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Ayhan Başer D, Çevik M, Gümüştakim Ş, Başara E. Assessment of individuals' attitude, knowledge and anxiety towards COVID-19 at the first period of the outbreak in Turkey: A web-based cross-sectional survey. Int J Clin Pract 2020; 74:e13622. [PMID: 32726515 DOI: 10.1111/ijcp.13622] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/15/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE The aim of this study is to evaluate the attitude, knowledge and anxiety status of individuals about COVID-19 at the first period of the outbreak. METHODS This was an observational study carried out in Turkey. An online semi-structured questionnaire was developed by using google forms and the link of the questionnaire was sent through emails, WhatsApp and other social media to the contacts of the investigators between 20th March 2020 and 25th March 2020. The questionnaire contained 21 questions and Beck anxiety scale. RESULTS About 1070 people were included in the study. Approximately one-fifth of the participants had no idea about treatment and immunisation against COVID-19. According to the categorisation of Beck Anxiety Inventory scores 8.6% showed severe anxiety symptoms. Anxiety levels of women, healthcare workers and those with psychiatric illness were higher (P < .05). It was observed that women, healthcare professionals, those with chronic diseases and those with moderate to severe anxiety used the medical facemask more frequently (P < .05). About 73% of the participants thought that they fully implemented the proposed measures; 25.2% of them stated that population did not take any measures for the COVID-19. CONCLUSION According to the results of the study individuals usually had better awareness and positive attitudes towards COVID-19 pandemic, but there were also things that needed improvement. The most important measure to be taken in order to prevent anxiety from increasing is to ensure the correct access of information and to establish psychological support lines.
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Affiliation(s)
- Duygu Ayhan Başer
- Department of Family Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Çevik
- Güdül Family Medicine Center, Ankara, Turkey
| | - Şule Gümüştakim
- Department of Family Medicine, Faculty of Medicine, Sütçü İmam University, Kahramanmaraş, Turkey
| | - Ekrem Başara
- Department of Family Medicine, Faculty of Medicine, Sağlık Bilimleri University, Ankara, Turkey
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What are the barriers to the SHAI being completed within a ME/CFS service? COGNITIVE BEHAVIOUR THERAPIST 2020. [DOI: 10.1017/s1754470x20000525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating condition, characterised by unexplained and excessive fatigue, muscle pain and sleep disturbances. Health anxiety is common in ME/CFS and accurate measurement is essential in facilitating therapeutic gains. However, there are clinical concerns over the utility of the Short Health Anxiety Inventory (SHAI) in measuring health anxiety in this population. This study aims to use qualitative responses from two ex-service users and specialist health clinicians to explore the barriers to completing the SHAI within a specialist ME/CFS service. Qualitative responses from a focus group consisting of 15 specialist health professionals including occupational therapists, physiotherapists, dieticians, cognitive behavioural therapists, counsellors, clinical psychologists and assistant psychologists were transcribed and analysed for themes. Patient voices were represented by two former service users through individual semi-structured interviews on the telephone, which were recorded, transcribed and later analysed thematically. Clinicians and service user involvement agreed on core difficulties with the utility of the SHAI in the ME/CFS population. The timing of the SHAI being administered pre-diagnosis, the language of the SHAI and lack of context around the questionnaire were identified as barriers that were likely to contribute to the SHAI not being completed by service users. Sensitive and accurate measurement is required in order to retain patient engagement, which could further facilitate appropriate assessment and treatment of health anxiety and ME/CFS. Findings suggest that adaption of the SHAI is vital for use with ME/CFS.
Key learning aims
(1)
To understand the different barriers to completing the SHAI in a ME/CFS service.
(2)
To understand the implications of administering the SHAI to ME/CFS service users.
(3)
To learn from multi-disciplinary ME/CFS health professionals about perceived difficulties in administering the SHAI.
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Leonidou C, Panayiotou G. Attentional processing of information related to illness: Biases and associations with emotional response in young adults with different levels of illness anxiety. J Health Psychol 2020; 27:726-742. [PMID: 33106033 DOI: 10.1177/1359105320967435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
This study investigated attentional processing of illness-related information and associations with emotional reactivity. 100 young adults with low to high illness anxiety levels underwent free and cued viewing tasks, while eye-tracking and emotional reactivity were recorded. During free viewing, participants showed early orienting bias and sustained vigilance bias toward illness vs neutral pictures. Increased illness anxiety predicted vigilance bias to illness vs fearful pictures. During cued viewing, participants showed avoidance bias for illness vs neutral pictures, predicted by greater cardiac acceleration. Task nature appears to influence attentional processing patterns of illness stimuli. Preliminary evidence supports that attention allocation may be an emotion regulation mechanism.
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Tull MT, Barbano AC, Scamaldo KM, Richmond JR, Edmonds KA, Rose JP, Gratz KL. The prospective influence of COVID-19 affective risk assessments and intolerance of uncertainty on later dimensions of health anxiety. J Anxiety Disord 2020; 75:102290. [PMID: 32823216 PMCID: PMC7422821 DOI: 10.1016/j.janxdis.2020.102290] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/20/2020] [Accepted: 08/08/2020] [Indexed: 12/17/2022]
Abstract
The COVID-19 pandemic is likely to increase risk for the development of health anxiety. Given that elevated health anxiety can contribute to maladaptive health behaviors, there is a need to identify individual difference factors that may increase health anxiety risk. This study examined the unique and interactive relations of COVID-19 affective risk assessments (worry about risk for contracting/dying from COVID-19) and intolerance of uncertainty to later health anxiety dimensions. A U.S. community sample of 364 participants completed online self-report measures at a baseline assessment (Time 1) and one month later (Time 2). Time 1 intolerance of uncertainty was uniquely associated with the Time 2 health anxiety dimension of body vigilance. Time 1 affective risk assessments and intolerance of uncertainty were uniquely associated with later perceived likelihood that an illness would be acquired and anticipated negative consequences of an illness. The latter finding was qualified by a significant interaction, such that affective risk assessments were positively associated with anticipated negative consequences of having an illness only among participants with mean and low levels of intolerance of uncertainty. Results speak to the relevance of different risk factors for health anxiety during the COVID-19 pandemic and highlight targets for reducing health anxiety risk.
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Affiliation(s)
- Matthew T. Tull
- Corresponding author at: Department of Psychology, Mail Stop 948, University of Toledo, 2801 West Bancroft Street, Toledo, OH, 43606, USA
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Mohammadi MR, Zarafshan H, Khayam Bashi S, Mohammadi F, Khaleghi A. The Role of Public Trust and Media in the Psychological and Behavioral Responses to the COVID-19 Pandemic. IRANIAN JOURNAL OF PSYCHIATRY 2020; 15:189-204. [PMID: 33193767 PMCID: PMC7603593 DOI: 10.18502/ijps.v15i3.3811] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: We investigated the level of psychological problems, perceived risk, safety behaviors, and the potential roles of demographic variables, public trust, media, and prior anxiety to illness during the COVID-19pandemic among Iranians. Method : In this cross sectional study, using a convenient and snowball sampling method, we distributed an online questionnaire to participants and collected data on their demographic variables, mental health status, the consumption of and level of trust to various media, the level of public trust, and perceived risk and safety behaviors regards COVID-19. Our final sample consisted of 1881 Iranian residents. We used descriptive analysis, bivariate correlation, univariable and multivariable linear regression analysis, and univariable and multivariable logistic regression analysis for data analysis. Results: The mental health problems have increased in comparison to past national survey; 24.1% vs 10.39% for depression, 37.93% vs 16.7% for social dysfunction, and 41.33% vs 29.5% for anxiety, and 31.12% vs 29.08% for somatization. We also found high percent of acute stress 52.71% (95% CI: 50.45-54.96). Being female, married, and having a higher educational level increased the odds of safety behaviors. Public trust and national media can regulate the negative effect of the pandemic, while increasing perceived risk and appropriate safety behaviors can decrease psychological problems and disorders. However, social media increases perceived risk, safety behaviors, and psychological problems, especially severe acute stress. Conclusion: We are in the early stages of the COVID-19 pandemic and its negative effects will increase. Many people have lost their relatives, their jobs, their social contacts, and are faced with a surge of negative news. Authorities should consider these critical issues and adopt appropriate communicative and supportive approaches to prevent their negative effects at both individual and societal levels.
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Affiliation(s)
- Mohammad Reza Mohammadi
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Zarafshan
- Department of Autism and Neurodevelopmental Disorders, Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Khayam Bashi
- Department of Autism and Neurodevelopmental Disorders, Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Mohammadi
- Department of Sociology, School of Social Sciences, Allameh Tabataba'i University, Tehran, Iran
| | - Ali Khaleghi
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Özdilek A, Yalınay Dikmen P, Acar E, Ayanoğlu Aksoy E, Korkut N. Determination of Anxiety, Health Anxiety and Somatosensory Amplification Levels in Individuals with Benign Paroxysmal Positional Vertigo. J Int Adv Otol 2020; 15:436-441. [PMID: 31347508 DOI: 10.5152/iao.2019.6874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Psychiatric comorbidities may intensify peripheral vertigo and increase the number of repositioning maneuvers required. This study was designed to examine the relationship between benign paroxysmal positional vertigo (BPPV) and anxiety and assess its association with somatic amplification and health anxiety. MATERIALS AND METHODS Sixty patients with BPPV (43 women, 17 men; age range: 24-81 years, mean age 40.4±13.3), and 60 healthy participants (29 women, 31 men; age range: 18-71, mean age 38.2±11.43) were prospectively enrolled. The participants completed the Beck Anxiety Inventory (BAI), Short Health Anxiety Inventory (SHAI), and Somatosensory Amplification Scale (SSAS) questionnaires. RESULTS The BAI scores of the patients with BPPV were higher than those of the control group participants and were as follows: (16.4 vs. 12.7; p=0.01). The SHAI (p=0.44) and SSAS (p=0.60) scores were not significantly different between the two groups. The BAI scores were positively correlated with the SHAI (rho: 0.273, p=0.035) and SSAS (rho: 0.357, p=0.005) scores. Neither the number of BPPV attacks nor the number of Epley maneuvers required showed any correlation with the BAI [(rho: 0.208, p=0.11); (rho: -0.007, p=0.96)], SHAI [(rho: 0.068, p=0.06); (rho: 0.021, p=0.87)], and SSAS [(rho: -0.081, p=0.53); (rho: -0.012, p=0.92)] scores. CONCLUSION Our findings indicate that patients with BPPV had higher anxiety scores than healthy participants. Although our findings indicated normal health anxiety and somatic amplification levels in patients with BPPV, regular evaluation of psychological status would be a good strategy to prevent chronic dizziness.
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Affiliation(s)
- Alper Özdilek
- Clinic of Ear Nose and Throat, Maslak Acibadem Hospital, İstanbul, Turkey
| | - Pınar Yalınay Dikmen
- Department of Neurology, Acibadem Mehmet Ali Aydinlar University School of Medicine, İstanbul, Turkey
| | - Erkan Acar
- Department of Neurology, Acibadem Mehmet Ali Aydinlar University School of Medicine, İstanbul, Turkey
| | - Elif Ayanoğlu Aksoy
- Department of Ear Nose and Throat, Acibadem Mehmet Ali Aydinlar University School of Medicine, İstanbul, Turkey
| | - Nazım Korkut
- Clinic of Ear Nose and Throat, Maslak Acibadem Hospital, İstanbul, Turkey
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Reiser SJ, Oliver AM, Power HA, Wright KD. Health anxiety and emotion regulation in children and adolescents: is there a relationship? CHILDRENS HEALTH CARE 2020. [DOI: 10.1080/02739615.2019.1629297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Sarah J. Reiser
- Department of Psychology, University of Regina, Regina, SK, Canada
| | - Amanda M. Oliver
- Department of Psychology, University of Regina, Regina, SK, Canada
| | - Hilary A. Power
- Department of Psychology, University of Regina, Regina, SK, Canada
| | - Kristi D. Wright
- Department of Psychology, University of Regina, Regina, SK, Canada
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Öztekin Ü, Hacimusalar Y, Gürel A, Karaaslan O. The Relationship of Male Infertility with Somatosensory Amplification, Health Anxiety and Depression Levels. Psychiatry Investig 2020; 17:350-355. [PMID: 32252512 PMCID: PMC7176565 DOI: 10.30773/pi.2019.0248] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 02/07/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the relationship between infertility and factors such as anxiety, health anxiety, depression, and somatosensory amplification in male patients presenting with infertility. METHODS In this study, we evaluated 198 patients (infertile group: 130, control group: 68). Patients that fit the inclusion criteria were informed about the aim and method of the study and filled out sociodemographic data collection form, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), The Somatosensory Amplification Scale (SSAS), and Health Anxiety Inventory (HAI) questionnaires. RESULTS The mean scores for SSAS, HAI, BAI, and BDI were significantly higher in the infertility group compared to the control group (p<0.001 for all comparisons). Moreover, the mean scores of the patients in the primary infertile group (n=107) were significantly higher than in the secondary infertile group (n=23) (p<0.05 for all comparisons). Logistic regression analysis revealed that infertility had a significant effect on age, HAI and BDI. CONCLUSION Psychiatric evaluation of infertile patients may contribute to more efficient use of health services, may reduce the negative effects of anxiety and depression on fertility, and in turn, increase the success of infertility treatment. Therefore, we recommend that each patient presenting with infertility undergoes psychiatric evaluation as part of their treatment.
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Affiliation(s)
- Ünal Öztekin
- Department of Urology, Bozok Unıversıty Faculty of Medicine, Yozgat, Turkey
| | - Yunus Hacimusalar
- Department of Psychiatry, Bozok Unıversıty Faculty of Medicine, Yozgat, Turkey
| | - Abdullah Gürel
- Department of Urology, Bozok Unıversıty Faculty of Medicine, Yozgat, Turkey
| | - Ozgul Karaaslan
- Department of Psychiatry, Bozok Unıversıty Faculty of Medicine, Yozgat, Turkey
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Prabha L, Ganjekar S, Gupta V, Desai G, Chaturvedi SK. A Comparative Study of Health Anxiety in Neurology and Psychiatry Settings. J Neurosci Rural Pract 2020; 11:125-129. [PMID: 32140015 PMCID: PMC7055604 DOI: 10.1055/s-0039-3399395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives
Prevalence of health anxiety is highly varied based on different settings and samples studied. This study aimed to assess the prevalence of health anxiety among outpatients attending neurology and psychiatry outpatient setting in tertiary care hospital and understand the clinical correlates.
Participants and Methods
This was a cross-sectional study conducted in the outpatient settings including participants fulfilling study criteria. The assessments included semi-structured proforma for demographic and clinical details, general hypochondriasis subscale of Illness Behavior Questionnaire, and Short Health Anxiety Inventory. Data were collected in Epi-info and data analysis was done using STATA12.
Results
The health anxiety was reported to be 25% and 19% among psychiatry and neurology outpatients, respectively. Higher education level positively correlated with health anxiety. Skilled workers tend to have higher health anxiety than semiskilled workers. Patients with diagnosis of somatoform disorder and multiple diagnosis scored higher on health anxiety in both the settings.
Conclusion
Health anxiety appears to be common in psychiatry and neurology settings and needs further evaluation to understand its impact on consultation and health resource usages.
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Affiliation(s)
- Lakshmi Prabha
- Department of Psychiatry, Sri Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Sundarnag Ganjekar
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Vivek Gupta
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Geetha Desai
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Santosh K Chaturvedi
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
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Rolison JJ, Morsanyi K, Peters E. Understanding Health Risk Comprehension: The Role of Math Anxiety, Subjective Numeracy, and Objective Numeracy. Med Decis Making 2020; 40:222-234. [PMID: 32052694 PMCID: PMC7502983 DOI: 10.1177/0272989x20904725] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background. Numeracy skills are important for medical decision making as lower numeracy is associated with misinterpreting statistical health risks. Math anxiety, characterized by negative emotions about numerical tasks, and lower subjective numeracy (i.e., self-assessments of numerical competence) are also associated with poor risk comprehension. Objective. To explore independent and mediated associations of math anxiety, numerical ability, and subjective numeracy with risk comprehension and to ascertain whether their associations are specific to the health domain. Methods. Objective numeracy was measured with a 14-item test. Math anxiety and subjective numeracy were assessed with self-report scales. Risk comprehension was measured with a 12-item test. In experiment 1, risk comprehension items were limited to scenarios in the health domain. In experiment 2, participants were randomly assigned to receive numerically equivalent risk comprehension items in either a health or nonhealth domain. Results. Linear regression analyses revealed that individuals with higher objective numeracy were more likely to respond correctly to the risk comprehension items, as were individuals with higher subjective numeracy. Higher math anxiety was associated with a lower likelihood of correct responding when controlling for objective numeracy but not when controlling for subjective numeracy. Mediation analyses indicated that math anxiety may undermine risk comprehension in 3 ways, including through 1) objective numeracy, 2) subjective numeracy, and 3) objective and subjective numeracy in serial, with subjective numeracy mediating the association between objective numeracy and risk comprehension. Findings did not differ by domain. Conclusions. Math anxiety, objective numeracy, and subjective numeracy are associated with risk comprehension through unique pathways. Education initiatives for improving health risk comprehension may be most effective if jointly aimed at tackling numerical ability as well as negative emotions and self-evaluations related to numeracy.
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Affiliation(s)
| | - Kinga Morsanyi
- School of Psychology, Queen's University Belfast, Belfast, GB, UK
| | - Ellen Peters
- School of Journalism and Communication, University of Oregon, Eugene, OR, USA
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Psychiatric disorders and compliance with prenatal care: A 10-year retrospective cohort compared to controls. Eur Psychiatry 2020; 49:23-29. [DOI: 10.1016/j.eurpsy.2017.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/22/2017] [Accepted: 11/24/2017] [Indexed: 11/16/2022] Open
Abstract
AbstractBackgroundInadequate prenatal care has been associated with adverse perinatal outcomes. We sought to compare compliance with prenatal care visits (PCV), oral glucose tolerance test (OGTT) and serum alfa-fetoprotein (aFP) in women with psychiatric disorders (PD) and healthy controls.MethodsSubjects were 5395 women (1043 PD and 4352 controls), members of Clalit Health Services (Tel-Aviv district, Israel), who gave birth during 2004–2014. We used Generalized Estimating Equations with binary-logistic models, considering consecutive pregnancies as repeated measures with unbalanced design. The diagnostic subgroup was the main independent, assessed once with and once without age, socioeconomic status and multiple gestation variables.ResultsRisk for non-compliance with OGTT was increased in women with depression (aOR = 1.4, 95% CI = 1.1–1.7) and schizophrenia (aOR = 1.8, 95% CI = 1.1–2.9), but not anxiety. Risk for non-compliance with aFP was decreased in women with anxiety (aOR = 0.6, 95% CI = 0.5-0.8), but women with depression and schizophrenia did not differ from controls. PD were at risk for both absence of PCV (aOR = 4.6, 95% CI = 2.7–8.0) and high utilization of PCV (>20 visits, aOR = 2.8, 95% CI = 2.1–3.7). Psychopharmacological treatment during pregnancy was associated with high utilization of PCV (OR = 2.2, 95% CI = 1.7–2.9), increased compliance with aFP tests (OR = 1.4, 95% CI = 1.1–1.7) and marginally-significant increased compliance with OGTT (OR = 0.82, 95% CI = 0.67–1.01).ConclusionPD under-utilized tests perceived for the wellbeing of the mother (OGTT) and over-utilize tests for the wellbeing of the fetus (aFP). PD exhibited patterns of both very low and very high utilization of PCV. Psychopharmacological treatment during pregnancy may improve some measures of compliance with prenatal care.
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Dömötör Z, Nordin S, Witthöft M, Köteles F. Modern health worries: A systematic review. J Psychosom Res 2019; 124:109781. [PMID: 31443819 DOI: 10.1016/j.jpsychores.2019.109781] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Modern health worries (MHWs) refer to people's concerns about possible harmful effects of modern technologies, and are widespread in the developed countries. The aim of the present work was to provide comprehensive, yet integrated understanding for MHWs and associated factors. METHODS Following the PRISMA guideline, a systematic review was conducted based on 48 empirical articles published between 2001 and 2018 (Prospero registration number: CRD42018103756). All empirical studies were included that (1) were published between 2001 and 2018 in peer-reviewed scientific journals in English, German, or Hungarian, (2) used the Modern Health Worries Scale or any of its sub-scales, and (3) assessed associations between MHWs and other constructs and/or compared criterion groups (i.e. purely psychometric studies were excluded). RESULTS The results from the review suggest that female gender, age, somatic symptom distress and idiopathic environmental intolerances, holistic thinking, and paranoid beliefs are positively associated with MHWs, whereas educational qualification and the five major dimensions of personality appear not to be. CONCLUSION Scientific inquiry on the MHWs phenomenon is still in its descriptive-explorative phase; more rigorously designed studies are needed. The presented theoretical framework integrates illness-related and holistic thinking-related aspects of MHWs as a starting point to guide further research in this area.
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Affiliation(s)
- Zsuzsanna Dömötör
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Hungary.
| | | | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg-University of Mainz, Germany.
| | - Ferenc Köteles
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Hungary.
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Abstract
Illness anxiety disorder is a primary disorder of anxiety about having or developing a serious illness. The core feature is the cycle of worry and reassurance seeking regarding health, as opposed to a focus on relief of distress caused by somatic symptoms (as in Somatic Symptom Disorder). Clinically significant health anxiety is common, with estimates ranging up to 13% in the general adult population. There are evidence-based treatments, including psychopharmacology and cognitive behavioral therapy, that can significantly alleviate symptoms. An understanding of the core psychopathology and clinical features of illness anxiety disorder is essential to fostering a working alliance with patients with health anxiety, as is the maintenance of an empathic, curious, and nonjudgmental stance toward their anxiety. Collaboration between medical providers is essential to avoid the pitfalls of excess testing and medical treatment.
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Kiss-Leizer M, Tóth-Király I, Rigó A. How the obsession to eat healthy food meets with the willingness to do sports: the motivational background of orthorexia nervosa. Eat Weight Disord 2019; 24:465-472. [PMID: 30726547 PMCID: PMC6531400 DOI: 10.1007/s40519-019-00642-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/16/2019] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Given its relevance, the present study sought to reveal the motivational background of orthorexia nervosa (ON) and to examine its association to do sports. METHODS A total number of 739 participants completed a self-administered, online questionnaire including questions related to sports and three scales: Ortho-11-Hu, Motivation for Healthy Behaviors in Orthorexia Nervosa Questionnaire (MHBONQ) and Short Health Anxiety Inventory (SHAI). The age of the respondents ranged from 18 to 72 years (M = 29.67, SD = 10.18) and 79.16% of them were female. The majority of the subjects trained 3-4 times a week (37.2%), usually for 1-2 h per week (25.8%). RESULTS According to the hierarchical multiple regression analysis, social desirability, guilt over skipping training and health anxiety were the strongest predictors of ON with explaining 46% of the variance of ON. DISCUSSION The results of the present study suggested that obsessive features of sport activities (guilt over skipping training, counting calories during training) play an important role in ON. People with a higher level of ON tend to reach other people's respect, protect their general health and regulate negative emotional states through healthy eating. LEVEL OF EVIDENCE Level V, descriptive cross-sectional study.
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Affiliation(s)
- Márton Kiss-Leizer
- Institute of Clinical Psychology, Semmelweis University, Budapest, Hungary
| | - István Tóth-Király
- School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Izabella utca 46, Budapest, 1064, Hungary
| | - Adrien Rigó
- Institute of Psychology, ELTE Eötvös Loránd University, Izabella utca 46, Budapest, 1064, Hungary.
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Owens VA, Hadjistavropoulos HD, Schneider LH, Gullickson KM, Karin E, Titov N, Dear BF. Transdiagnostic, internet-delivered cognitive behavior therapy for depression and anxiety: Exploring impact on health anxiety. Internet Interv 2019; 15:60-66. [PMID: 30723691 PMCID: PMC6350228 DOI: 10.1016/j.invent.2019.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 01/15/2019] [Accepted: 01/15/2019] [Indexed: 11/17/2022] Open
Abstract
Health anxiety is associated with significant personal distress and economic cost; as such, widely available and effective treatment options are crucial. Several studies suggest that Internet-delivered cognitive behavior therapy (ICBT) programs that specifically target health anxiety are efficacious for this condition. However, no known studies have examined the impact of transdiagnostic ICBT, which emphasizes the acquisition of broad coping skills applicable to a variety of mental health concerns, on symptoms of health anxiety. The current study sought to explore changes in health anxiety symptoms by utilizing data available from a previously published study of 8-week transdiagnostic ICBT. Specifically, changes in symptoms of health anxiety in response to a transdiagnostic ICBT program that targeted broad symptoms of depression and anxiety, were examined in a subsample of individuals who endorsed elevated symptom scores on the Short Health Anxiety Inventory at pre-treatment (n = 72). Following treatment, large reductions in health anxiety symptoms (Cohen's d = 0.91; 20% improvement), depression (Cohen's d = 0.85; reduction = 38%), generalized anxiety (Cohen's d = 1.21; reduction = 42%), and disability (Cohen's d = 0.90; reduction = 35%) were reported. Furthermore, results showed that transdiagnostic ICBT was rated as acceptable to people with high health anxiety symptoms. Despite elevated pre-treatment health anxiety scores, email correspondence between clients and their therapist revealed very few mentions of health anxiety. These findings provide preliminary evidence for transdiagnostic ICBT for symptoms of health anxiety and suggest further research is warranted.
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Affiliation(s)
| | - Heather D. Hadjistavropoulos
- Department of Psychology, University of Regina, Regina, Canada
- Corresponding author at: University of Regina, Department of Psychology, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada.
| | | | | | - Eyal Karin
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Nickolai Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Blake F. Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
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66
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Ferentzi E, Horváth Á, Köteles F. Do body-related sensations make feel us better? Subjective well-being is associated only with the subjective aspect of interoception. Psychophysiology 2019; 56:e13319. [PMID: 30629298 DOI: 10.1111/psyp.13319] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/21/2018] [Accepted: 11/24/2018] [Indexed: 01/06/2023]
Abstract
According to the proposition of several theoretical accounts, the perception of the bodily cues, interoceptive accuracy and interoceptive sensibility, has a significant positive impact on subjective well-being. Others assume a negative association; however, empirical evidence is scarce. In this study, 142 young adults completed questionnaires assessing subjective well-being, interoceptive sensibility, and subjective somatic symptoms and participated in measurements of proprioceptive accuracy (reproduction of the angle of the elbow joint), gastric sensitivity (water load test), and heartbeat tracking ability (Schandry task). Subjective well-being showed weak to medium positive associations with interoceptive sensibility and weak negative associations with symptom reports. No associations with measures of interoceptive accuracy were found. Gastric sensitivity as opposed to heartbeat perception and proprioceptive accuracy moderated the association between interoceptive sensibility and well-being. Thus, subjective well-being is associated only with the self-reported (perceived) aspect of interoception but not related to the sensory measures of interoceptive accuracy.
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Affiliation(s)
- Eszter Ferentzi
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.,Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Áron Horváth
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.,Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Ferenc Köteles
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
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67
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Pan B, Zhang Q, Tsai H, Zhang B, Wang W. Hypochondriac concerns and correlates of personality styles and affective states in bipolar I and II disorders. BMC Psychiatry 2018; 18:398. [PMID: 30577769 PMCID: PMC6303968 DOI: 10.1186/s12888-018-1988-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/13/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Hypochondriac concerns are associated with the treatment-difficulty of bipolar disorder, which might be due to the personality styles and affective states. METHODS We invited outpatients with bipolar I disorder (BD I, n = 87), bipolar II disorder (BD II, n = 92) and healthy volunteers (n = 129) to undergo the Illness Attitude Scales and Parker Personality Measure tests, and measurements of concurrent affective states. RESULTS Compared to healthy volunteers, BD I and BD II patients scored significantly higher on mania, hypomania and depression. BD I and BD II patients also scored significantly higher on Symptom Effect and Treatment Seeking, and BD II patients scored higher on Patho-thanatophobia and Hypochondriacal Belief. BD II in addition scored higher on Patho-thanatophobia than BD I did. In controls, the Dependent style predicted Patho-thanatophobia and Symptom Effect, Schizoid with Hypochondriacal Belief; in BD I, Narcissistic (-) with Hypochondriacal Belief, Histrionic with Patho-thanatophobia and Hypochondriacal Belief, depression with Hypochondriacal Belief, and hypomania with Symptom Effect and Hypochondriacal Belief; in BD II, depression with Symptom Effect and Hypochondriacal Belief, mania with Symptom Effect. CONCLUSIONS Bipolar disorder, especially BD II, is associated with greater hypochondriac concerns, which relates to personality disorder functioning styles and concurrent affective states.
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Affiliation(s)
- Bing Pan
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
- Department of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Zhejiang, 310058 Hangzhou China
| | - Qing Zhang
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Huitzong Tsai
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Bingren Zhang
- Department of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Zhejiang, 310058 Hangzhou China
| | - Wei Wang
- Department of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Zhejiang, 310058 Hangzhou China
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68
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O’Bryan EM, Luberto CM, Kraemer KM, McLeish AC. An examination of mindfulness skills in terms of affect tolerance among individuals with elevated levels of health anxiety. ANXIETY, STRESS, AND COPING 2018; 31:702-713. [PMID: 30205718 PMCID: PMC6540987 DOI: 10.1080/10615806.2018.1521515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Affect tolerance factors, including anxiety sensitivity, intolerance of uncertainty, and emotional distress tolerance, have been implicated in the exacerbation of health anxiety. Therefore, identifying methods to improve affect tolerance in health anxious populations is imperative. Despite the link between mindfulness and greater affect tolerance in non-clinical populations, no work has examined the role of mindfulness skills in terms of affect tolerance among individuals with elevated health anxiety. The aim of the current study was to examine the unique contribution of mindfulness skills in terms of distress tolerance, anxiety sensitivity, and intolerance of uncertainty. METHODS Participants were 218 undergraduates with clinically elevated levels of health anxiety (75.7% female; Mage = 19.53, SD = 3.16, Range = 18-45) who completed self-report measures for course credit. RESULTS Findings indicated that, after controlling for theoretically relevant covariates, greater acting with awareness, non-judgment, and non-reactivity were uniquely associated with greater distress tolerance, and greater non-reactivity was associated with lower levels of intolerance of uncertainty. Though none of the mindfulness skills emerged as specific individual predictors of anxiety sensitivity, these skills collectively accounted for unique variance in anxiety sensitivity. CONCLUSIONS These findings suggest that mindfulness skills may be helpful in targeting affect tolerance factors among individuals with elevated health anxiety.
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Affiliation(s)
| | | | - Kristen M. Kraemer
- University of Cincinnati
- Beth Israel Deaconess Medical Center /Harvard Medical School
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69
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Optimizing Exposure Therapy for Pathological Health Anxiety: Considerations From the Inhibitory Learning Approach. COGNITIVE AND BEHAVIORAL PRACTICE 2018. [DOI: 10.1016/j.cbpra.2017.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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70
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Melli G, Bailey R, Carraresi C, Poli A. Metacognitive beliefs as a predictor of health anxiety in a self-reporting Italian clinical sample. Clin Psychol Psychother 2017; 25:263-271. [PMID: 29226504 DOI: 10.1002/cpp.2159] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 01/25/2023]
Abstract
Research has supported the specific role that anxiety sensitivity, health-related dysfunctional beliefs, and metacognitive beliefs may play in the development and maintenance of health anxiety symptoms. However, the role of metacognitive beliefs in health anxiety has only been explored in analogue samples. The aim of this study was to explore for the first time the association between metacognitive beliefs and health anxiety symptoms in a sample of participants who reported having received a diagnosis of severe health anxiety (hypochondriasis) or illness anxiety disorder and test whether these beliefs are significant predictors of health anxiety after controlling for anxiety, depression, anxiety sensitivity, and dysfunctional beliefs. A series of dimensional self-report measures were administered to a large Italian sample (N = 458). At a bivariate level, Beliefs that Thoughts are Uncontrollable had a stronger association with health anxiety than any of the dysfunctional beliefs and anxiety sensitivity subscales. Results from hierarchical multiple regression analysis indicated that Beliefs that Thoughts are Uncontrollable predicted health anxiety symptoms over-and-above depression, general anxiety, anxiety sensitivity, and health-related dysfunctional beliefs. Despite many important limitations, this study supported the hypothesis that metacognition may have an important role in health anxiety in clinical samples.
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Affiliation(s)
- Gabriele Melli
- Department of Surgery, Medical, Molecular, and Critical Area Pathology, University of Pisa, Pisa, Italy.,Institute for Behavioral and Cognitive Psychology and Psychotherapy of Florence (IPSICO), Florence, Italy
| | | | - Claudia Carraresi
- Institute for Behavioral and Cognitive Psychology and Psychotherapy of Florence (IPSICO), Florence, Italy
| | - Andrea Poli
- Institute for Behavioral and Cognitive Psychology and Psychotherapy of Florence (IPSICO), Florence, Italy
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71
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Hedman-Lagerlöf E, Axelsson E, Andersson E, Ljótsson B, Andreasson A, Lekander M. The impact of exposure-based cognitive behavior therapy for severe health anxiety on self-rated health: Results from a randomized trial. J Psychosom Res 2017; 103:9-14. [PMID: 29167052 DOI: 10.1016/j.jpsychores.2017.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 09/24/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Self-rated health (SRH) has been shown to be a stable predictor of illness and mortality. Improvement in SRH, even in the absence of change in objective health, predicts better health and reduced mortality. Severe health anxiety (SHA) is characterized by fear of illness and distorted health perception. The objective of the present study was to investigate if exposure-based cognitive behavior therapy (CBT) for SHA can lead to improvement in SRH and whether this improvement is mediated by reduced health anxiety. METHODS Data were collected from a randomized controlled trial where participants with SHA were allocated to 12weeks of exposure-based CBT (n=99) for SHA or to a no treatment control condition (n=33). The mediation analysis was based on SRH- and health anxiety data collected weekly during the treatment phase. RESULTS Linear mixed effects models analysis showed a significant interaction effect of group and time indicating superior improvements in SRH in exposure-based CBT compared to the control condition (Z=2.69, p=0.007). The controlled effect size was moderately large (d=0.64) and improvements were stable at 1-year follow-up. Reduced health anxiety was a significant mediator of improvement in SRH. CONCLUSIONS 12weeks of exposure-based CBT for SHA can lead to significant improvements in SRH. Considering the previously established importance of SRH as a predictor for disease and mortality, exposure-based CBT for severe health anxiety may lead to improvements on several important health parameters, possibly even increasing the likelihood of longevity.
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Affiliation(s)
- Erik Hedman-Lagerlöf
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
| | - Erland Axelsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Andreasson
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden; Department of Psychology, Macquarie University, North Ryde, NSW, Australia
| | - Mats Lekander
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden
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72
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Abstract
The threat of a United States (U.S.) Zika virus pandemic during 2015-2016 was associated with public anxiety. Such threats represent opportunities to examine hypotheses about health anxiety. The present study investigated psychological predictors of Zika-related anxiety during the 2015-2016 outbreak. U.S. adults (N = 216) completed a battery of measures assessing Zika-related anxiety as well as psychological variables hypothesized to predict anxious responding to the threat of a domestic Zika outbreak. Contrary to hypotheses, regression analyses indicated that only contamination severity overestimates and greater Zika knowledge significantly predicted Zika-related anxiety. Study limitations and clinical implications are discussed.
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Affiliation(s)
- Shannon M Blakey
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, CB # 3270, Davie Hall, Chapel Hill, NC, 27599, USA.
| | - Jonathan S Abramowitz
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, CB # 3270, Davie Hall, Chapel Hill, NC, 27599, USA
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73
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A Case Study of Individually Delivered Mindfulness-Based Cognitive Behavioral Therapy for Severe Health Anxiety. COGNITIVE AND BEHAVIORAL PRACTICE 2017. [DOI: 10.1016/j.cbpra.2016.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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74
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Reuman L, Jacoby RJ, Blakey SM, Riemann BC, Leonard RC, Abramowitz JS. Predictors of illness anxiety symptoms in patients with obsessive compulsive disorder. Psychiatry Res 2017; 256:417-422. [PMID: 28697487 DOI: 10.1016/j.psychres.2017.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/01/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
Abstract
Illness anxiety and OCD symptoms appear to overlap in their presentation as well as in other conceptually important ways (e.g., dysfunctional cognitions). Little research, however, has directly examined these putative relationships. The present study examined the extent to which illness anxiety symptoms were associated with OCD symptom dimensions and relevant cognitive factors in a large treatment-seeking sample of patients with OCD. Patients completed a battery of self-report measures of OCD and health anxiety symptoms and related cognitive biases. Results from regression analyses indicated that illness anxiety symptoms were associated with harm obsessions and checking rituals, as well as with the tendency to overestimate threat and responsibility for harm. Illness anxiety was not associated with perfectionism. Conceptual and clinical implications of these findings are discussed.
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Affiliation(s)
- Lillian Reuman
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ryan J Jacoby
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Shannon M Blakey
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Jonathan S Abramowitz
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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75
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Hedman E, Hesser H, Andersson E, Axelsson E, Ljótsson B. The mediating effect of mindful non-reactivity in exposure-based cognitive behavior therapy for severe health anxiety. J Anxiety Disord 2017; 50:15-22. [PMID: 28528015 DOI: 10.1016/j.janxdis.2017.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 04/20/2017] [Accepted: 04/26/2017] [Indexed: 01/26/2023]
Abstract
Exposure-based cognitive behavior therapy (CBT) has been shown to be effective in the treatment of severe health anxiety, but little is known about mediators of treatment effect. The aim of the present study was to investigate mindful non-reactivity as a putative mediator of health anxiety outcome using data from a large scale randomized controlled trial. We assessed mindful non-reactivity using the Five Facets Mindfulness Questionnaire-Non-Reactivity scale (FFMQ-NR) and health anxiety with the Short Health Anxiety Inventory (SHAI). Participants with severe health anxiety (N=158) were randomized to internet-delivered exposure-based CBT or behavioral stress management (BSM) and throughout the treatment, both the mediator and outcome were measured weekly. As previously reported, exposure-based CBT was more effective than BSM in reducing health anxiety. In the present study, latent process growth modeling showed that treatment condition had a significant effect on the FFMQ-NR growth trajectory (α-path), estimate=0.18, 95% CI [0.04, 0.32], p=.015, indicating a larger increase in mindful non-reactivity among participants receiving exposure-based CBT compared to the BSM group. The FFMQ-NR growth trajectory was significantly correlated with the SHAI trajectory (β-path estimate=-1.82, 95% CI [-2.15, -1.48], p<.001. Test of the indirect effect, i.e. the estimated mediation effect (αβ) revealed a significant cross product of -0.32, which was statistically significant different from zero based on the asymmetric confidence interval method, 95% CI [-0.59, -0.06]. We conclude that increasing mindful non-reactivity may be of importance for achieving successful treatment outcomes in exposure-based CBT for severe health anxiety.
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Affiliation(s)
- Erik Hedman
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
| | - Hugo Hesser
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Erland Axelsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
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76
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Abstract
Emotion reactivity, defined as heightened sensitivity, intensity, and persistence of emotional states, has been shown to contribute to the exacerbation of anxiety. However, the association between emotion reactivity and health anxiety has yet to be examined. The aim of the present investigation was to examine the unique predictive ability of emotion reactivity in terms of health anxiety in a sample of medically healthy undergraduates ( n = 194; 59.3% female, Mage = 19.42, SD = 1.51, range = 18-26 years; 84.0% Caucasian). Findings indicated that, after controlling for the effects of gender, age, and anxiety sensitivity, greater emotion reactivity significantly predicted greater overall health anxiety (3.1% variance), as well as higher levels of affective (4.1% unique variance) and behavioral (4.8% unique variance) components. Findings suggest that experiencing emotions more frequently, intensely, and for longer durations of time prior to returning to baseline are associated with greater health preoccupations.
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77
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Korkmaz H, Korkmaz S, Yildiz S, Gündoğan B, Atmaca M. Determination of health anxiety, anxiety, and somatosensory amplification levels in individuals with normal coronary angiography. Psychiatry Res 2017; 252:114-117. [PMID: 28260641 DOI: 10.1016/j.psychres.2017.02.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 02/24/2017] [Indexed: 10/20/2022]
Abstract
The objective of the present study is to determine the somatosensory amplification, anxiety, and depression levels in patients with normal coronary arteries. Thirty-five patients with normal coronary arteries and 35 healthy individuals of similar age and gender as the patient group were included in the study. Somatosensory Amplification Scale (SSAS), Health Anxiety Inventory (HAI-18), Penn State Anxiety Scale (PSWQ), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI) were applied to all participants. Comparison of the patient group with the control group demonstrated that SSAS (22.7±8.2; 18.5±5.98; p=0.018), BAI (15.4±9.43; 9.4±7.3; p=0.004), BDI (24.9±13.5; 13.7±7.5; p<0.001), PSWQ (55.3±13.7; 33.8±6.7; p<0.001), and HAI-18 (18.8±8.7; 12.3±7.1; p=0.001) scores were statistically significantly higher in the patient group. Furthermore, a positive correlation was found between SSAS, BAI, BDI, PSWQ, and HAI-18 scores. It was found that concerns about disease prevailed in patients having normal coronary arteries, the patients continued to amplify their somatic sensations, and their anxiety and depression scores were higher than those of healthy individuals. Thus, the necessity of these interventions should be assessed in detail in the future.
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Affiliation(s)
- Hasan Korkmaz
- Department of Cardiology, Fırat University Medicine Faculty, Elazıg, Turkey
| | - Sevda Korkmaz
- Department of Psychiatry, Fırat University Medicine Faculty, Elazıg, Turkey.
| | - Sevler Yildiz
- Department of Psychiatry, Fırat University Medicine Faculty, Elazıg, Turkey
| | - Burcu Gündoğan
- Department of Psychiatry, Fırat University Medicine Faculty, Elazıg, Turkey
| | - Murad Atmaca
- Department of Psychiatry, Fırat University Medicine Faculty, Elazıg, Turkey
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78
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Bailer J, Witthöft M, Erkic M, Mier D. Emotion dysregulation in hypochondriasis and depression. Clin Psychol Psychother 2017; 24:1254-1262. [PMID: 28444850 DOI: 10.1002/cpp.2089] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 03/17/2017] [Accepted: 03/23/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aim of this study was to explore whether certain aspects of emotion dysregulation (i.e., facets of alexithymia and rumination) are more closely linked to hypochondriasis than to depression and vice versa. METHODS Nineteen patients with hypochondriasis (HYP), 33 patients with depression, and 52 healthy control participants completed the Toronto Alexithymia Scale, the Response Styles Questionnaire, and additional symptom and illness behaviour scales. A clinical interview was used to establish DSM-IV diagnoses and to exclude all cases with more than one axis I diagnosis. RESULTS Depression patients reported more difficulties describing feelings and more symptom- and self-focused rumination than both HYP patients and healthy individuals, whereas HYP patients differed only from healthy individuals in regard to more difficulties in identifying feelings and more symptom-focused rumination. Multiple regression analyses, including all assessed facets of emotion dysregulation, showed that the degree of somatoform features (somatic symptoms, health anxiety, and illness behaviour) was specifically predicted by higher difficulties in identifying feelings scores, whereas depressive symptom levels were specifically predicted by higher rumination scores. CONCLUSIONS Specific associations were found between difficulties in identifying feelings and key features of HYP, whereas depression was linked to a more generalized pattern of emotion regulation deficits. KEY PRACTITIONER MESSAGE Emotion dysregulation can be found in hypochondriasis and depression Difficulties in identifying own feelings are specifically linked to somatic symptoms, health anxiety, and illness behaviour, whereas a more generalized pattern of emotion dysregulation is found in relation to depression Further research is needed to investigate whether the effectiveness of current treatments for depression, hypochondriasis, health anxiety, and related disorders could be improved by additional emotion regulation interventions.
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Affiliation(s)
- Josef Bailer
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, University of Mainz, Mainz, Germany
| | - Maja Erkic
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Daniela Mier
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
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79
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Halldorsson B, Salkovskis PM. Why Do People with OCD and Health Anxiety Seek Reassurance Excessively? An Investigation of Differences and Similarities in Function. COGNITIVE THERAPY AND RESEARCH 2017; 41:619-631. [PMID: 28751797 PMCID: PMC5504131 DOI: 10.1007/s10608-016-9826-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Excessive reassurance seeking (ERS) is commonly reported in patients who have OCD or health anxiety. Despite its prevalence and associated risk of ongoing difficulties, little is known about the function of ERS. It has been conceptualised as a type of compulsive checking behaviour, but could also be seen as being a supportive maneuver. This study offers a new approach towards defining ERS and support seeking (SS), and similarities between these two constructs in a sample of OCD and health anxious patients. A semi-structured interview was employed. Participants reflected on the nature and goals of their reassurance and support seeking-its impact on themselves and other people. Twenty interviews were conducted, transcribed and analysed in accordance to framework thematic analysis. Six overarching themes were identified in terms of ERS and five for SS. Results revealed limited diagnosis specificity of ERS. Strikingly, participants with health anxiety did not report seeking support.
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Affiliation(s)
- Brynjar Halldorsson
- Department of Psychology, University of Bath, Bath, UK
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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80
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Hyperactive performance monitoring as a transdiagnostic marker: Results from health anxiety in comparison to obsessive–compulsive disorder. Neuropsychologia 2017; 96:1-8. [DOI: 10.1016/j.neuropsychologia.2016.12.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 12/15/2016] [Accepted: 12/28/2016] [Indexed: 11/22/2022]
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81
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Hedman E, Ljótsson B, Axelsson E, Andersson G, Rück C, Andersson E. Health anxiety in obsessive compulsive disorder and obsessive compulsive symptoms in severe health anxiety: An investigation of symptom profiles. J Anxiety Disord 2017; 45:80-86. [PMID: 27988419 DOI: 10.1016/j.janxdis.2016.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 11/23/2016] [Accepted: 11/24/2016] [Indexed: 11/17/2022]
Abstract
Severe health anxiety (SHA) shares features with obsessive-compulsive disorder (OCD) and in recent years there has been a debate as to whether the two disorders may represent two facets of the same condition. Few studies have however investigated the overlap and differences in symptom profiles between the disorders. The primary aim of the present study was to investigate these aspects using one sample of participants with a principal diagnosis of SHA and one sample of participants with a principal OCD diagnosis. The second aim was to examine differences in improvement trajectories on measures of health anxiety and OCD symptoms in patients with SHA receiving treatment with exposure and response prevention. We compared persons participating in clinical trials with a principal diagnosis of SHA (N=290) to persons with a principal diagnosis of OCD (n=95) on measures of health anxiety, OCD symptoms, and depressive symptoms. A subsample of SHA participants (n=99) received exposure and response prevention (ERP) for SHA over 12 weeks and was assessed at baseline and post-treatment. The results showed large and significant differences between SHA and OCD patients on measures of health anxiety (ds=2.99-3.09) and OCD symptoms (ds=1.64-2.14), while they had equivalent levels of depressive symptoms (d=0.19, 95% CI [-0.04, 0.43]). In the SHA sample 7.6% had comorbid OCD, and in the OCD sample 9.5% had SHA. For participants with a principal diagnosis of SHA, ERP led to large reductions of health anxiety, but effects on OCD symptoms were small to moderate. Among participants with comorbid OCD, effect sizes were large on measures of health anxiety and moderate to large on OCD measures. We conclude that SHA and OCD are separate psychiatric disorders with limited overlap in symptom profiles.
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Affiliation(s)
- Erik Hedman
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden; Karolinska Institutet, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Stockholm, Sweden.
| | - Brjánn Ljótsson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden
| | - Erland Axelsson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden
| | - Gerhard Andersson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden; Linköping University, Department of Behavioural Sciences and Learning, Linköping, Sweden
| | - Christian Rück
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden
| | - Erik Andersson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden
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82
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The curious case of cyberchondria: A longitudinal study on the reciprocal relationship between health anxiety and online health information seeking. J Anxiety Disord 2016; 43:32-40. [PMID: 27497667 DOI: 10.1016/j.janxdis.2016.07.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 07/20/2016] [Accepted: 07/28/2016] [Indexed: 11/21/2022]
Abstract
The current study is the first to longitudinally investigate the reciprocal relationship between online health information seeking and health anxiety, i.e., cyberchondria. Expectations were that health anxious individuals who go online to find health information, experience an increase in health anxiety, which in turn will reinforce online seeking. A 4-wave longitudinal survey study among 5322 respondents aged 16-93 was conducted. Our results showed that individuals who are more health anxious than others, search online for health information more. Moreover, the results provided initial evidence for the expected reciprocal relationship between health anxiety and online health information seeking in respondents with non-clinical levels of health anxiety at the start of the study. However, this reciprocal relationship could not be found in a subsample of clinically health anxious individuals. Although for these individuals online health information seeking did not seem to exacerbate health anxiety levels, it might still serve as a maintaining factor of clinical health anxiety.
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83
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Morales A, Reis S, Espada JP, Orgilés M. Portuguese validation of the Short Health Anxiety Inventory: Factor structure, reliability, and factor invariance. J Health Psychol 2016; 23:1872-1883. [PMID: 27682334 DOI: 10.1177/1359105316669859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The Short Health Anxiety Inventory is a brief instrument to assess health anxiety widely used across countries; however, no validated version is available for Portuguese-speaking population. Factorial structure, reliability, and equivalency factor with the Spanish version were analyzed with Portuguese adolescents aged 14-18 years. A Portuguese adolescent cohort ( N = 629) and a comparative Spanish adolescent cohort ( N = 1502) were evaluated. The original two-factor version was the best fitting model for the Portuguese version. The reliability was excellent. Complete measurement invariance across both countries was supported. The Portuguese version of the Short Health Anxiety Inventory is a valid screening inventory to assess health anxiety in adolescents.
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84
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Fergus TA, Kelley LP, Griggs JO. The combination of health anxiety and somatic symptoms: Specificity to anxiety sensitivity cognitive concerns among patients in primary care. Psychiatry Res 2016; 239:117-21. [PMID: 27137971 DOI: 10.1016/j.psychres.2016.02.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/17/2016] [Accepted: 02/27/2016] [Indexed: 12/20/2022]
Abstract
Prior research has found that health anxiety is related to poor patient outcomes in primary care settings. Health anxiety is characterized by at least two presentations: with either severe or no/mild somatic symptoms. Preliminary data indicate that anxiety sensitivity may be important for understanding the presentation of health anxiety with severe somatic symptoms. We further examined whether the combination of health anxiety and somatic symptoms was related to anxiety sensitivity. Participants were adults presenting for treatment at a community health center (N=538). As predicted, the interactive effect between health anxiety and somatic symptoms was associated with anxiety sensitivity cognitive concerns. Health anxiety shared a stronger association with anxiety sensitivity cognitive concerns when coupled with severe, relative to mild, somatic symptoms. Contrary to predictions, the interactive effect was not associated with the other dimensions of anxiety sensitivity. We discuss the potential relevancy of anxiety sensitivity cognitive concerns to the combined presentation of health anxiety and severe somatic symptoms, as well as how this dimension of anxiety sensitivity could be treated in primary care settings.
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Affiliation(s)
- Thomas A Fergus
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA.
| | - Lance P Kelley
- Waco Family Medicine Residency Program, Heart of Texas Community Health Center, Waco, TX, USA
| | - Jackson O Griggs
- Waco Family Medicine Residency Program, Heart of Texas Community Health Center, Waco, TX, USA
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85
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Roberts-Collins C. A Case Study of an Adolescent With Health Anxiety and OCD, Treated Using CBT: Single-Case Experimental Design. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2016; 29:95-104. [PMID: 27222495 DOI: 10.1111/jcap.12136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PROBLEM The sparse research evidence base for adolescents with health anxiety proposes a challenge in the treatment of such mental health difficulties. Similarities are drawn between health anxiety and obsessive-compulsive disorder (OCD) in terms of their development and maintenance. The literature is reviewed and discussed in relation to the referral, assessment, formulation, cognitive behavioral intervention, and treatment outcome. METHODS The case of an adolescent girl (aged 15 years) who presented with significant levels of health anxiety and OCD is described. An adult cognitive behavioral model of health anxiety was adapted and integrated with evidence-based cognitive behavioral therapy (CBT) for children and adolescents with OCD. These models were used to collaboratively conceptualize the young person's presenting difficulties. A single-case experimental design was employed to assess the effectiveness of the intervention. FINDINGS AND CONCLUSION Routine outcome measures demonstrated the effectiveness of the OCD intervention, and the need for further research in health anxiety in young people, including the development of disorder and age-specific measures. The implications for the use of CBT to treat health anxiety for young people are discussed.
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86
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Saigo T, Takebayashi Y, Tayama J, Bernick PJ, Schmidt NB, Shirabe S, Sakano Y. Validation of the Japanese Version of the Body Vigilance Scale. Psychol Rep 2016; 118:918-36. [PMID: 27207736 DOI: 10.1177/0033294116648139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Body Vigilance Scale is a self-report measure of attention to bodily sensations. The measure was translated into Japanese and its reliability, validity, and factor structure were verified. Participants comprised 286 university students (age: 19 ± 1 years). All participants were administered the scale, along with several indices of anxiety (i.e., Anxiety Sensitivity Index, Short Health Anxiety Inventory Illness Likelihood Scale, Social Interaction Anxiety Scale, and Hospital Anxiety and Depression Scale). The Japanese version of the Body Vigilance Scale exhibited a unidimensional factor structure and strong internal consistency. Construct validity was demonstrated by significant correlations with the above measures. Results suggest that the Japanese version of the scale is a reliable, valid tool for measuring body vigilance in Japanese university students.
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Affiliation(s)
- Tatsuo Saigo
- Center for Health and Community Medicine, Department of Preventive Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | | | - Jun Tayama
- Center for Health and Community Medicine; Graduate School of Education, Nagasaki University, Nagasaki, Japan
| | - Peter J Bernick
- Center for Health and Community Medicine and the Student Accessibility Office, Nagasaki University, Nagasaki, Japan
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Susumu Shirabe
- Center for Health and Community Medicine, Nagasaki University, Nagasaki, Japan
| | - Yuji Sakano
- Department of Clinical Psychology, School of Psychological Science, Health Sciences University of Hokkaido, Hokkaido, Japan
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87
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Bailey R, Wells A. Is metacognition a causal moderator of the relationship between catastrophic misinterpretation and health anxiety? A prospective study. Behav Res Ther 2016; 78:43-50. [PMID: 26851713 DOI: 10.1016/j.brat.2016.01.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/30/2015] [Accepted: 01/23/2016] [Indexed: 01/20/2023]
Abstract
Psychological theories have identified a range of variables contributing to health anxiety, including, dysfunctional illness beliefs, catastrophic misinterpretation, somatosensory amplification and neuroticism. More recently, metacognitive beliefs have been proposed as important in health anxiety. This study aimed to test the potential causal role of metacognitive beliefs in health anxiety. A prospective design was employed and participants (n = 105) completed a battery of questionnaire at two time points (6 months apart). Results demonstrated that cognitive, personality and metacognitive variables were bi-variate prospective correlates of health anxiety. Hierarchical regression analysis revealed that only metacognitive beliefs emerged as independent and significant prospective predictors of health anxiety. Moderation analysis demonstrated that metacognitive beliefs prospectively moderated the relationship between catastrophic misinterpretation and health anxiety. Follow-up regression analysis incorporating the interaction term (metacognition × misinterpretation) showed that the term explained additional variance in health anxiety. The results confirm that metacognition is a predictor of health anxiety and it is more substantive than misinterpretations of symptoms, somatosensory amplification, neuroticism, and illness beliefs. These results may have major implications for current cognitive models and for the treatment of health anxiety.
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Affiliation(s)
- Robin Bailey
- Division of Clinical Psychology, University of Manchester, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK; School of Health, BB235, University of Central Lancashire, Preston, Lancashire, PR1 2HE, UK.
| | - Adrian Wells
- Division of Clinical Psychology, University of Manchester, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
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88
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Melli G, Carraresi C, Poli A, Bailey R. The role of metacognitive beliefs in health anxiety. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.paid.2015.10.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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89
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Norr AM, Oglesby ME, Raines AM, Macatee RJ, Allan NP, Schmidt NB. Relationships between cyberchondria and obsessive-compulsive symptom dimensions. Psychiatry Res 2015; 230:441-6. [PMID: 26429148 DOI: 10.1016/j.psychres.2015.09.034] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 07/28/2015] [Accepted: 09/22/2015] [Indexed: 10/23/2022]
Abstract
Researchers have recently begun to investigate a vicious cycle of escalating physical health concerns and online medical information seeking coined "cyberchondria". Research has shown that cyberchondria is strongly associated with health anxiety (HA), but there is a dearth of work investigating the potential relationships between cyberchondria and other anxiety-related pathologies. One such condition is obsessive-compulsive disorder (OCD), which could theoretically be related to cyberchondria given the physical health relevant focus of certain types of OC symptoms. The current study sought to investigate the potential relationship between cyberchondria OCD across OC symptom dimensions. Community participants (N=468) were recruited via online crowdsourcing to complete a battery of self-report questionnaires including cyberchondria and OC measures. Structural equation modeling revealed significant unique associations between both contamination/washing and responsibility for harm/checking symptoms, and cyberchondria, such that greater cyberchondria was associated with greater OC symptoms after controlling for HA and trait negative affect. These results suggest that similar to proposed models of cyberchondria and HA, cyberchondria could potentially play a role in the development/maintenance of two dimensions of OC symptoms, or vice versa. Future work will need to determine the causal nature of these relationships or whether they are simply co-occurring phenomena.
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Affiliation(s)
- Aaron M Norr
- Department of Psychology, Florida State University Tallahassee, FL, USA
| | - Mary E Oglesby
- Department of Psychology, Florida State University Tallahassee, FL, USA
| | - Amanda M Raines
- Department of Psychology, Florida State University Tallahassee, FL, USA
| | - Richard J Macatee
- Department of Psychology, Florida State University Tallahassee, FL, USA
| | - Nicholas P Allan
- Department of Psychology, Florida State University Tallahassee, FL, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University Tallahassee, FL, USA.
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90
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The Relationship of Hypochondriasis to Anxiety, Depressive, and Somatoform Disorders. PSYCHOSOMATICS 2015; 57:200-7. [PMID: 26785798 DOI: 10.1016/j.psym.2015.10.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/19/2015] [Accepted: 10/21/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Though the phenotype of anxiety about medical illness has long been recognized, there continues to be debate as to whether it is a distinct psychiatric disorder and, if so, to which diagnostic category it belongs. OBJECTIVE Our objective was to investigate the pattern of psychiatric comorbidity in hypochondriasis (HC) and to assess the relationship of health anxiety to anxiety, depressive, and somatoform disorders. METHODS Data were collected as part of a clinical trial on treatment methods for HC. In all, 194 participants meeting criteria for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) HC were assessed by sociodemographic variables, results of structured diagnostic interviews, and validated instruments for assessing various symptom dimensions of psychopathology. RESULTS Most of the individuals with HC had comorbid psychiatric illness; the mean number of comorbid diagnoses was 1.4, and 35.1% had HC as their only diagnosis. Participants were more likely to have only comorbid anxiety disorders than only comorbid depressive or somatoform disorders. Multiple regression analysis of continuous measures of symptoms revealed the strongest correlation of health anxiety with anxiety symptoms, and a weaker correlation with somatoform symptoms; in multiple regression analysis, there was no correlation between health anxiety and depressive symptoms. CONCLUSION Our findings suggest that the entity of health anxiety (HC in DSM-IV and illness anxiety disorder in DSM-5) is a clinical syndrome distinct from other psychiatric disorders. Analysis of comorbidity patterns and continuous measures of symptoms suggest that its appropriate classification is with anxiety rather than somatoform or mood disorders.
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91
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A Preliminary Investigation into Worry about Mental Health: Development of the Mental Health Anxiety Inventory. Behav Cogn Psychother 2015; 44:347-60. [PMID: 26299438 PMCID: PMC4877520 DOI: 10.1017/s1352465815000454] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Worry about physical health is broadly referred to as health anxiety and can range from mild concern to severe or persistent anxiety such as that found in DSM-IV hypochondriasis. While much is known about anxiety regarding physical health, little is known about anxiety regarding mental health. However, recent conceptualizations of health anxiety propose that individuals can experience severe and problematic worry about mental health in similar ways to how people experience extreme worry about physical health. AIMS Given the paucity of research in this area, the aim of the current study was to explore anxiety regarding mental health through validation of the Mental Health Anxiety Inventory (MHAI), a modified version of the Short Health Anxiety Inventory. METHOD The MHAI, and measures of state anxiety (Depression, Anxiety and Stress Scales-21), trait worry (Penn State Worry Questionnaire), and health anxiety (Short Health Anxiety Inventory) were administered to 104 adult volunteers from the general community. RESULTS The MHAI demonstrated high internal consistency, acceptable test-retest reliability, and good construct validity when correlated with other measures of anxiety. Results also indicated that participants worried about their mental health and physical health equally, and that almost 9% of participants reported levels of mental health anxiety that were potentially problematic. CONCLUSION Preliminary results suggest that a small proportion of adults in the community may experience high levels of mental health anxiety requiring treatment, and that the MHAI, if validated further, could be a useful tool for assessing this form of anxiety.
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92
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Sansom-Daly UM, Bryant RA, Cohn RJ, Wakefield CE. Rumination and self-defining memories in the context of health concerns. Memory 2015; 24:939-48. [PMID: 26273962 DOI: 10.1080/09658211.2015.1059860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Individuals with health anxiety report experiencing a strong sense of vulnerability to illness. Such beliefs may be driven by the biased recollection of past illness-related events. However, little research has explored the role of memory in health anxiety. In other disorders, rumination has also been identified as a process that leads individuals to recall memories dominated by the content of their concerns. This study examined the proposition that rumination might impact the content of "self-defining" autobiographical memories among 60 college students with varying health anxiety (35% with clinical-level health anxiety). Participants were randomised to experiential/ruminative self-focus conditions, and then they completed the Self-Defining Memory Task. Responses were coded for valence and illness-relatedness. Results indicated that rumination led participants to retrieve more illness-related self-defining memories, while higher health anxiety scores were associated with more negative, but not more illness-focused memories. Ruminative thinking appears to activate health concerns, and may play a role in maintaining ongoing health anxiety.
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Affiliation(s)
- Ursula M Sansom-Daly
- a School of Psychology , University of New South Wales (UNSW) , Kensington , Australia.,b Kids Cancer Centre , Sydney Children's Hospital , Randwick , Australia.,c School of Women's and Children's Health , University of New South Wales (UNSW) , Kensington , Australia
| | - Richard A Bryant
- a School of Psychology , University of New South Wales (UNSW) , Kensington , Australia
| | - Richard J Cohn
- b Kids Cancer Centre , Sydney Children's Hospital , Randwick , Australia.,c School of Women's and Children's Health , University of New South Wales (UNSW) , Kensington , Australia
| | - Claire E Wakefield
- b Kids Cancer Centre , Sydney Children's Hospital , Randwick , Australia.,c School of Women's and Children's Health , University of New South Wales (UNSW) , Kensington , Australia
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93
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Zhang Y, Liu R, Li G, Mao S, Yuan Y. The reliability and validity of a Chinese-version Short Health Anxiety Inventory: an investigation of university students. Neuropsychiatr Dis Treat 2015; 11:1739-47. [PMID: 26213472 PMCID: PMC4509540 DOI: 10.2147/ndt.s83501] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Short Health Anxiety Inventory (SHAI) is widely used in English-speaking populations, with good reliability and validity. For further research needs in the Chinese population, it was translated into a Chinese version (CSHAI). Furthermore, the reliability, validity, and cutoff score were examined in a nonclinical population in the People's Republic of China. METHODS Three hundred and sixteen undergraduates were evaluated by a set of questionnaires including CSHAI, Zung Self-Rating Anxiety Scale (SAS), Zung Self-Rating Depression Scale (SDS), and the State-Trait Anxiety Inventory (STAI). Fifty-eight students completed CSHAI again after 30 days. RESULTS The two-factor model had satisfactory fit indices. The correlation coefficients between each item with the CSHAI total and each subscale were between 0.386 and 0.779. The Cronbach's alpha coefficients of CSHAI total and its subscales were 0.742, 0.743, and 0.788, respectively, and the split-half coefficients were 0.757, 0.788, and 0.912. The test-retest correlation coefficients were, respectively, 0.598 (P<0.001), 0.539 (P<0.001), and 0.691 (P<0.001). Convergent validities were respectively 0.389-0.453, 0.389-0.410, and 0.250-0.401, and discriminant validities were -5.689 (P<0.001), -5.614 (P<0.001), and -3.709 (P<0.001). The cutoff score was 15. CONCLUSION CSHAI showed good factor structure, reliability, convergent validity, and discriminant validity, and 15 was determined to be the appropriate cutoff score for screening health anxiety.
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Affiliation(s)
- Yuqun Zhang
- Department of Psychosomatics and Psychiatry, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, People’s Republic of China
| | - Rui Liu
- Information Science and Engineering School of Southeast University, Nanjing, People’s Republic of China
| | - Guohong Li
- Nursing Department, Affiliated Zhongda Hospital, Medical School of Southeast University, Nanjing, People’s Republic of China
| | - Shengqin Mao
- Department of Psychosomatics and Psychiatry, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, People’s Republic of China
| | - Yonggui Yuan
- Department of Psychosomatics and Psychiatry, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, People’s Republic of China
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Abstract
The relationship between health behavior and hypochondriasis has not yet been sufficiently examined, as previous studies investigated only individual dimensions of health behavior. In the present study, we extend current literature by examining multiple dimensions of health behavior. One hundred twenty-six participants, consisting of 40 participants with a primary diagnosis of hypochondriasis, 41 participants with a primary diagnosis of anxiety disorder, and 45 healthy controls, completed a multidimensional questionnaire for the assessment of health behavior and other measures for the evaluation of general psychopathology, illness anxiety, depression, and general anxiety. Patients with hypochondriasis revealed a less active way of life (d = 0.89) and lower hygiene (d = 0.60) than healthy controls, but did not differ from healthy controls regarding their compliance to medical recommendations. No differences were found in substance avoidance, security orientation, and diet. Hypochondriasis-specific behavior should be monitored in the treatment of the disorder.
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95
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LeBouthillier DM, Thibodeau MA, Alberts NM, Hadjistavropoulos HD, Asmundson GJG. Do people with and without medical conditions respond similarly to the short health anxiety inventory? An assessment of differential item functioning using item response theory. J Psychosom Res 2015; 78:384-90. [PMID: 25592160 DOI: 10.1016/j.jpsychores.2014.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 12/22/2014] [Accepted: 12/23/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Individuals with medical conditions are likely to have elevated health anxiety; however, research has not demonstrated how medical status impacts response patterns on health anxiety measures. Measurement bias can undermine the validity of a questionnaire by overestimating or underestimating scores in groups of individuals. We investigated whether the Short Health Anxiety Inventory (SHAI), a widely-used measure of health anxiety, exhibits medical condition-based bias on item and subscale levels, and whether the SHAI subscales adequately assess the health anxiety continuum. METHODS Data were from 963 individuals with diabetes, breast cancer, or multiple sclerosis, and 372 healthy individuals. Mantel-Haenszel tests and item characteristic curves were used to classify the severity of item-level differential item functioning in all three medical groups compared to the healthy group. Test characteristic curves were used to assess scale-level differential item functioning and whether the SHAI subscales adequately assess the health anxiety continuum. RESULTS Nine out of 14 items exhibited differential item functioning. Two items exhibited differential item functioning in all medical groups compared to the healthy group. In both Thought Intrusion and Fear of Illness subscales, differential item functioning was associated with mildly deflated scores in medical groups with very high levels of the latent traits. Fear of Illness items poorly discriminated between individuals with low and very low levels of the latent trait. CONCLUSIONS While individuals with medical conditions may respond differentially to some items, clinicians and researchers can confidently use the SHAI with a variety of medical populations without concern of significant bias.
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96
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Norr AM, Albanese BJ, Oglesby ME, Allan NP, Schmidt NB. Anxiety sensitivity and intolerance of uncertainty as potential risk factors for cyberchondria. J Affect Disord 2015; 174:64-9. [PMID: 25486275 DOI: 10.1016/j.jad.2014.11.023] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 11/13/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Online medical information seeking has become an increasingly common behavior. Despite the benefits of easily accessible medical information on the Internet, researchers have identified a vicious cycle of increased physical health concerns and online medical information seeking known as "cyberchondria". Despite proposed theoretical models of cyberchondria, there is a dearth of research investigating risk factors for the development of cyberchondria. Two potential risk factors are anxiety sensitivity (AS) and intolerance of uncertainty (IU). METHODS The current study investigated the relationships among AS, IU, and cyberchondria in a large community sample. Participants (N=526) completed self-report questionnaires via online crowdsourcing. RESULTS Structural equation models utilizing latent variables revealed a significant unique positive relationship between AS, as well as the IU Inhibitory lower-order factor, and cyberchondria, controlling for the effects of health anxiety. Additionally, results revealed a significant unique relationship between the IU Inhibitory factor and mistrust of medical professionals, a proposed cyberchondria-relevant construct. LIMITATIONS The cross-sectional data in the current study do not offer a true test of AS and IU as risk factors. However, establishing these unique relationships is an important step forward in the literature. CONCLUSIONS The results of the current study suggest the potential importance of both AS and IU in the development of cyberchondria. Future research is needed to establish the temporal precedence of elevated AS and/or IU to determine if they are true risk factors or simply correlates of cyberchondria.
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Affiliation(s)
- Aaron M Norr
- Department of Psychology, Florida State University, 1107W. Call St., Tallahassee, FL 32306-4301, USA.
| | - Brian J Albanese
- Department of Psychology, Florida State University, 1107W. Call St., Tallahassee, FL 32306-4301, USA.
| | - Mary E Oglesby
- Department of Psychology, Florida State University, 1107W. Call St., Tallahassee, FL 32306-4301, USA.
| | - Nicholas P Allan
- Department of Psychology, Florida State University, 1107W. Call St., Tallahassee, FL 32306-4301, USA.
| | - Norman B Schmidt
- Department of Psychology, Florida State University, 1107W. Call St., Tallahassee, FL 32306-4301, USA.
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97
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Hedman E, Andersson E, Lekander M, Ljótsson B. Predictors in Internet-delivered cognitive behavior therapy and behavioral stress management for severe health anxiety. Behav Res Ther 2015; 64:49-55. [DOI: 10.1016/j.brat.2014.11.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/07/2014] [Accepted: 11/28/2014] [Indexed: 10/24/2022]
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Medical information seeking: impact on risk for anxiety psychopathology. J Behav Ther Exp Psychiatry 2014; 45:402-7. [PMID: 24818986 DOI: 10.1016/j.jbtep.2014.04.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/15/2014] [Accepted: 04/16/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Increased utilization of online medical information seeking demands investigation of potentially detrimental effects of these activities. The present study investigated whether viewing medical websites may adversely affect anxiety sensitivity (AS), a well-established risk factor for the development of psychopathology. METHODS Participants (N = 52) were randomly assigned to view medical symptom related websites or general health and wellness control websites. AS was measured before and after the website viewing. RESULTS Individuals in the medical website group reported higher AS compared to the control group at post-manipulation after controlling for baseline health anxiety and baseline AS. Additionally, intolerance of uncertainty (IU), an individual difference variable assessing negative beliefs about uncertainty, significantly moderated this effect such that medical website viewing only affected AS in participants with high IU but not in participants with low IU. LIMITATIONS The limitations of the current study include the lack of individualization of the website viewing and the short duration of the website viewing. CONCLUSIONS The results of this study provide initial evidence that exposure to online medical information could increase risk for anxiety psychopathology in individuals with elevated IU. Additionally, these results provide support for a learning based model of the etiology of AS.
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Weck F, Neng JM, Göller K, Müller-Marbach AM. Previous Experiences With Illness and Traumatic Experiences: A Specific Risk Factor For Hypochondriasis? PSYCHOSOMATICS 2014; 55:362-371. [DOI: 10.1016/j.psym.2013.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 10/21/2013] [Accepted: 10/21/2013] [Indexed: 10/26/2022]
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Linking Illness in Parents to Health Anxiety in Offspring: Do Beliefs about Health Play a Role? Behav Cogn Psychother 2014; 44:18-29. [PMID: 24963560 DOI: 10.1017/s1352465814000319] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The cognitive behavioural (CB) model of health anxiety proposes parental illness leads to elevated health anxiety in offspring by promoting the acquisition of specific health beliefs (e.g. overestimation of the likelihood of illness). AIMS Our study tested this central tenet of the CB model. METHOD Participants were 444 emerging adults (18-25-years-old) who completed online measures and were categorized into those with healthy parents (n = 328) or seriously ill parents (n = 116). RESULTS Small (d = .21), but significant, elevations in health anxiety, and small to medium (d = .40) elevations in beliefs about the likelihood of illness were found among those with ill vs. healthy parents. Mediation analyses indicated the relationship between parental illness and health anxiety was mediated by beliefs regarding the likelihood of future illness. CONCLUSIONS Our study incrementally advances knowledge by testing and supporting a central proposition of the CB model. The findings add further specificity to the CB model by highlighting the importance of a specific health belief as a central contributor to health anxiety among offspring with a history of serious parental illness.
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