Skip to main content
SpringerLink
Log in

Health Anxiety: A Cognitive-Behavioral Framework

  • Chapter
  • First Online:
Somatoform and Other Psychosomatic Disorders

Abstract

Health anxiety, while not a diagnosis, refers to a set of symptoms characterized by preoccupied worry with having or developing a serious medical illness. An individual presenting with interfering and distressing symptoms of health anxiety may receive a DSM-5 diagnosis of illness anxiety disorder (previously known as hypochondriasis) or somatic symptom disorder, based on the amount of physical complaints they have. Unfortunately, health anxiety is often initially misdiagnosed or undiagnosed due to an individual’s belief that their symptoms are solely physical. Health anxiety is costly to society due to lost work productivity and increased use of medical services. However, health anxiety can be successfully treated within a cognitive-behavioral framework. Intervention techniques include psychoeducation, exposure and response prevention, stress management, and mindfulness processes. Health anxiety symptoms have also shown improvement through pharmacological interventions. Chapter highlights include the definition of health anxiety, various treatment approaches and their efficacies, considerations in light of comorbid physical conditions, and case examples. Ultimately, we conclude that health anxiety, while challenging to diagnose and build trust for treatment in the beginning stages, can be treated effectively within a cognitive-behavioral framework through targeting dysfunctional beliefs about illness.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 49.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 64.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 89.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Abramowitz, J. S., Deacon, B. J., & Valentiner, D. P. (2007). The short health anxiety inventory: Psychometric properties and construct validity in a non-clinical sample. Cognitive Therapy and Research, 31(6), 871–883.

    Article  Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

    Book  Google Scholar 

  • Andersson, G., Cuijpers, P., Carlbring, P., Riper, H., & Hedman, E. (2014). Internet-based vs. face-to-face cognitive behaviour therapy for psychiatric and somatic disorders: A systematic review and meta-analysis. World Psychiatry, 13, 288–295.

    Article  Google Scholar 

  • Asmundson, G. J. G., Taylor, S., & Cox, B. J. (Eds.). (2001). Health anxiety: Clinical and research perspectives on hypochondriasis and related disorders. New York: Wiley.

    Google Scholar 

  • Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13, 27–45.

    Article  Google Scholar 

  • Barsky, A. J., & Ahern, D. K. (2004). Cognitive behavior therapy for hypochondriasis: A randomized controlled trial. JAMA: Journal of the American Medical Association, 291(12), 1464–1470.

    Article  Google Scholar 

  • Barsky, A. J., Wyshak, G., Latham, K. S., & Klerman, G. L. (1991). The relationship between hypochondriasis and medical illness. Archives of Internal Medicine, 151(1), 84–88.

    Article  Google Scholar 

  • Bennett, P., Patterson, K., & Noble, S. (2016). Predicting post-traumatic stress and health anxiety following a venous thrombotic embolism. Journal of Health Psychology, 21(5), 863–871.

    Article  Google Scholar 

  • Bernstein, I. C., Callahan, W. A., & Jaranson, J. M. (1975). Lobotomy in private practice: Long-term follow-up. Archives of General Psychiatry, 32(8), 1041–1047.

    Article  Google Scholar 

  • Christoph, M., Christoph, A., Dannemann, S., Poitz, D., Pfluecke, C., Strasser, R. H., … Ibrahim, K. (2014). Mental symptoms in patients with cardiac symptoms and normal coronary arteries. Open Heart, 1(1), e000093.

    Article  Google Scholar 

  • Cooper, K., Gregory, J. D., Walker, I., Lambe, S., & Salkovskis, P. M. (2017). Cognitive behaviour therapy for health anxiety: A systematic review and meta-analysis. Behavioural and Cognitive Psychotherapy, 45(2), 110–123.

    Article  Google Scholar 

  • Dinkel, A., Kremsreiter, K., Marten-Mittag, B., & Lahmann, C. (2014). Comorbidity of fear of progression and anxiety disorders in cancer patients. General Hospital Psychiatry, 36(6), 613–619.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Fallon, B. A., Ahern, D. K., Pavlicova, M., Slavov, I., Skritskya, N., & Barksy, A. J. (2017). A randomized controlled trial of medication and cognitive-behavioral therapy for psychochondriasis. American Journal of Psychiatry, 174, 756–764.

    Article  Google Scholar 

  • Fallon, B. A., Petkova, E., Skritskaya, N., Sanchez-Lacay, A., Schneier, F., Vermes, D., … Liebowitz, M. R. (2008). A double-masked, placebo-controlled study, of fluoxetine for hypochondriasis. Journal of Clinical Psychopharmacology, 28(6), 638–645.

    Article  Google Scholar 

  • Fazil, M., Akram, M., & Kapoor, P. (2013). General hypochondriasis in diabetes mellitus type- II (DM-II): Implications for clinicians. Global Journal of Medicine and Public Health, 2(3), 1–11.

    Google Scholar 

  • Feuerstein, M., Bruns, G. L., Pollman, C., & Todd, B. L. (2010). Management of unexplained symptoms in survivors of cancer. Journal of Oncology Practice, 6(6), 308–311.

    Article  Google Scholar 

  • Fietta, P., & Manganelli, P. (2007). Fibromyalgia and psychiatric disorders. Acta Bio Medica Atenei Parmensis, 78(2), 88–95.

    PubMed  Google Scholar 

  • Fink, P., Hansen, M. S., & Oxhoj, M. L. (2004). The prevalence of somatoform disorders among internal medical inpatients. Journal of Psychosomatic Research, 56(4), 413–418.

    Article  Google Scholar 

  • Fishbain, D. A., Lewis, J. E., Gao, J., Cole, B., & Steele Rosomoff, R. (2009). Is chronic pain associated with somatization/hypochondriasis? An evidence-based structured review. Pain Practice, 9(6), 449–467.

    Article  Google Scholar 

  • Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99(1), 20–35.

    Article  Google Scholar 

  • Fujishiro, H., Iritani, S., Sekiguchi, H., Habuchi, C., Torii, Y., Matsunaga, S., … Fujita, K. (2016). Hypochondriasis as an early manifestation of dementia with Lewy bodies: An autopsied case report. Psychogeriatrics, 16(2), 139–144.

    Article  Google Scholar 

  • Gomborone, J., Dewsnap, P., Libby, G., & Farthing, M. (1995). Abnormal illness attitudes in patients with irritable bowel syndrome. Journal of Psychosomatic Research, 39(2), 227–230.

    Article  Google Scholar 

  • Greeven, A., van Balkom, A. M., Visser, S., Merkelbach, J. W., van Rood, Y. R., van Dyck, R., … Spinhoven, P. (2007). Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: A randomized controlled trial. The American Journal of Psychiatry, 164(1), 91–99.

    Article  Google Scholar 

  • Hedman, E., Axelsson, E., Görling, A., Ritzman, C., Ronnheden, M., El Alaoui, S., … Ljótsson, B. (2014). Internet-delivered exposure-based cognitive–behavioural therapy and behavioural stress management for severe health anxiety: Randomised controlled trial. The British Journal of Psychiatry, 205(4), 307–314.

    Article  Google Scholar 

  • Hedman, E., Lindefors, N., Andersson, G., Andersson, E., Lekander, M., Rück, C., & Ljótsson, B. (2013). Predictors of outcome in Internet-based cognitive behavior therapy for severe health anxiety. Behaviour Research and Therapy, 51(10), 711–717.

    Article  Google Scholar 

  • Hedman, E., Ljótsson, B., Andersson, E., Rück, C., Andersson, G., & Lindefors, N. (2010). Effectiveness and cost offset analysis of group CBT for hypochondriasis delivered in a psychiatric setting: An open trial. Cognitive Behaviour Therapy, 39(4), 239–250.

    Article  Google Scholar 

  • Hedman, E., Ljótsson, B., Axelsson, E., Andersson, G., Rück, C., & Andersson, E. (2017). Health anxiety in obsessive compulsive disorder and obsessive compulsive symptoms in severe health anxiety: An investigation of symptom profiles. Journal of Anxiety Disorders, 4, 580–586.

    Google Scholar 

  • Janzen Claude, J. A., Hadjistavropoulos, H. D., & Friesen, L. (2014). Exploration of health anxiety among individuals with diabetes: Prevalence and implications. Journal of Health Psychology, 19(2), 312–322.

    Article  Google Scholar 

  • Jones, S. L., Hadjistavropoulos, H. D., & Sherry, S. B. (2012). Health anxiety in women with early-stage breast cancer: What is the relationship to social support? Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement, 44(2), 108.

    Article  Google Scholar 

  • Korkmaz, H., Korkmaz, S., Yildiz, S., Gündoğan, B., & Atmaca, M. (2017). Determination of health anxiety, anxiety, and somatosensory amplification levels in individuals with normal coronary angiography. Psychiatry Research, 252, 114–117.

    Article  Google Scholar 

  • Lebel, S., Tomei, C., Feldstain, A., Beattie, S., & McCallum, M. (2013). Does fear of cancer recurrence predict cancer survivors’ health care use? Supportive Care in Cancer, 21(3), 901–906.

    Article  Google Scholar 

  • Miles, A., & Wardle, J. (2006). Adverse psychological outcomes in colorectal cancer screening: Does health anxiety play a role? Behaviour Research and Therapy, 44(8), 1117–1127.

    Article  Google Scholar 

  • Olatunji, B. O., Deacon, B. J., & Abramowitz, J. S. (2009). Is hypochondriasis an anxiety disorder? The British Journal of Psychiatry, 194(6), 481–482.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Olatunji, B. O., Kauffman, B. Y., Meltzer, S., Davis, M. L., Smits, 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.

    Article  Google Scholar 

  • Sarkar, S., Sautier, L., Schilling, G., Bokemeyer, C., Koch, U., & Mehnert, A. (2015). Anxiety and fear of cancer recurrence and its association with supportive care needs and health-care service utilization in cancer patients. Journal of Cancer Survivorship, 9(4), 567–575.

    Article  Google Scholar 

  • Shafran, R., Clark, D. M., Fairburn, C. G., Arntz, A., Barlow, D. H., Ehlers, A., … Salkovskis, P. M. (2009). Mind the gap: Improving the dissemination of CBT. Behaviour Research and Therapy, 47(11), 902–909.

    Article  Google Scholar 

  • Sørensen, P., Birket-Smith, M., Wattar, U., Buemann, I., & Salkovskis, P. (2011). A randomized clinical trial of cognitive behavioural therapy versus short-term psychodynamic psychotherapy versus no intervention for patients with hypochondriasis. Psychological Medicine, 41(2), 431–441.

    Article  Google Scholar 

  • Strang, S., Ekberg-Jansson, A., & Henoch, I. (2014). Experience of anxiety among patients with severe COPD: A qualitative, in-depth interview study. Palliative and Supportive Care, 12(6), 465–472.

    Article  Google Scholar 

  • Tang, N. K., Salkovskis, P. M., Hodges, A., Soong, E., Hanna, M. H., & Hester, J. (2009). Chronic pain syndrome associated with health anxiety: A qualitative thematic comparison between pain patients with high and low health anxiety. British Journal of Clinical Psychology, 48(1), 1–20.

    Article  Google Scholar 

  • Taylor, S. (2004). Understanding and treating health anxiety: A cognitive-behavioral approach. Cognitive and Behavioral Practice, 11(1), 112–123.

    Article  Google Scholar 

  • Taylor, S., & Asmundson, G. J. G. (2004). Treating health anxiety: A cognitive-behavioral approach. New York: The Guilford Press.

    Google Scholar 

  • Taylor, S., Asmundson, G. J. G., & Coons, M. J. (2005). Current directions in the treatment of hypochondriasis. Journal of Cognitive Psychotherapy, 19(3), 285–304.

    Article  Google Scholar 

  • Thakur, E. R., Sansgiry, S., Petersen, N. J., Stanley, M., Kunik, M. E., Naik, A. D., & Cully, J. A. (2018). Cognitive and perceptual factors, not disease severity, are linked with anxiety in COPD: Results from a cross-sectional study. International Journal of Behavioral Medicine, 25(1), 74–84.

    Article  Google Scholar 

  • Thewes, B., Brebach, R., Dzidowska, M., Rhodes, P., Sharpe, L., & Butow, P. (2014). Current approaches to managing fear of cancer recurrence; A descriptive survey of psychosocial and clinical health professionals. Psychooncology, 23(4), 390–396.

    Article  Google Scholar 

  • Thomson, A. B., & Page, L. A. (2007). Psychotherapies for hypochondriasis. Cochrane Database of Systematic Reviews, 4, CD006520.

    Google Scholar 

  • Trumbo, C. W., McComas, K. A., & Kannaovakun, P. (2007). Cancer anxiety and the perception of risk in alarmed communities. Risk Analysis, 27(2), 337–350.

    Article  Google Scholar 

  • Tyrer, P., Tyrer, H., Morriss, R., Crawford, M., Cooper, S., Yang, M., … Barrett, B. (2017). Clinical and cost-effectiveness of adapted cognitive behaviour therapy for non-cardiac chest pain: A multicentre, randomised controlled trial. Open Heart, 4(1), e000582.

    Article  Google Scholar 

  • von Leupoldt, A., & Janssens, T. (2016). Could targeting disease specific fear and anxiety improve COPD outcomes? Expert Review of Respiratory Medicine, 10(8), 835–837.

    Article  Google Scholar 

  • Weck, F., Neng, J. M., Göller, K., & Müller-Marbach, A. M. (2014). Previous experiences with illness and traumatic experiences: A specific risk factor for hypochondriasis? Psychosomatics, 55(4), 362–371.

    Article  Google Scholar 

  • Weck, F., Neng, J. B., Schwind, J., & Höfling, V. (2015). Exposure therapy changes dysfunctional evaluations of somatic symptoms in patients with hypochondriasis (health anxiety). A randomized controlled trial. Journal of Anxiety Disorders, 34, 1–7.

    Article  Google Scholar 

  • Weck, F., Richtberg, S., Jakob, M., Neng, J. B., & Höfling, V. (2015). Therapist competence and therapeutic alliance are important in the treatment of health anxiety (hypochondriasis). Psychiatry Research, 228(1), 53–58.

    Article  Google Scholar 

  • Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. Chichester, UK: Wiley.

    Google Scholar 

  • Willgoss, T. G., & Yohannes, A. M. (2013). Anxiety disorders in patients with COPD: A systematic review. Respiratory Care, 58(5), 858–866.

    PubMed  Google Scholar 

  • Zwart, J. A., Dyb, G., Hagen, K., Ødegård, K. J., Dahl, A. A., Bovim, G., & Stovner, L. J. (2003). Depression and anxiety disorders associated with headache frequency. The Nord-Trøndelag Health Study. European Journal of Neurology, 10(2), 147–152.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. McLean Hospital, Belmont, MA, USA

    Lauren Rutter, Jacob A. Nota, Miryam Yusufov & Thröstur Björgvinsson

  2. Harvard Medical School, Boston, MA, USA

    Lauren Rutter, Jacob A. Nota, Miryam Yusufov & Thröstur Björgvinsson

Authors
  1. Lauren Rutter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jacob A. Nota
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Miryam Yusufov
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thröstur Björgvinsson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thröstur Björgvinsson .

Editor information

Editors and Affiliations

  1. Dillenburg, Germany

    Christos Charis

  2. Department of Psychology and Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus

    Georgia Panayiotou

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Rutter, L., Nota, J.A., Yusufov, M., Björgvinsson, T. (2018). Health Anxiety: A Cognitive-Behavioral Framework. In: Charis, C., Panayiotou, G. (eds) Somatoform and Other Psychosomatic Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-89360-0_11

Download citation

Publish with us

Policies and ethics

Search

Navigation