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Hypochondriasis Treatment Options

There are only a handful of treatment studies of hypochondriasis. The treatment outcome depends very much on the type of hypochondriasis. Treatment for a disease phobia can be easily implemented with a behavioral package (e.g., flooding, implosion, and thought stopping), but a strict behavioral approach will be less successful with monosymptomatic hypochondriasis. Kellner  reported improvement in hypochondriacal patients at 2-year follow-up with techniques that included reassurance and explanations, multiple physical examinations, and suggestions. If depression or anxiety is present, then treatment of these conditions may lead to a resolution of hypochondriasis. Electroconvulsive therapy and leucotomy as options of last resort have been used to treat hypochondriasis but without much success.

In a test of the effectiveness of cognitivebehavioral intervention, Avia et al. assigned patients with hypochondriasis to either a cognitive-behavioral treatment condition (N = 9) or a waiting-list control condition (N = 8). The treatment, based on Barsky, Geringer, and Wool’s  treatment model, consisted of six 11⁄2 hour sessions that largely covered discussions of inadequate and selective attention, muscle tension and bad breathing habits, environmental factors, stress and dysphoric mood, and explanations of somatic signals. Improvements were noted in decreasing fears, reducing dysphoric mood, as well-treated subjects noted an improvement in being more warm, open, and extroverted. Five subjects in the waiting group were also treated, and similar improvements were noted. However, the small sample size severely limits the strength of the conclusions in this study. In a better controlled study, Warwick, Clark, Cobb, and Salkovskis  randomly assigned thirty-two hypochondriacs either to a cognitive-behavioral treatment group or to a waiting-list control group.

Treatment consisted of sixteen individual sessions conducted during a 4-month period, followed by a 3-month reassessment. Treatment emphasized identifying and challenging misinterpretations of symptoms and signs, restructuring images, modifying dysfunctional assumptions, deliberate body focusing, response prevention for body checking, graded exposure to previously avoided illness-related situations, and prevention of reassurance seeking. Treatment was provided by the first author, who is also a psychiatrist. The waiting-list group waited for 4 months and then were given sixteen individual treatment sessions. The treatment group showed improvement in a number of dependent variables including, among others, disease conviction, need for reassurance, time spent worrying about health, health anxiety, and Beck Depression and Anxiety. The treatment group also showed significant improvements in therapist and assessor ratings of subjects. More recently, in a systematic, three-case analysis, attention training  was used to treat hypochondriasis, and early results appear very promising. This type of treatment consists of regular practice of selective attention, attention switching, and divided attention. The treatment is designed to teach patients how to ‘‘switch off’’ preservative selffocused processing. Clinical improvements were noted in self-report measures of anxiety, mood, health, worry, and illness-related beliefs and behaviors. Most impressive was the finding that none of the three subjects met the criteria for DSM-III-R hypochondriasis at the end of treatment. Obviously, controlled outcome studies are required before embracing this technique to treat hypochondriasis. The advent of specific serotonin re-uptake inhibitors has also been instrumental in improving hypochondriasis. Preliminary data suggest that fluoxetine may be beneficial in treating hypochondriasis. Future studies that integrate cognitive-behavioral treatment and pharmacotherapy will aid in managing hypochondriasis. Hypochondriacal patients are generally best managed in medical rather than psychiatric settings. In terms of prognosis, hypochondriasis is generally believed to be chronic with periodic remissions and exacerbations. A better prognosis for hypochondriasis is reportedly associated with the concurrent presence of anxiety or depression, less serious personality disorder, acute onset of symptomatology, younger age, less secondary gain, absence of an organic process, shorter duration of illness, and less severe hypochondriasis at the time of assessment.

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