Hong Kong J Psychiatry 2009;19:164


Psychological Treatment of Health Anxiety and Hypochondriasis: a Biopsychosocial Approach

Authors: Jonathan S. Abramowitz, Autumn E. Braddock
Hogrefe & Huber Publishers
USD59.00; pp332; ISBN: 978-0-88937-347-1

As its name suggests, this book is about psychological treatment, mainly cognitive behavioural therapy (CBT), for hypochondriasis. The two authors are experienced clinical psychologists working at the Mayo Clinic. The book is divided into 2 parts with the first part discussing the theoretical framework for understanding anxiety and related phenomena while the second deals with the assessment and treatment of health-related anxiety. The authors’ empathy and sensitivity towards their patients are conveyed by the terms they use. In general, they use the term “health anxiety” to encompass hypochondriasis and related problems in this book. However they use the phrase “unexplained physical symptoms” when discussing symptoms with their patients during their initial assessment, as many such patients have been quite upset by comments like “the symptoms are all in your head” or “it is all related to stress and anxiety”. The authors emphasise the importance of rapport building and empathy when assessing patients with health anxiety. Tables are used quite extensively to illustrate important topics like “Open-ended interview questions for assessing unexplained medical symptoms and health anxiety” (p.112), “Reflective listening strategies” (p.126), “Procedures for inducing feared body sensations” (p.217) etc. There are also many case scenarios and the verbatim approach that a therapist should adopt has been clearly described. This should be of great assistance to all those who are interested in treating patients with health anxiety, especially those wishing to use CBT. Psychiatric trainees who are interested in using CBT to treat patients with similar problems would also benefit greatly from this book.

The authors offer a comprehensive approach to, and detailed guidelines for, assessing a patient with health anxiety. Some of these are often underemphasised in other books on this topic, e.g. parents’ reaction, family’s reinforcement, patient’s personal strength, how to motivate the patient for change, how to encourage the patient to hear himself making the argument for change instead of lecturing to him.

The approach used by the authors to apply the concept of anxiety to patients with medically unexplained symptoms is to refer to the 3 specific response systems — physiological (fight- or -flight response), cognitive (gut feelings or perception of body sensations), and behavioural (avoidance or precautions taken by the patient) and so we do not even need to use the term “anxiety”. Patients with health anxiety are very sensitive about hearing the word “anxiety” coming from their therapist’s mouth. The authors are very tactful and skilful and sensitive to patients’ needs. They also give valuable suggestions on how to avoid arguments and to roll with resistance, which are two very common challenges we face when treating patients with health anxiety. Readers should not miss the strategy on “agreement with a twist” and how to raise the issue of “body vigilance and body noise”. Close to the end of the book, the authors give an example of two 4-cell tables that illustrate one patient’s perceived short- and long-term pros and cons related to becoming more comfortable with uncertainty and seeking assurance.

This 331-page book is basically a manual dealing with how to manage patients with health anxiety. It is nicely written, with many ‘real life’ examples and tables. I consider it a useful companion for all colleagues treating patients with health anxiety.

W Lin, MBChB, MRCPsych(UK), FHKCPsych, FHKAM (Psychiatry)

Department of Psychiatry Shatin Hospital
Hong Kong SAR


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