928.CrossRefGoogle Scholar
  10. Barsky, A. J., Orav, E. J., & Bates, D. W. (2005). Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Archives of General Psychiatry, 62(8), 903. CrossRefPubMedGoogle Scholar
  11. Barsky, A. J., & Wyshak, G. (1990). Hypochondriasis and somatosensory amplification. British Journal of Psychiatry, 157(3), 404–409. CrossRefPubMedGoogle Scholar
  12. Barsky, A. J., Wyshak, G., Klerman, G. L., & Latham, K. S. (1990). The prevalence of hypochondriasis in medical outpatients. Social Psychiatry and Psychiatric Epidemiology, 25(2), 89–94. CrossRefPubMedGoogle Scholar
  13. Bogaerts, K., Notebaert, K., Van Diest, I., Devriese, S., De Peuter, S., & Van Den Bergh, O. (2005). Accuracy of respiratory symptom perception in different affective contexts. Journal of Psychosomatic Research, 58(6), 537–543. CrossRefPubMedGoogle Scholar
  14. Bonanno, G. A., Papa, A., Lalande, K., Westphal, M., & Coifman, K. (2004). The importance of being flexible: The ability to both enhance and suppress emotional expression predicts long-term adjustment. Psychological Science, 15(7), 482–487. CrossRefPubMedGoogle Scholar
  15. Brady, R. E., & Lohr, J. M. (2014). A behavioral test of contamination fear in excessive health anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 45(1), 122–127. CrossRefPubMedGoogle Scholar
  16. Bravo, I. M., & Silverman, W. K. (2001). Anxiety sensitivity, anxiety, and depression in older patients and their relation to hypochondriacal concerns and medical illnesses. Aging & Mental Health, 5(4), 349–357. CrossRefGoogle Scholar
  17. Brownlee, S., Leventhal, H., & Balaban, M. (1992). Autonomic correlates of illness imagery. Psychophysiology, 29(2), 142–153. CrossRefPubMedGoogle Scholar
  18. Burton, C. (2003). Beyond somatisation: A review of the understanding and treatment of medically unexplained physical symptoms (MUPS). British Journal of General Practice, 53(488), 231–239.PubMedGoogle Scholar
  19. Buss, K. A., & Kiel, E. J. (2013). Temperamental risk factors for pediatric anxiety disorders. In R. A. Vasa & A. Krain Roy (Eds.), Pediatric anxiety disorders: A clinical guide (pp. 47–68). New York: Springer. CrossRefGoogle Scholar
  20. Cameron, O. G. (2002). Visceral sensory neuroscience: Interoception. New York: Oxford University Press.Google Scholar
  21. Chaturvedi, S. K., Desai, G., & Shaligram, D. (2006). Somatoform disorders, somatization and abnormal illness behaviour. International Review of Psychiatry, 18(1), 75–80. CrossRefPubMedGoogle Scholar
  22. Cisler, J. M., & Koster, E. H. W. (2010). Mechanisms of attentional biases towards threat in anxiety disorders: An integrative review. Clinical Psychology Review, 30(2), 203–216. CrossRefPubMedGoogle Scholar
  23. Constantinou, E. (2014). Affective processing of interoceptive information in persons with medically unexplained symptoms. Leuven: KU Leuven.Google Scholar
  24. Craig, A. D., & Craig, A. D. (2002). How do you feel? Interoception: The sense of the physiological condition of the body. Nature Reviews. Neuroscience, 3(8), 655–666. CrossRefPubMedGoogle Scholar
  25. Creed, F., & Barsky, A. (2004). A systematic review of the epidemiology of somatisation disorder and hypochondriasis. Journal of Psychosomatic Research, 56(4), 391–408. CrossRefPubMedGoogle Scholar
  26. Damasio, A. R. (1994). Descartes’ error: Emotion, reason and the human brain. New York: Grosset/Putman.Google Scholar
  27. Damasio, A. R. (1999). The feeling of what happens: Body and emotion in the making of consciousness. New York: Harcourt Brace.Google Scholar
  28. Derakshan, N., Eysenck, M. W., & Myers, L. B. (2007). Emotional information processing in repressors: The vigilance-avoidance theory. Cognition & Emotion, 21(8), 1585–1614. CrossRefGoogle Scholar
  29. Duddu, V., Chaturvedi, S. K., & Isaac, M. K. (2003). Amplification and attribution styles in somatoform and depressive disorders: A study from Bangalore, India. Psychopathology, 36(2), 98–103. CrossRefPubMedGoogle Scholar
  30. Eftekhari, A., Zoellner, L. A., & Vigil, S. A. (2009). Patterns of emotion regulation and psychopathology. Anxiety, Stress & Coping, 22(5), 571–586. CrossRefGoogle Scholar
  31. Eilenberg, T., Kronstrand, L., Fink, P., & Frostholm, L. (2013). Acceptance and commitment group therapy for health anxiety: Results from a pilot study. Journal of Anxiety Disorders, 27(5), 461–468. CrossRefGoogle Scholar
  32. Fairclough, S. H., & Goodwin, L. (2007). The effect of psychological stress and relaxation on interoceptive accuracy: Implications for symptom perception. Journal of Psychosomatic Research, 62(3), 289–295. CrossRefPubMedGoogle Scholar
  33. Fergus, T. A., & Valentiner, D. P. (2010). Disease phobia and disease conviction are separate dimensions underlying hypochondriasis. Journal of Behavior Therapy and Experimental Psychiatry, 41(4), 438–444. CrossRefPubMedGoogle Scholar
  34. Ferguson, E., Moghaddam, N. G., & Bibby, P. A. (2007). Memory bias in health anxiety is related to the emotional valence of health-related words. Journal of Psychosomatic Research, 62(3), 263–274. CrossRefPubMedGoogle Scholar
  35. Frazier, L. D., & Waid, L. D. (1999). Influences on anxiety in later life: The role of health status, health perceptions, and health locus of control. Aging & Mental Health, 3(3), 213–220. CrossRefGoogle Scholar
  36. Fulton, J. J., Marcus, D. K., & Merkey, T. (2011). Irrational health beliefs and health anxiety. Journal of Clinical Psychology, 67(6), 527–538. CrossRefPubMedGoogle Scholar
  37. Goetz, A. R., Lee, H.-J., & Cougle, J. R. (2012). The association between health anxiety and disgust reactions in a contamination-based behavioral approach task. Anxiety, Stress & Coping, 26(4), 1–16. CrossRefGoogle Scholar
  38. Görgen, S. M., Hiller, W., & Witthöft, M. (2014). Health anxiety, cognitive coping, and emotion regulation: A latent variable approach. International Journal of Behavioral Medicine, 21(2), 364–374. CrossRefPubMedGoogle Scholar
  39. Grabe, H. J., Baumeister, S. E., John, U., Freyberger, H. J., & Völzke, H. (2009). Association of mental distress with health care utilization and costs: A 5-year observation in a general population. Social Psychiatry and Psychiatric Epidemiology, 44(10), 835–844. CrossRefPubMedGoogle Scholar
  40. Gramling, S. E., Clawson, E. P., & McDonald, M. K. (1996). Perceptual and cognitive abnormality model of hypochondriasis: Amplification and physiological reactivity in women. Psychosomatic Medicine, 58(5), 423–431. Retrieved from Scholar
  41. Gropalis, M., Bleichhardt, G., Hiller, W., & Witthöft, M. (2012). Specificity and modifiability of cognitive biases in hypochondriasis. Journal of Consulting and Clinical Psychology, 81(3), 558–565. CrossRefPubMedGoogle Scholar
  42. Gureje, O., Üstun, T. B., & Simon, G. E. (1997). The syndrome of hypochondriasis: A cross-national study in primary care. Psychological Medicine, 27(5), 1001–1010.CrossRefGoogle Scholar
  43. Hadjistavropoulos, H. D., Janzen, J. A., Kehler, M. D., Leclerc, J. A., Sharpe, D., & Bourgault-Fagnou, M. D. (2012). Core cognitions related to health anxiety in self-reported medical and non-medical samples. Journal of Behavioral Medicine, 35(2), 167–178. CrossRefPubMedGoogle Scholar
  44. Haga, S. M., Kraft, P., & Corby, E.-K. (2009). Emotion regulation: Antecedents and well-being outcomes of cognitive reappraisal and expressive suppression in cross-cultural samples. Journal of Happiness Studies, 10(3), 271–291. CrossRefGoogle Scholar
  45. Hager, A. D., & Runtz, M. G. (2012). Physical and psychological maltreatment in childhood and later health problems in women: An exploratory investigation of the roles of perceived stress and coping strategies. Child Abuse & Neglect, 36(5), 393–403. CrossRefGoogle Scholar
  46. Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., … McCurry, S. M. (2004). Measuring experiential avoidance: A preliminary test of a working model. The Psychological Record, 54(4), 553–578.CrossRefGoogle Scholar
  47. Hedman, E., Andersson, G., Andersson, E., Ljótsson, B., Rück, C., Asmundson, G. J. G., & Lindefors, N. (2011). Internet-based cognitive-behavioural therapy for severe health anxiety: Randomised controlled trial. British Journal of Psychiatry, 198(3), 230–236. CrossRefPubMedGoogle Scholar
  48. Hitchcock, P. B., & Mathews, A. (1992). Interpretation of bodily symptoms in hypochondriasis. Behaviour Research and Therapy, 30(3), 223–234. CrossRefPubMedGoogle Scholar
  49. Hu, T., Zhang, D., Wang, J., Mistry, R., Ran, G., & Wang, X. (2014). Relation between emotion regulation and mental health: A meta-analysis review. Psychological Reports: Measures & Statistics, 114(2), 341–362. CrossRefGoogle Scholar
  50. Hyphantis, T., Tomenson, B., Paika, V., Almyroudi, A., Pappa, C., Tsifetaki, N., … Creed, F. (2009). Somatization is associated with physical health-related quality of life independent of anxiety and depression in cancer, glaucoma and rheumatological disorders. Quality of Life Research, 18(8), 1029–1042. CrossRefPubMedGoogle Scholar
  51. James, W. (1984). What is emotion? Mind, 9, 188–205.Google Scholar
  52. Jasper, F., & Witthoft, M. (2011). Health anxiety and attentional bias: The time course of vigilance and avoidance in light of pictorial illness information. Journal of Anxiety Disorders, 25(8), 1131–1138. CrossRefPubMedGoogle Scholar
  53. Jasper, F., & Witthöft, M. (2013). Automatic evaluative processes in health anxiety and their relations to emotion regulation. Cognitive Therapy and Research, 37(3), 521–533. CrossRefGoogle Scholar
  54. Karademas, E. C., Christopoulou, S., Dimostheni, A., & Pavlu, F. (2008). Health anxiety and cognitive interference: Evidence from the application of a modified Stroop task in two studies. Personality and Individual Differences, 44(5), 1138–1150. CrossRefGoogle Scholar
  55. Karekla, M., & Panayiotou, G. (2011). Coping and experiential avoidance: Unique or overlapping constructs? Journal of Behavior Therapy and Experimental Psychiatry, 42(2), 163–170. CrossRefPubMedGoogle Scholar
  56. Kashdan, T. B., Barrios, V., Forsyth, J. P., & Steger, M. F. (2006). Experiential avoidance as a generalized psychological vulnerability: Comparisons with coping and emotion regulation strategies. Behaviour Research and Therapy, 44(9), 1301–1320. CrossRefPubMedGoogle Scholar
  57. Katzer, A., Oberfeld, D., Hiller, W., & Witthöft, M. (2011). Tactile perceptual processes and their relationship to medically unexplained symptoms and health anxiety. Journal of Psychosomatic Research, 71(5), 335–341. CrossRefPubMedGoogle Scholar
  58. Kellner, R. (1986). Somatization and hypochondriasis. Santa Barbara, CA: Praeger.Google Scholar
  59. Kim, J., & Cicchetti, D. (2009). Longitudinal pathways linking child maltreatment, emotion regulation, peer relations, and psychopathology. Journal of Child Psychology and Psychiatry, 51(6), 706–716. CrossRefPubMedGoogle Scholar
  60. Kim, S., Kim, K., & Lee, J.-H. (2014). Effects of dispositional coping strategy and level of health anxiety on attention bias. Social Behavior & Personality: An International Journal, 42(7), 1183–1190. CrossRefGoogle Scholar
  61. Kim, S., & Lee, J. H. (2014). Time course of attentional bias for health-related information in individuals with health anxiety. Journal of Health Psychology, 21(8), 1527–1535. CrossRefPubMedGoogle Scholar
  62. Köteles, F., & Simor, P. (2014). Modern health worries, somatosensory amplification, health anxiety, and well-being: A cross-sectional study. European Journal of Mental Health, 9(1), 20–33. CrossRefGoogle Scholar
  63. Köteles, F., Szemerszky, R., Freyler, A., & Bárdos, G. (2011). Somatosensory amplification as a possible source of subjective symptoms behind modern health worries. Scandinavian Journal of Psychology, 52(2), 174–178. CrossRefPubMedGoogle Scholar
  64. Krautwurst, S., Gerlach, A. L., Gomille, L., Hiller, W., & Witthöft, M. (2014). Health anxiety: An indicator of higher interoceptive sensitivity? Journal of Behavior Therapy and Experimental Psychiatry, 45(2), 303–309. CrossRefPubMedGoogle Scholar
  65. Krautwurst, S., Gerlach, A. L., & Witthöft, M. (2016). Interoception in pathological health anxiety. Journal of Abnormal Psychology, 125(8), 1179–1184. CrossRefPubMedGoogle Scholar
  66. Kroenke, K. (2003). Patients presenting with somatic complaints: Epidemiology, psychiatric co-morbidity and management. International Journal of Methods in Psychiatric Research, 12(1), 34–43. CrossRefPubMedGoogle Scholar
  67. Lee, H., Turkel, J. E., Cotter, S. P., Milliken, J. M., Cougle, J., Goetz, A. R., & Lesnick, A. M. (2013). Attentional bias toward personally relevant health-threat words. Anxiety, Stress & Coping, 26(5), 493–507. CrossRefGoogle Scholar
  68. Lee, H. J., Goetz, A. R., Turkel, J. E., & Siwiec, S. G. (2015). Computerized attention retraining for individuals with elevated health anxiety. Anxiety, Stress, and Coping, 28(2), 226–237. CrossRefPubMedGoogle Scholar
  69. Leibbrand, R., Hiller, W., & Fichter, M. M. (2000). Hypochondriasis and somatization: Two distinct aspects of somatoform disorders? Journal of Clinical Psychology, 56(1), 63–72.<63::AID-JCLP6>3.0.CO;2-OCrossRefPubMedGoogle Scholar
  70. Leonidou, C., & Panayiotou, G. (2016). Assessing health anxiety with the Greek SHAI and identifying correlates and predictors. In Oral presentation at the 30th Annual Conference of the European Health Psychology Society, Aberdeen, Scotland.Google Scholar
  71. Leonidou, C., Panayiotou, G., Bati, A., & Karekla, M. (2014a). Correlates and predictors of severe health anxiety. In Poster presented at the 4th Annual Conference of the Centre of Applied Neuroscience, Nicosia, Cyprus.Google Scholar
  72. Leonidou, C., Panayiotou, G., Bati, A., & Karekla, M. (2014b). Factors associated with the clinical levels of somatization and hypochondriasis: The role of anxiety and panic symptoms. In Poster presented at the EABCT Congress (p. 19). Hague, Netherlands: Psychomed.Google Scholar
  73. Leonidou, C., Panayiotou, G., Karekla, M., & Bati, A. (2016). Coping with psychosomatic symptoms: The buffering role of psychological flexibility and impact on quality of life. Journal of Health Psychology.
  74. 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(8), 931–935. CrossRefPubMedGoogle Scholar
  75. MacLeod, A. K., Haynes, C., & Sensky, T. (1998). Attributions about common bodily sensations: Their associations with hypochondriasis and anxiety. Psychological Medicine, 28(1), 225–228. CrossRefPubMedGoogle Scholar
  76. MacSwain, K. L. H., Sherry, S. B., Stewart, S. H., Watt, M. C., Hadjistavropoulos, H. D., & Graham, A. R. (2009). Gender differences in health anxiety: An investigation of the interpersonal model of health anxiety. Personality and Individual Differences, 47(8), 938–943. CrossRefGoogle Scholar
  77. Magariños, M., Zafar, U., Nissenson, K., & Blanco, C. (2002). Epidemiology and treatment of hypochondriasis. CNS Drugs, 16(1), 9–22. CrossRefPubMedGoogle Scholar
  78. Mailloux, J., & Brener, J. (2002). Somatosensory amplification and its relationship to heartbeat detection ability. Psychosomatic Medicine, 64(2), 353–357. CrossRefPubMedGoogle Scholar
  79. 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(2), 127–139. CrossRefPubMedGoogle Scholar
  80. Marcus, D. K., Hughes, K. T., Arnau, R. C., Salkovskis, P., Warwick, H., Salkovskis, P., … Baer, R. (2008). Health anxiety, rumination, and negative affect: A mediational analysis. Journal of Psychosomatic Research, 64(5), 495–501. CrossRefPubMedGoogle Scholar
  81. Martin, A., Buech, A., Schwenk, C., & Rief, W. (2007). Memory bias for health-related information in somatoform disorders. Journal of Psychosomatic Research, 63(6), 663–671. CrossRefPubMedGoogle Scholar
  82. Masuda, A., & Tully, E. C. (2012). The role of mindfulness and psychological flexibility in somatization, depression, anxiety, and general psychological distress in a nonclinical college sample. Journal of Evidence-Based Complementary & Alternative Medicine, 17(1), 66–71. CrossRefGoogle Scholar
  83. McManus, F., Muse, K., Surawy, C., Hackmann, A., & Williams, J. M. G. (2015). Relating differently to intrusive images: The impact of mindfulness-based cognitive therapy (MBCT) on intrusive images in patients with severe health anxiety (hypochondriasis). Mindfulness, 6(4), 788–796. CrossRefGoogle Scholar
  84. Muse, K., McManus, F., Hackmann, A., Williams, M., & Williams, M. (2010). Intrusive imagery in severe health anxiety: Prevalence, nature and links with memories and maintenance cycles. Behaviour Research and Therapy, 48(8), 792–798. CrossRefPubMedPubMedCentralGoogle Scholar
  85. Neng, J. M. B., & Weck, F. (2015). Attribution of somatic symptoms in hypochondriasis. Clinical Psychology and Psychotherapy, 22(2), 116–124. CrossRefPubMedGoogle Scholar
  86. Noyes, R., Stuart, S., Langbehn, D. R., Happel, R. L., Longley, S. L., Yagla, S. J., … Goldberg, S. (2002). Childhood antecedents of hypochondriasis. Psychosomatics, 43(4), 282–289. CrossRefPubMedGoogle Scholar
  87. Noyes, R., Stuart, S. P., Langbehn, D. R., Happel, R. L., Longley, S. L., Muller, B. A., & Yagla, S. J. (2003). Test of an interpersonal model of hypochondriasis. Psychosomatic Medicine, 65(2), 292–300. Retrieved from Scholar
  88. Olatunji, B. O., Deacon, B. J., & Abramowitz, J. S. (2009). Is hypochondriasis an anxiety disorder? British Journal of Psychiatry, 194(6), 481–482. CrossRefPubMedGoogle Scholar
  89. Olatunji, B. O., Deacon, B. J., Abramowitz, J. S., & Valentiner, D. P. (2007). Body vigilance in nonclinical and anxiety disorder samples: Structure, correlates, and prediction of health concerns. Behavior Therapy, 38(4), 392–401. CrossRefPubMedGoogle Scholar
  90. Olatunji, B. O., Etzel, E. N., Tomarken, A. J., Ciesielski, B. G., & Deacon, B. (2011). The effects of safety behaviors on health anxiety: An experimental investigation. Behaviour Research and Therapy, 49(11), 719–728. CrossRefPubMedPubMedCentralGoogle Scholar
  91. Olatunji, B. O., Kauffman, B. Y., Meltzer, S., Davis, M. L., Smits, J. A. J. J., & Powers, M. B. (2014). Cognitive-behavioral therapy for hypochondriasis/health anxiety: A meta-analysis of treatment outcome and moderators. Behaviour Research and Therapy, 58, 65–74. CrossRefPubMedPubMedCentralGoogle Scholar
  92. Otto, M. W., Pollack, M. H., Sachs, G. S., & Rosenbaum, J. F. (1992). Hypochondriacal concerns, anxiety sensitivity, and panic disorder. Journal of Anxiety Disorders, 6(2), 93–104. CrossRefGoogle Scholar
  93. Owens, K., Asmundson, G., Hadjistavropoulos, T., & Owens, T. (2004). Attentional bias toward illness threat cues in individuals with health anxiety. Cognitive Therapy and Research, 28(1), 57–66. CrossRefGoogle Scholar
  94. Panayiotou, G., Karekla, M., & Mete, I. (2014). Dispositional coping in individuals with anxiety disorder symptomatology: Avoidance predicts distress. Journal of Contextual Behavioral Science, 3(4), 314–321. CrossRefGoogle Scholar
  95. Papageorgiou, C., & Wells, A. (1998). Effects of attention training on hypochondriasis: A brief case series. Psychological Medicineedicine, 28(1), 193–200. CrossRefGoogle Scholar
  96. Parker, J. D. A., Bagby, R. M., & Taylor, G. J. (1989). Toronto alexithymia scale, EPQ and self-report measures of somatic complaints. Personality and Individual Differences, 10(6), 599–604. CrossRefGoogle Scholar
  97. Pauli, P., & Alpers, G. W. (2002). Memory bias in patients with hypochondriasis and somatoform pain disorder. Journal of Psychosomatic Research, 52(1), 45–53. CrossRefPubMedGoogle Scholar
  98. Pollatos, O., Matthias, E., & Schandry, R. (2007). Heartbeat perception and P300 amplitude in a visual oddball paradigm. Clinical Neurophysiology, 118(10), 2248–2253. CrossRefPubMedGoogle Scholar
  99. Rachman, S. (2012). Health anxiety disorders: A cognitive construal. Behaviour Research and Therapy, 50(7–8), 502–512. CrossRefPubMedGoogle Scholar
  100. Rachman, S., Radomsky, A. S., & Shafran, R. (2008). Safety behaviour: A reconsideration. Behaviour Research and Therapy, 46(2), 163–173. CrossRefPubMedGoogle Scholar
  101. Rief, W., & Broadbent, E. (2007). Explaining medically unexplained symptoms: Models and mechanisms. Clinical Psychology Review, 27(7), 821–841. CrossRefPubMedGoogle Scholar
  102. Rief, W., & Hiller, W. (1998). Cognitive aspects of hypochondriasis and the somatization syndrome. Journal of Abnormal Psychology, 107(4), 587–595. CrossRefPubMedGoogle Scholar
  103. Rodic, D., Meyer, A. H., Lieb, R., & Meinlschmidt, G. (2016). The association of sensory responsiveness with somatic symptoms and illness anxiety. International Journal of Behavioral Medicine, 23(1), 39–48. CrossRefPubMedGoogle Scholar
  104. Salkovskis, P. M. (1991). The importance of behaviour in the maintenance of anxiety and panic: A cognitive account. Behavioural and Cognitive Psychotherapy, 19(1), 6–19.CrossRefGoogle Scholar
  105. Salkovskis, P. M. (2003). Cognitive-behavioral treatment for severe and persistent health anxiety (hypochondriasis). Brief Treatment and Crisis Intervention, 3(3), 353–368. CrossRefGoogle Scholar
  106. Salkovskis, P. M., & Warwick, H. M. C. (2001). Meaning, misinterpretations, and medicine: A cognitive-behavioral approach to understanding health anxiety and hypochondriasis. In D. R. Starcevic & V. Lipsitt (Eds.), Hypochondriasis: Modern perspectives on an ancient malady (pp. 202–222). New York: Oxford University Press.Google Scholar
  107. Sansom-Daly, U. M., Bryant, R. A., Cohn, R. J., & Wakefield, C. E. (2014). Imagining the future in health anxiety: The impact of rumination on the specificity of illness-related memory and future thinking. Anxiety, Stress, and Coping, 27(5), 587–600. CrossRefPubMedGoogle Scholar
  108. Schachter, S., & Singer, J. E. (1962). Cognitive, social and psychological determinants of emotional state. Psychological Review, 69(5), 379–399.CrossRefGoogle Scholar
  109. Schmidt, E., Witthöft, M., Kornadt, A., Rist, F., & Bailer, J. (2013). Negative automatic evaluation and better recognition of bodily symptom words in college students with elevated health anxiety. Cognitive Therapy and Research, 37(5), 1027–1040. CrossRefGoogle Scholar
  110. Schreiber, F., Neng, J. M. B., Heimlich, C., Witthöft, M., & Weck, F. (2014). Implicit affective evaluation bias in hypochondriasis: Findings from the affect misattribution Procedure. Journal of Anxiety Disorders, 28(7), 671–678. CrossRefPubMedGoogle Scholar
  111. Sempertegui, G. A., Karreman, A., van Hout, G. C., & Bekker, M. H. (2016). Functional status in patients with medically unexplained physical symptoms: Coping styles and their relationship with depression and anxiety. Journal of Health Psychology.
  112. Sherry, D. L., Sherry, S. B., Vincent, N. A., Stewart, S. H., Hadjistavropoulos, H. D., Doucette, S., & Hartling, N. (2014). Anxious attachment and emotional instability interact to predict health anxiety: An extension of the interpersonal model of health anxiety. Personality and Individual Differences, 56, 89–94. CrossRefGoogle Scholar
  113. Stuart, S., & Noyes, R. (1999). Attachment and interpersonal communication in somatization. Psychosomatics, 40(1), 34–43. CrossRefPubMedGoogle Scholar
  114. Surawy, C., McManus, F., Muse, K., & Williams, J. M. G. (2015). Mindfulness-based cognitive therapy (MBCT) for health anxiety (hypochondriasis): Rationale, implementation and case illustration. Mindfulness, 6(2), 382–392. CrossRefPubMedGoogle Scholar
  115. 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(12), 2821–2835. CrossRefPubMedGoogle Scholar
  116. Taylor, G. J., Bagby, R. M., & Parker, J. D. A. (1997). Disorders of affect regulation: Alexithymia in medical and psychiatric illness (Vol. 7). Cambridge: Cambridge University Press.<240::AID-CPP245>3.0.CO;2-7CrossRefGoogle Scholar
  117. Taylor, S., & Asmundson, G. J. G. (2004). What is health anxiety? In Treating health anxiety: A cognitive-behavioral approach (pp. 1–18). New York: Guilford.Google Scholar
  118. Terluin, B., van Rhenen, W., Anema, J. R., & Taris, T. W. (2011). Psychological symptoms and subsequent sickness absence. International Archives of Occupational and Environmental Health, 84(7), 825–837. CrossRefPubMedGoogle Scholar
  119. Thastum, M., Watson, M., Kienbacher, C., Piha, J., Steck, B., Zachariae, R., … Romer, G. (2009). Prevalence and predictors of emotional and behavioural functioning of children where a parent has cancer. Cancer, 115(17), 4030–4039. CrossRefPubMedGoogle Scholar
  120. Thompson, R. A. (1994). Emotion regulation: A theme in search of definition. Monographs of the Society for Research in Child Development, 59(2–3), 25–52. CrossRefPubMedGoogle Scholar
  121. Tull, M. T., Gratz, K. L., Salters, K., & Roemer, L. (2004). The role of experiential avoidance in posttraumatic stress symptoms and symptoms of depression, anxiety, and somatization. The Journal of Nervous and Mental Disease, 192(11), 754–761. Retrieved from Scholar
  122. Tyrer, P., Cooper, S., Salkovskis, P., Tyrer, H., Crawford, M., Byford, S., … Barrett, B. (2014). Clinical and cost-effectiveness of cognitive behaviour therapy for health anxiety in medical patients: A multicentre randomised controlled trial. The Lancet, 383(9913), 219–225. CrossRefGoogle Scholar
  123. Van Den Heuvel, O. A., Veltman, D. J., Groenewegen, D. J., Witter, M. P., Merkelbach, J., Cath, D. C., … Van Dyck, R. (2005). Disorder-specific neuroanatomical correlates of attentional bias in obsessive-compulsive disorder. Panic Disorder, and Hypochondriasis, 62(8), 922–933.Google Scholar
  124. Waldinger, R. J., Schulz, M. S., Barsky, A. J., & Ahern, D. K. (2006). Mapping the road from childhood trauma to adult somatization: The role of attachment. Psychosomatic Medicine, 68(1), 129–135. CrossRefPubMedGoogle Scholar
  125. Warwick, H., & Salkovskis, P. (1990). Hypochondriasis. Behaviour Research and Therapy, 28(2), 105–117. Retrieved from Scholar
  126. Warwick, H. M., Clark, D. M., Cobb, A. M., & Salkovskis, P. M. (1996). A controlled trial of cognitive-behavioural treatment of hypochondriasis. The British Journal of Psychiatry, 169(2), 189–195.CrossRefGoogle Scholar
  127. Watt, M. C., O’Connor, R. M., Stewart, S. H., Moon, E. C., & Terry, L. (2008). Specificity of childhood learning experiences in relation to anxiety sensitivity and illness/injury sensitivity: Implications for health anxiety and pain. Journal of Cognitive Psychotherapy, 22(2), 128–142. CrossRefGoogle Scholar
  128. Watt, M. C., Stewart, S. H., Asmundson, G., Norton, G., Asmundson, G., Taylor, S., … Costa, P. (2000). Anxiety sensitivity mediates the relationships between childhood learning experiences and elevated hypochondriacal concerns in young adulthood. Journal of Psychosomatic Research, 49(2), 107–118. CrossRefPubMedGoogle Scholar
  129. Weck, F., Neng, J. M. B., Göller, K., Müller-Marbach, A. M., Witthöft, M., Hiller, W., … Craig, T. K. (2010). Previous experiences with illness and traumatic experiences: A specific risk factor for hypochondriasis? Psychosomatics, 55(4), 362–371. CrossRefGoogle Scholar
  130. Williams, M. J., McManus, F., Muse, K., & Williams, J. M. G. (2011). Mindfulness-based cognitive therapy for severe health anxiety (hypochondriasis): An interpretative phenomenological analysis of patients’ experiences. British Journal of Clinical Psychology, 50(4), 379–397. CrossRefPubMedGoogle Scholar
  131. Witthoft, M., Kerstner, T., Ofer, J., Mier, D., Rist, F., Diener, C., … Witthöft, M. (2016). Cognitive biases in pathological health anxiety: The contribution of attention, memory, and evaluation processes. Clinical Psychological Science, 4(3), 464–479. CrossRefGoogle Scholar
  132. Witthöft, M., Mier, D., Ofer, J., Müller, T., Rist, F., Kirsch, P., … Diener, C. (2013). Neuronal and behavioral correlates of health anxiety: Results of an illness-related emotional Stroop task. Neuropsychobiology, 67(2), 93–102. CrossRefPubMedGoogle Scholar
  133. Witthöft, M., Rist, F., & Bailer, J. (2008). Enhanced early emotional intrusion effects and proportional habituation of threat response for symptom and illness words in college students with elevated health anxiety. Cognitive Therapy and Research, 32(6), 818–842. CrossRefGoogle Scholar
  134. Zincir, S. B., Sunbul, M., Sunbul, E. A., Dalkilic, B., Cengiz, F., Kivrak, T., & Durmus, E. (2016). Evaluation of alexithymia, somatosensory sensitivity, and health anxiety levels in patients with noncardiac chest pain health anxiety levels in patients with noncardiac chest pain. Biomedical Research International, 2014, 1–6. CrossRefGoogle Scholar
  135. Zvolensky, M. J., & Forsyth, J. P. (2002). Anxiety sensitivity dimensions in the prediction of body vigilance and emotional avoidance. Cognitive Therapy and Research, 26(4), 449–460. CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of CyprusNicosiaCyprus
  2. 2.Department of Psychology and Center for Applied NeuroscienceUniversity of CyprusNicosiaCyprus

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