The effects of safety behaviors on health anxiety: an experimental investigation

Medical information seeking: impact on risk for anxiety psychopathology

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.

The Multidimensional Inventory of Hypochondriacal Traits

Severe health anxiety constitutes a disabling and costly clinical condition. The Multidimensional Inventory of Hypochondriacal Traits (MIHT) represents an innovative instrument that was developed according to cognitive-behavioral, cognitive-perceptual, interpersonal, and trait models of hypochondriasis. We aimed at evaluating the psychometric properties of the MIHT in a sample of patients with the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnosis of hypochondriasis. Using confirmatory factor analysis (CFA), the postulated four-factor structure of the MIHT was found in a first CFA in patients with hypochondriasis ( n = 178) and in a second CFA based on a mixed sample, with other somatoform disorders ( n = 27), panic disorder ( n = 25), and healthy controls ( n = 31) added to the original group of patients with hypochondriasis ( n = 178). In terms of specificity, patients with hypochondriasis showed larger scores on all four MIHT subscales (i.e., affective, cognitive, behavioral, and perceptual) compared to all other groups. Analyses of convergent and discriminant validity revealed promising results concerning the MIHT affective and perceptual scales but also point to certain problematic issues concerning the MIHT cognitive and behavioral scales. The findings suggest that the proposed structure of the MIHT is valid also in patients with hypochondriasis and demonstrate the specificity of the four hypochondriacal traits assessed in the MIHT.

Health anxiety, cognitive coping, and emotion regulation: a latent variable approach

BACKGROUND

Health anxiety, the fear or conviction of suffering from a severe disorder, represents a dimensional and multifactorial construct consisting of cognitive, behavioral, affective, and perceptual components. It has recently been proposed that dysfunctional emotion regulation strategies contribute to health anxiety, but the empirical evidence for this claim is sparse.

PURPOSE

The current research was aimed at broadly exploring and clarifying possible relationships between dimensions of health anxiety and cognitive coping and emotion regulation strategies.

METHOD

In two studies with non-clinical samples (n study 1 = 172; n study 2 = 242), health anxiety, cognitive coping, and emotion regulation strategies were assessed using multidimensional self-report measures. Functional (e.g., reappraisal) and dysfunctional (e.g., rumination) cognitive coping and emotion regulation strategies were differentiated.

RESULTS

Using structural equation modeling, the results of Study 1 revealed significant and consistent associations between the dimensions of health anxiety and dysfunctional coping and emotion regulation strategies. Study 2 replicated and extended the main findings of Study 1 by demonstrating that the associations between health anxiety and strategies of coping and emotion regulation were independent of the current level of depressive symptoms.

CONCLUSION

Health anxiety was found to be associated with dysfunctional coping and emotion regulation strategies (e.g., suppression). The positive associations between behavioral dimensions of health anxiety (e.g., seeking reassurance) and dysfunctional coping strategies may suggest that behavioral dimensions of health anxiety serve as a compensatory strategy to overcome difficulties in cognitive coping.

Treatment of mental hypochondriasis: a case report

Hypochondriasis is characterized by intensive fears of serious disease. Most patients with hypochondriasis worry about physical diseases like cancer, although in rare cases, patients report severe fears of mental disorders (e.g., schizophrenia), a phenomenon described in the literature as mental hypochondriasis. However, little is known about this rare subtype of hypochondriasis and experts have questioned whether mental hypochondriasis has much in common with the type of hypochondriasis in which somatic diseases are the focus of preoccupation. This paper presents, a case report of a woman with a fear of schizophrenia, which was treated with cognitive therapy. This patient fulfills the DSM-IV criteria of hypochondriasis and exhibits many characteristics (e.g., selective attention, safety behavior) considered to be maintaining factors in well-established cognitive-behavioral models of hypochondriasis. Cognitive treatment strategies for hypochondriasis (e.g., attention training, behavioral experiments) also proved effective in this case of mental hypochondriasis.

The Short Health Anxiety Inventory: a systematic review and meta-analysis

INTRODUCTION

The Short Health Anxiety Inventory (SHAI) measures health anxiety in medical and non-medical contexts.

OBJECTIVE

To review the literature pertaining to the psychometric properties of the SHAI in non-clinical, clinical, and medical samples. Meta-analysis was also conducted to examine the strength of associations between the SHAI and other constructs.

METHODS

Direct search of digital databases for papers that cited the original SHAI publication.

RESULTS

Seventy-eight papers were identified, with 42 providing relevant information. The SHAI has acceptable Cronbach's alpha scores, strong construct validity, and is sensitive to treatment. Discrepancies have been observed between the findings of factor analytic studies, largely as a result of varying methods used. Overall, there appears to be greatest support for the original two factors, with one factor assessing health anxiety and one factor assessing negative consequences of illness. As expected, individuals with hypochondriasis score higher as compared to non-clinical samples. The strongest association was observed between the SHAI and other measures of health anxiety, followed by measures related to health anxiety vulnerability, and then general anxiety and worry.

CONCLUSIONS

The SHAI is a psychometrically sound tool for assessing health anxiety across samples. Future studies are needed, however, to assess test-retest reliability, incremental validity, and cut-off scores as well as use of the SHAI among diverse samples.

Hypochondriacal attitudes comprise heterogeneous non-illness-related cognitions

BACKGROUND

Hypochondriacal attitudes were associated with cognitions not related to illness: Social fears, low self-esteem, and reduced warm glow effect, i.e. less positive appraisal of familiar stimuli. Only a single study had investigated the correlation of hypochondriacal attitudes with the warm glow effect so far and the present study aimed to corroborate this association. Particularly, the present investigation tested for the first time whether social fears, low self-esteem, and reduced warm glow effect represent distinct or related biases in hypochondriacal attitudes.

METHODS

Fifty-five volunteers filled in the Hypochondriacal Beliefs and Disease Phobia scales of the Illness Attitude Scales, two scales enquiring social fears of criticism and intimacy, and the Rosenberg Self-Esteem Scale. The interaction of valence and spontaneous familiarity ratings of Chinese characters indicated the warm glow effect.

RESULTS

A stepwise regression model revealed specific covariance of social fears and warm glow with hypochondriacal attitudes independent from the respective other variable. The correlation between low self-esteem and hypochondriacal attitudes missed significance.

CONCLUSIONS

Hypochondriacal attitudes are embedded in a heterogeneous cluster of non-illness-related cognitions. Each social fears and a reduced cognitive capacity to associate two features--positive appraisal and familiarity--could diminish the susceptibility to safety signals such as medical reassurance. To compensate for reduced susceptibility to safety signals, multifocal treatment and repeated consultations appear advisable.

Entwicklung und Validierung eines Fragebogens zur Erfassung von hypochondrischem Sicherheitsverhalten

Theoretischer Hintergrund: Sicherheitsverhalten wird für die Aufrechterhaltung von hypochondrischen Ängsten ein wichtiger Stellenwert beigemessen. Fragestellung: In der vorliegenden Untersuchung soll die Güte eines Fragebogens zur Erfassung von Sicherheitsverhalten bei vorliegender Hypochondrie (FSVH) überprüft werden. Methode: Zur Validierung wurden eine Patientenstichprobe (N = 108) und eine Online-Stichprobe (N = 503) herangezogen. Ergebnisse: Mittels explorativer und konfirmatorischer Faktorenanalysen ließen sich die Faktoren Rückversicherungs- und Vermeidungsverhalten extrahieren. Es zeigten sich deutliche Hinweise für die konvergente und diskriminante Validität des FSVH. Für den FSVH fanden sich signifikant höhere Werte für Patienten mit Hypochondrie als für solche mit Angststörungen, somit war es möglich, mittels des FSVH zwischen diesen beiden Störungsgruppen mit hoher Genauigkeit zu diskriminieren. Schlussfolgerung: Der FSVH stellt eine geeignete Ergänzung zu etablierten Verfahren dar.