Cognitive‐Behavioral Treatment for Severe and Persistent Health Anxiety (Hypochondriasis)

Hypochondriasis is presently classified as a somatoform disorder. In this paper, the classification and phenomenology of health anxiety is explained in terms of a specific cognitive-behavioral conceptualization. The all-important task of engagement is accomplished as part of the cognitive assessment, which helps the patient develop and evaluate an alternative understanding of their problems. This understanding focuses on how misinterpretations of health-related information (mainly bodily variations and medical information) leads to a pattern of responses including anxiety, distorted patterns of attention, safety-seeking behaviors, and physiological arousal. These responses in turn account for the patient's pattern of symptoms and functional impairment. This objective is accomplished through two avenues: one, discussion, which has the purpose of making sense of the person's experience; and two, active evaluation of the mechanisms involved, through collaboratively designed and implemented behavioral experiments. Evidence from randomized controlled trials strongly suggests that cognitive treatments are effective and that the effects are specific to the treatment techniques used.