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Kikas K, Werner-Seidler A, Upton E, Newby J. Illness Anxiety Disorder: A Review of the Current Research and Future Directions. Curr Psychiatry Rep 2024; 26:331-339. [PMID: 38748190 PMCID: PMC11211185 DOI: 10.1007/s11920-024-01507-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE OF REVIEW We review recent evidence on Illness Anxiety Disorder (IAD), including risk factors and precipitants, diagnostic classification, clinical characteristics of the disorder, and assessment and treatment in both children and adults. RECENT FINDINGS IAD places a substantial burden on both individuals and society. Despite its impact, understanding of the disorder is lacking and debates remain about whether IAD should be classified as an anxiety disorder and whether it is distinct from Somatic Symptom Disorder. Cognitive behavioural therapy (CBT) is an effective treatment for IAD and there are multiple validated measures of health anxiety available. However, research on health anxiety in children and youth is limited. IAD is chronic, and debilitating, but when identified, it can be effectively treated with CBT. Research using DSM-5 IAD criteria is lacking, and more research is needed to better understand the disorder, particularly in children and youth.
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Affiliation(s)
- Katarina Kikas
- Black Dog Institute, University of New South Wales, Hospital Road Randwick, Sydney, NSW, 2031, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Aliza Werner-Seidler
- Black Dog Institute, University of New South Wales, Hospital Road Randwick, Sydney, NSW, 2031, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Emily Upton
- Black Dog Institute, University of New South Wales, Hospital Road Randwick, Sydney, NSW, 2031, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Jill Newby
- Black Dog Institute, University of New South Wales, Hospital Road Randwick, Sydney, NSW, 2031, Australia.
- School of Psychology, University of New South Wales, Sydney, Australia.
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Harnik MA, Scheidegger A, Blättler L, Nemecek Z, Sauter TC, Limacher A, Reisig F, Grosse Holtforth M, Streitberger K. Acceptance, Satisfaction, and Preference With Telemedicine During the COVID-19 Pandemic in 2021-2022: Survey Among Patients With Chronic Pain. JMIR Form Res 2024; 8:e53154. [PMID: 38684086 PMCID: PMC11060324 DOI: 10.2196/53154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/13/2024] [Accepted: 03/16/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has forced many health care providers to make changes in their treatment, with telemedicine being expanded on a large scale. An earlier study investigated the acceptance of telephone calls but did not record satisfaction with treatment or patients' preferences. This warranted a follow-up study to investigate acceptance, satisfaction, and preferences regarding telemedicine, comprising of phone consultations, among health care recipients. OBJECTIVE The primary aim was to assess the acceptance and satisfaction of telemedicine during the subsequent months of 2021-2022, after the initial wave of the COVID-19 pandemic in Switzerland. Furthermore, we aimed to assess patients' preferences and whether these differed in patients who had already experienced telemedicine in the past, as well as correlations between acceptance and satisfaction, pain intensity, general condition, perception of telemedicine, and catastrophizing. Finally, we aimed to investigate whether more governmental restrictions were correlated with higher acceptance. METHODS An anonymous cross-sectional web-based survey was conducted between January 27, 2021, and February 4, 2022, enrolling patients undergoing outpatient pain therapy in a tertiary university clinic. We conducted a descriptive analysis of acceptance and satisfaction with telemedicine and investigated patients' preferences. Further, we conducted a descriptive and correlational analysis of the COVID-19 stringency index. Spearman correlation analysis and a chi-square test for categorical data were used with Cramer V statistic to assess effect sizes. RESULTS Our survey was completed by 60 patients. Telemedicine acceptance and satisfaction were high, with an average score of 7.6 (SD 3.3; on an 11-point Numeric Rating Scale from 0=not at all to 10=completely), and 8.8 (SD 1.8), respectively. Respondents generally preferred on-site consultations to telemedicine (n=35, 58% vs n=24, 40%). A subgroup analysis revealed that respondents who already had received phone consultation, showed a higher preference for telemedicine (n/N=21/42, 50% vs n/N=3/18, 17%; χ22 [N=60]=7.5, P=.02, Cramer V=0.354), as well as those who had been treated for more than 3 months (n/N=17/31, 55% vs n/N=7/29, 24%; χ22 [N=60]=6.5, P=.04, Cramer V=0.329). Acceptance of telemedicine showed a moderate positive correlation with satisfaction (rs{58}=0.41, P<.05), but there were no correlations between the COVID-19 stringency index and the other variables. CONCLUSIONS Despite high acceptance of and satisfaction with telemedicine, patients preferred on-site consultations. Preference for telemedicine was markedly higher in patients who had already received phone consultations or had been treated for longer than 3 months. This highlights the need to convey knowledge of eHealth services to patients and the value of building meaningful relationships with patients at the beginning of treatment. During the COVID-19 pandemic, the modality of patient care should be discussed individually.
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Affiliation(s)
- Michael Alexander Harnik
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Centre for Interdisciplinary Pain Medicine, Würzburg, Germany
| | - Alina Scheidegger
- Psychosomatic Medicine, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Larissa Blättler
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Zdenek Nemecek
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas C Sauter
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Emergency Telemedicine, University of Bern, Bern, Switzerland
| | - Andreas Limacher
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Florian Reisig
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Grosse Holtforth
- Psychosomatic Medicine, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Bern, Bern, Switzerland
| | - Konrad Streitberger
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Sauer KS, Witthöft M, Rief W. Somatic Symptom Disorder and Health Anxiety: Assessment and Management. Neurol Clin 2023; 41:745-758. [PMID: 37775202 DOI: 10.1016/j.ncl.2023.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Somatic Symptom Disorder (SSD) and Illness Anxiety Disorder (IAD) replaced the diagnostic entities of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) somatoform disorders and hypochondriasis. SSD turns away from specifying the presence or absence of a medical condition for presented symptoms and instead focuses on excessive symptom-related affects, cognitions, and behaviors. People with pathological health anxiety can be diagnosed with SSD or IAD, depending on the intensity of accompanying somatic symptoms. Cognitive-behavioral therapy shows the best empirical evidence for an effective treatment of SSD and IAD.
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Affiliation(s)
- Karoline S Sauer
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg-University of Mainz, Wallstraße 3, Mainz 55122, Germany.
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg-University of Mainz, Wallstraße 3, Mainz 55122, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
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Axelsson E, Österman S, Hedman-Lagerlöf E. Joint factor analysis and approximate equipercentile linking of common trait health anxiety measures: a cross-sectional study of the 14-, 18- and 64-item health anxiety inventory, the illness attitude scale, and the 14-item Whiteley Index. BMC Psychiatry 2023; 23:658. [PMID: 37674135 PMCID: PMC10483785 DOI: 10.1186/s12888-023-05151-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Research on health anxiety has bloomed in recent years, but summaries of the literature are complicated by the use of dissimilar self-report questionnaires. Furthermore, these instruments have rarely been administered in parallel, and especially not in clinical samples. In this study, we aimed to investigate the relationship between five widespread health anxiety measures, and to draft guidelines for the conversion of different sum scores. METHODS Clinical trial participants with principal pathological health anxiety (n = 335) and a sample of healthy volunteers (n = 88) completed the 14-item Whiteley Index (WI-14), the Illness Attitude Scale (IAS), and the 14-, 18-, and 64-item Health Anxiety Inventory (the HAI-64, HAI-18, and HAI-14). Cross-sectional data from all participants were pooled (N = 423) and we conducted a joint factor analysis and approximate equipercentile linking of the WI-14, IAS, HAI-64, HAI-18, and HAI-14. RESULTS Inter-scale correlations were high (rs ≥ 0.90 and ≥ 0.88 in adjusted analyses), and the scree plot of the joint factor analysis spoke for a unifactorial solution where 89/105 items (85%) had loadings ≥ 0.40. Most items at the core of this broad trait health anxiety factor pertained to the worry about health, the fear of having or developing a serious disease, and to some extent bodily preoccupation. We present a cross-walk table of observed equipercentile linked sum scores. CONCLUSIONS This study speaks clearly in favor of the WI-14, IAS, HAI-64, HAI-18, and HAI-14 all tapping into the same trait health anxiety construct, the core of which appears to concern the worry about health, the fear of having or developing a serious disease, and to some extent bodily preoccupation. Based on recently reported cut-offs for the HAI-14, a reasonable cutoff for pathological health anxiety in a psychiatric setting probably lies around 7-8 on the WI-14, 52-53 on the IAS, 82-83 on the HAI-64, and 26-27 on the HAI-18. TRIAL REGISTRATION ClinicalTrials.gov NCT01966705, NCT02314065.
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Affiliation(s)
- Erland Axelsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
- Liljeholmen Primary Health Care Center, Region Stockholm, Liljeholmstorget 7, Stockholm, SE-117 94, Sweden.
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden.
| | - Susanna Österman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Gustavsberg Primary Health Care Center, Region Stockholm, Stockholm, Sweden
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Li Z, Zhang Y, Pang Y, He Y, Song L, Wang Y, He S, Tang L. The mediating effect of somatic symptom disorder between psychological factors and quality of life among Chinese breast cancer patients. Front Psychiatry 2023; 14:1076036. [PMID: 37252145 PMCID: PMC10213318 DOI: 10.3389/fpsyt.2023.1076036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/18/2023] [Indexed: 05/31/2023] Open
Abstract
Objective We conducted this cross-sectional study to explore the mediating and predicting role of somatic symptom disorder (SSD) between psychological measures and quality of life (QOL) among Chinese breast cancer patients. Methods Breast cancer patients were recruited from three clinics in Beijing. Screening tools included the Patient Health Questionnaire-15 (PHQ-15), the Patient Health Questionnaire-9 (PHQ-9), the General Anxiety Disorder-7 scale (GAD-7), the Health Anxiety Scale (Whiteley Index-8, WI-8), the Somatic Symptom Disorder B-Criteria Scale (SSD-12), the Fear of Cancer Recurrence scale (FCR-4), the Brief Illness Perception Questionnaire (BIPQ-8), and the Functional Assessment of Cancer Therapy-Breast (FACT-B). Chi-square tests, nonparametric tests, mediating effect analysis, and linear regression analysis were used for the data analysis. Results Among the 264 participants, 25.0% were screened positive for SSD. The patients with screened positive SSD had a lower performance status, and a greater number of patients with screened positive SSD received traditional Chinese medicine (TCM) (p < 0.05). Strong mediating effects of SSD were found between psychological measures and QOL among patients with breast cancer after adjusting for sociodemographic variables as covariates (p < 0.001). The range of the percentage mediating effects was 25.67% (independent variable = PHQ-9) to 34.68% (independent variable = WI-8). Screened positive SSD predicted low QOL in physical (B = -0.476, p < 0.001), social (B = -0.163, p < 0.001), emotional (B = -0.304, p < 0.001), and functional (B = -0.283, p < 0.001) well-being, as well as substantial concerns caused by breast cancer (B = -0.354, p < 0.001). Conclusion Screened positive SSD had strong mediating effects between psychological factors and quality of life among breast cancer patients. Additionally, screened positive SSD was a significant predictor of lower QOL among breast cancer patients. Effective psychosocial interventions for improving QOL should consider the prevention and treatment of SSD or integrated SSD caring dimensions for breast cancer patients.
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Levinson A, Mahaffey B, Lobel M, Preis H. Development and psychometric properties of the Pandemic-Related Postpartum Stress Scale (PREPS-PP). J Psychosom Obstet Gynaecol 2022; 43:426-432. [PMID: 34967691 PMCID: PMC9243190 DOI: 10.1080/0167482x.2021.2013798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/07/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Postpartum experiences have been adversely affected by the burdens of the COVID-19 pandemic. However, there are no well-tested measures of pandemic-specific postpartum stress. We developed a modified, postpartum version of the Pandemic-Related Pregnancy Stress Scale (PREPS) and examined the psychometric properties of this novel measure. METHODS Online questionnaires were administered at 3-4 month intervals throughout pregnancy and postpartum to women pregnant at the start of the pandemic. This study reports psychometric properties of the Pandemic-Related Postpartum Stress Scale (PREPS-PP) among women who were administered this instrument at either of two postpartum timepoints. RESULTS At both timepoints (n = 1301 and n = 1009), CFAs revealed good model fit of the same three-factor structure identified for the prenatal PREPS (Preparedness Stress, Infection Stress, and Positive Appraisal). All PREPS-PP subscales demonstrated good reliability (α's .78-87). Higher levels of Preparedness Stress and Infection Stress were associated with greater health and financial burdens and psychological distress. CONCLUSIONS The PREPS-PP is a reliable and valid measure of postpartum stress related to the COVID-19 pandemic. It is a valuable tool for future research into how pandemic-related postpartum stress may affect families in the short- and long-term.
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Affiliation(s)
- Amanda Levinson
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794 USA
| | - Brittain Mahaffey
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794 USA
| | - Marci Lobel
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794 USA
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794 USA
| | - Heidi Preis
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794 USA
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794 USA
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Inhibitory Learning-Based Exposure Therapy for Patients With Pathological Health Anxiety: Results From a Single Case Series Study. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Interoceptive anxiety-related processes: Importance for understanding COVID-19 and future pandemic mental health and addictive behaviors and their comorbidity. Behav Res Ther 2022; 156:104141. [PMID: 35752013 PMCID: PMC9212258 DOI: 10.1016/j.brat.2022.104141] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 05/18/2022] [Accepted: 06/03/2022] [Indexed: 01/08/2023]
Abstract
The COVID-19 pandemic is associated with an increased prevalence of mental health problems and addictive behaviors. There is a growing theoretical and empirical evidence that individual differences in interoceptive anxiety-related processes are a one set of vulnerability factors that are important in understanding the impact of pandemic-related mental health problems and addictive behavior. However, there has not been a comprehensive effort to explore this rapidly growing body of research and its implications for public health. In this paper, we discuss why interoceptive anxiety-related processes are relevant to understanding mental health and addictive behaviors during the COVID-19 pandemic. We then provide a narrative review of the available COVID-19 literature linking interoceptive fear and anxiety-related processes (e.g., anxiety sensitivity, health anxiety, and COVID-19 anxiety, fear, and worry) to mental health and addictive behaviors. We then propose a novel transdiagnostic theoretical model that highlights the role of interoceptive anxiety-related processes in mental health and addictive behavior in the context of the present and future pandemics. In the final section, we utilize this conceptualization to underscore clinical implications and provide guidance for future research initiatives in the management of COVID-19 mental health and addictive behaviors and inform the public health field for future pandemics.
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Norbye AD, Abelsen B, Førde OH, Ringberg U. Distribution of health anxiety in a general adult population and associations with demographic and social network characteristics. Psychol Med 2022; 52:2255-2262. [PMID: 33183380 PMCID: PMC9527669 DOI: 10.1017/s0033291720004122] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/01/2020] [Accepted: 10/20/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Health anxiety (HA) is associated with increased risk of disability, increased health care utilization and reduced quality of life. However, there is no consensus on which factors are important for the level of HA. The aim of this study was to explore the distribution of HA in a general adult population and to investigate whether demographic and social factors were associated with HA. METHODS This study used cross-sectional data from the seventh Tromsø study. A total of 18 064 participants aged 40 years or older were included in the analysis. The six-item Whiteley Index (WI-6) with a 5-point Likert scale was used to measure HA. Sociodemographic factors included age, sex, education, household income, quality of friendship and participation in an organized activity. RESULTS HA showed an exponential distribution among the participants with a median score of 2 points out of 24 points. In total, 75% had a total score of 5 points or less, whereas 1% had a score >14 points. Education, household income, quality of friendship and participation in organized activity were significantly associated with HA. The variable quality of friendship demonstrated the strongest association with HA. CONCLUSION Our study showed an exponential distribution of HA in a general adult population. There was no evident cut-off point to distinguish participants with severe HA based on their WI-6 score, indicating the importance of analysing HA as a complex, continuous construct. HA demonstrated strong associations with quality of friendship and participation in an organized activity.
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Affiliation(s)
- Anja Davis Norbye
- Department of Community Medicine, UiT The Arctic University of Norway, Postbox 6050 Langnes, 9037 Tromsø, Norway
| | - Birgit Abelsen
- Department of Community Medicine, UiT The Arctic University of Norway, Postbox 6050 Langnes, 9037 Tromsø, Norway
| | - Olav Helge Førde
- Department of Community Medicine, UiT The Arctic University of Norway, Postbox 6050 Langnes, 9037 Tromsø, Norway
| | - Unni Ringberg
- Department of Community Medicine, UiT The Arctic University of Norway, Postbox 6050 Langnes, 9037 Tromsø, Norway
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Health anxiety and attentional control interact to predict uncertainty-related attentional biases. J Behav Ther Exp Psychiatry 2022; 74:101697. [PMID: 34678633 DOI: 10.1016/j.jbtep.2021.101697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 09/13/2021] [Accepted: 10/15/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Current theories of health anxiety and a growing body of empirical literature suggest that those high in health anxiety symptoms might find uncertainty itself threatening and demonstrate attentional biases for uncertainty-related information (ABU). Moreover, a dual processes model of attention would suggest that individual differences in attentional control might modify such a relationship. The present study was designed to explore this proposed health anxiety-ABU relationship and also to consider attentional control as a moderator of theoretical and clinical relevance. METHODS Undergraduate participants (N = 148) completed a self-report measure of health anxiety symptoms and two performance-based tasks to assess ABU and attentional control. RESULTS Hierarchical regression analyses showed a significant interaction between health anxiety and attention control in predicting attentional disengagement from, but not engagement with, uncertainty-related words. Specifically, results of the simple slopes analysis suggested that those with elevated health anxiety symptoms and better attentional control may use top-down attentional control processes to disengage their attention from distressing uncertainty-related stimuli faster than those with worse attentional control. LIMITATIONS The analogue sample is a study limitation. CONCLUSIONS Results provide new insights into the nature of attentional biases within health anxiety. Results are discussed in light of recent work on attentional control and avoidance-based psychopathology.
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Kisely S, Strathearn L, Najman JM. Self-reported and agency-notified child abuse as a contributor to health anxiety in a population-based birth cohort study at 30-year-follow-up. J Acad Consult Liaison Psychiatry 2022; 63:445-453. [DOI: 10.1016/j.jaclp.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/24/2022] [Accepted: 02/06/2022] [Indexed: 11/30/2022]
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Huang M, Chen R, Wei J, Fritzsche K, Toussaint AC, Zhang Y, Chen H, Wu H, Ma X, Li W, Ren J, Lu W, Müller AM, Leonhart R, Zhang L. Validation of the Chinese version bodily distress syndrome checklist in Chinese out-patients of general hospitals. J Psychosom Res 2022; 153:110702. [PMID: 34998103 DOI: 10.1016/j.jpsychores.2021.110702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The 25-item Bodily Distress Syndromes (BDS) checklist was developed to assess BDS symptoms with high validity and reliability. The aim of this study was to reveal the psychometric properties of the Chinese version of the BDS checklist in Chinese outpatients of general hospitals. METHOD A cross-sectional study was carried out in nine Chinese general hospitals, consisting of three different medicine settings: biomedicine, traditional medicine, and psychosomatic medicine. The 25-item BDS checklist was translated into the Chinese version and conducted on outpatients from all nine centers. We performed validity and reliability analyses, including test-retest reliability, construct validity, and internal consistency reliability, on the collected checklist data. The convergent validity of the BDS checklist was analyzed with Pearson's Coefficient vs. Patient Health Questionnaire-15 (PHQ-15). The discriminant validity of the BDS checklist was analyzed with Pearson's Coefficient vs. Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7) and Whiteley-8 (WI-8). RESULTS A total of 699 patients were included in this study. The test-retest reliability, construct validity, and internal consistency reliability of the Chinese version of the BDS were satisfactory in our study. Factor analyses identified five distinct determining factors: cardiopulmonary, gastric, intestinal, musculoskeletal, and general symptoms. Pearson's coefficients were found to be high in both discriminant validity and convergent validity analyses. CONCLUSION The results provide empirical support for the Chinese version of the BDS checklist in patients in general hospitals. The Chinese version of the BDS checklist is potentially valuable for case finding in both clinical practice and research in Chinese.
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Affiliation(s)
- Mingjin Huang
- Mental Health Center, West China Hospital, Sichuan University, China; Sichuan Mental Health Center (The Third Hospital of Mianyang), Mianyang, China
| | - Ran Chen
- Mental Health Center, West China Hospital, Sichuan University, China; University-town Hospital of Chongqing Medical University Mental Health Center, Chongqing, China
| | - Jing Wei
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Freiburg, Germany
| | - Anne Christin Toussaint
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Yaoyin Zhang
- Department of Psychosomatic Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, China
| | - Hua Chen
- Department of Psychological Medicine, Zhong Shan Hospital, Fudan University, China
| | - Heng Wu
- Department of Psychosomatic Medicine, Tongji Hospital, School of Medicine, Tongji University, China
| | - Xiquan Ma
- Department of Psychosomatic Medicine, Dongfang Hospital, School of Medicine, Tongji University, China
| | - Wentian Li
- Department of Clinic Psychology, Wuhan Mental Health Center, Wuhan, China
| | - Jie Ren
- Department of Rehabilitation, General Hospital of Jincheng Anthracite Coal Mining Group Co. Ltd, China
| | - Wei Lu
- Department of Psychosomatic Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital University, China
| | - Anne-Maria Müller
- Center for Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Center, University of Freiburg, Germany
| | | | - Lan Zhang
- Mental Health Center, West China Hospital, Sichuan University, China.
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Fergus TA, Wilder K, Koester P, Kelley LP, Griggs JO. Metacognitive Beliefs about Uncontrollability Relate Most Strongly to Health Anxiety among U.S.-based non-Latinx White Primary Care Patients: Comparing Strength of Relations with U.S.-based non-Latinx Black and Latinx Primary Care Patients. Clin Psychol Psychother 2022; 29:1331-1341. [PMID: 35023259 DOI: 10.1002/cpp.2711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/17/2021] [Accepted: 01/10/2022] [Indexed: 11/09/2022]
Abstract
Metacognitive beliefs have emerged as important to health anxiety, particularly beliefs that health-related thoughts are uncontrollable. Preliminary research examining generalized worry indicates uncontrollability beliefs relate more strongly to anxiety among U.S.-based self-identifying White relative to Black college students. The present study sought to extend that line of research by examining if metacognitive beliefs about the uncontrollability of health-related thoughts differentially relate to health anxiety among self-identifying non-Latinx Black (n = 123), Latinx (n = 104), and non-Latinx White (n = 80) U.S.-based primary care patients. As predicted, although positive associations were seen across all three groups, beliefs that health-related thoughts are uncontrollable more strongly related to health anxiety among White patients compared to both Black and Latinx patients. Those differential relations held in multivariate analyses while statistically controlling for positive depression screening status, generalized anxiety symptom severity, and medical morbidity. Although the effect size surrounding the differential relations was small in magnitude, the present results further support the notion that metacognitive beliefs about uncontrollability relate less strongly to anxiety among U.S.-based ethnoracial minorities compared to White individuals. Potential reasons for the differential relations are discussed, along with additional areas for future research.
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Affiliation(s)
- Thomas A Fergus
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Kayla Wilder
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
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14
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Luo Y, Keefer L. Role of psychological questionnaires in clinical practice and research within functional gastrointestinal disorders. Neurogastroenterol Motil 2021; 33:e14297. [PMID: 34786802 DOI: 10.1111/nmo.14297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 01/25/2023]
Abstract
Functional gastrointestinal (GI) disorders, also known as disorders of gut-brain interaction (DGBI), affect 40% of the global population. Up to two-thirds of patients with FGIDs experience a major psychological disorder making a thorough psychosocial assessment a critical part of patient care as it can impact treatment approach. Many psychological questionnaires exist in the clinical realm serving different purposes including screening for anxiety and depression, somatization symptoms, health-related anxiety, illness impact, and health-related quality of life. Given the abundance of questionnaires used to screen for similar psychiatric comorbidities, correlation between different instruments is needed to allow for pooling of data. In this issue of Neurogastroenterology & Motility, Snijkers et al. conducted the first comparative study to assess the correlation between the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) to determine optimal cutoffs for diagnosis of depressive and anxiety disorders in a cohort of irritable bowel syndrome patients. The biopsychosocial framework as it applies to FGID has led to the inclusion of both psychosocial assessments in clinical management and research protocols. Future directions include the development of symptom-specific questionnaires for groups of FGIDs, culturally specific psychosocial questionnaires, and inclusion of psychosocial well-being as primary or secondary outcomes in clinical research trials. In this review, we aim to explore the role of psychological questionnaires in clinical care and research trials and share practical tips on incorporating a biopsychosocial framework in the care of patients with FGIDs.
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Affiliation(s)
- Yuying Luo
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laurie Keefer
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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15
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Wurthmann S, Holle D, Obermann M, Roesner M, Nsaka M, Scheffler A, Kleinschnitz C, Naegel S. Reduced vestibular perception thresholds in persistent postural-perceptual dizziness- a cross-sectional study. BMC Neurol 2021; 21:394. [PMID: 34641808 PMCID: PMC8507224 DOI: 10.1186/s12883-021-02417-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 09/20/2021] [Indexed: 01/17/2023] Open
Abstract
Background Persistent postural-perceptual dizziness (PPPD) is the most common functional vestibular disorder. A multisensory mismatch altered by psychological influences is considered to be an important pathophysiological mechanism. Increased cortical and subcortical excitability may play a role in the pathophysiology of PPPD. We hypothesized that decreased motion perception thresholds reflect one mechanism of the abnormal vestibular responsiveness in this disorder. We investigated the vestibular perception thresholds and the vestibular ocular reflex with a rotatory chair experiment to gain insights in the processing and adaption to vestibular provocation. Methods In this cross-sectional study 26 female PPPD patients and 33 healthy female age matched controls (HC) were investigated sitting in a motorized rotary chair shielded regarding visual and acoustic stimuli. The chair was rotated for 20 minutes with slowly increasing velocity to a maximum of 72°/s. We functionally tested motion perception thresholds and vegetative responses to rotation as well as vestibular-ocular reflex thresholds. We additionally investigated several psychological comorbidities (i.e. depression, anxiety, somatosensory amplification) using validated scores. Conventional dizziness scores were obtained to quantify the experienced dizziness and impact on daily life. Results PPPD patients showed a significant reduced vestibulo-perceptual threshold (PPPD: 10.9°/s vs. HC: 29.5°/s; p<0.001) with increased motion sensitivity and concomitant vegetative response during and after the chair rotation compared to healthy controls. The extent of increased vestibular sensitivity was in correlation with the duration of the disease (p=0.043). No significant difference was measured regarding nystagmus parameters between both groups. Conclusion PPPD patients showed increased vegetative response as well as decreased vestibulo-perceptual thresholds which are related to disease duration. This is of interest as PPPD might be sustained by increased vestibular excitability leading to motion intolerance and induction of dizziness when exposed to movement. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02417-z.
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Affiliation(s)
- Sebastian Wurthmann
- Department of Neurology and Dizziness and Vertigo Center Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany. .,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany.
| | - Dagny Holle
- Department of Neurology and Dizziness and Vertigo Center Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Mark Obermann
- Department of Neurology, Weser-Egge Hospital Höxter, University of Duisburg-Essen, Höxter, Germany
| | - Miriam Roesner
- Department of Neurology and Dizziness and Vertigo Center Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Michael Nsaka
- Department of Neurology and Dizziness and Vertigo Center Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Armin Scheffler
- Department of Neurology and Dizziness and Vertigo Center Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology and Dizziness and Vertigo Center Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Steffen Naegel
- Department of Neurology and Dizziness and Vertigo Center Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.,Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
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16
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Zheng H, Kyung Kim H, Joanna Sin SC, Theng YL. A theoretical model of cyberchondria development: Antecedents and intermediate processes. TELEMATICS AND INFORMATICS 2021. [DOI: 10.1016/j.tele.2021.101659] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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17
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Chen Y, Fink P, Wei J, Toussaint AK, Zhang L, Zhang Y, Chen H, Ma X, Li W, Ren J, Lu W, Leonhart R, Fritzsche K, Wu H. Psychometric Evaluation of the Whiteley Index-8 in Chinese Outpatients in General Hospitals. Front Psychol 2021; 12:557662. [PMID: 34276457 PMCID: PMC8280456 DOI: 10.3389/fpsyg.2021.557662] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/03/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Excessive and persistent health anxiety is a common and disabling but often unrecognized illness. Therefore, screening patients for health anxiety is recommended in primary care. The aim of the present study was to examine the psychometric properties of an updated version of the eight-item Whiteley Index (WI-8) among outpatients in general hospitals in China. Methods: The presented data were derived from a multicenter cross-sectional study. The Chinese version of the WI-8 was administered to a total of 696 outpatients. Cronbach's alpha was used to evaluate the internal consistency of the scale. The validity of the scale was evaluated based on factor analysis and correlation analyses. To assess the discriminant ability, receiver operating characteristic (ROC) analysis was conducted. Results: Cronbach's alpha was 0.937, and it decreased (0.925) after deleting the new 8th item. Factor analysis extracted one factor accounting for 69.2% of the variance. Moderate correlations were found (0.414-0.662) between the WI-8 and General Anxiety Disorder (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Patient Health Questionnaire-15 (PHQ-15) and Somatic Symptom Disorder B-criteria (SSD-12). The ROC curve indicated excellent discriminatory ability to discriminate among patients with health anxiety (AUC = 0.822). Conclusions: The new WI-8 version is a reliable and valid tool to screen for health anxiety in general hospital patients. We recommend the WI-8 as a useful screening tool for health anxiety.
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Affiliation(s)
- Yixiao Chen
- Department of Psychosomatic Medicine, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Per Fink
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Jing Wei
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Anne-Kristin Toussaint
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lan Zhang
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Yaoyin Zhang
- Department of Psychosomatic Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Hua Chen
- Department of Psychological Medicine, Zhong Shan Hospital, Fudan University, Shanghai, China
| | - Xiquan Ma
- Department of Psychosomatic Medicine, School of Medicine, Dongfang Hospital, Tongji University, Shanghai, China
| | - Wentian Li
- Department of Clinical Psychology, Wuhan Mental Health Center, Wuhan, China
| | - Jie Ren
- Department of Rehabilitation, General Hospital of Jincheng Anthracite Coal Mining Group Co. Ltd., Jincheng, China
| | - Wei Lu
- Department of Psychosomatic Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital University, Beijing, China
| | - Rainer Leonhart
- Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Heng Wu
- Department of Psychosomatic Medicine, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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18
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Rogowska AM, Kwaśnicka A, Ochnik D. Validation and Polish Adaptation of the Authorized Bratman Orthorexia Self-Test (ABOST): Comparison of Dichotomous and Continuous Likert-Type Response Scales. Psychol Res Behav Manag 2021; 14:921-931. [PMID: 34234588 PMCID: PMC8254612 DOI: 10.2147/prbm.s308356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/08/2021] [Indexed: 12/29/2022] Open
Abstract
Purpose Although research on orthorexia nervosa (ON) has developed in recent years, there exists a continuous need to develop valid tools to assess ON risk, according to strict diagnostic criteria. The present study aims to conduct Polish adaptation and validation of the Authorized Bratman Orthorexia Self-Test (ABOST), through a comparison of dichotomous and continuous Likert response scales. Participants and Methods This cross-sectional study involved 472 people with mean age of 27 years (ranging between 18 and 78 years, M = 26.88, SD = 10.40). The survey included demographic questions and measures of orthorexia (the ABOST and ORTO-15), eating disorders (EAT-26), body mass index (BMI), obsessive–compulsive disorder (OCI-R), anxiety (GAD-7), and depression (PHQ-9). The following statistical tests were performed to explore the psychometric properties of the ABOST: descriptive statistics, Student’s t-test, Pearson’s correlation, Cronbach’s α reliability, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). Results The ABOST using a five-point Likert scale for responses demonstrated good psychometric properties. The CFA goodness-of-fit indices confirmed the one-factor solution. Positive correlations were found between the ABOST and the ORTO-15, EAT-26, OCI-R, GAD-7, and PHQ-9. Women scored higher in the ABOST than men, while BMI was unrelated to the ABOST. Conclusion The ABOST using the Likert scale provides a reliable and valid instrument to assess ON risk, as indicated by the face, structural, and convergent validity results. However, more research in various countries is needed, in order to verify the results of this study.
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Affiliation(s)
| | | | - Dominika Ochnik
- Faculty of Medicine, University of Technology, Katowice, Poland
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19
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Albery IP, Spada MM, Nikčević AV. The COVID-19 anxiety syndrome and selective attentional bias towards COVID-19-related stimuli in UK residents during the 2020-2021 pandemic. Clin Psychol Psychother 2021; 28:1367-1378. [PMID: 34169609 PMCID: PMC8426988 DOI: 10.1002/cpp.2639] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 12/15/2022]
Abstract
The psychological and social effects of the COVID‐19 pandemic are pervasive, and there is potential for a long‐lasting impact on mental health. In the current study, we sought to provide, in a representative sample of UK residents during the third COVID‐19 lockdown in February 2021, further evidence for the validation of the COVID‐19 anxiety syndrome construct. We did this by evaluating the COVID‐19 anxiety syndrome against measures of personality, health anxiety and COVID‐19 anxiety in predicting levels of generalized anxiety and depression and by examining whether increased health anxiety and COVID‐19 psychological distress (COVID‐19 anxiety and COVID‐19 anxiety syndrome) scores were associated with increased attentional bias to COVID‐19‐related stimuli. A series of correlation analyses revealed that neuroticism, health anxiety, COVID‐19 anxiety and COVID‐19 anxiety syndrome scores were positively and significantly correlated with generalized anxiety and depression scores and that the perseveration component of the COVID‐19 anxiety syndrome predicted generalized anxiety and depression scores independently of age, gender, conscientiousness, openness, health anxiety and COVID‐19 anxiety. Furthermore, results indicated that only the total COVID‐19 anxiety syndrome score and the scores on the avoidance and perseveration components were positively and significantly correlated with attentional bias indices. More specifically, the general attentional bias index was only shown to be positively and significantly correlated with the total COVID‐19 anxiety syndrome score and its perseveration component, while slowed disengagement was only shown to be negatively and significantly correlated with the total COVID‐19 anxiety syndrome score and its avoidance component. The implications of these findings are discussed.
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Affiliation(s)
- Ian P Albery
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, UK
| | - Marcantonio M Spada
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, UK
| | - Ana V Nikčević
- Department of Psychology, Kingston University, London, UK
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20
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Wurthmann S, Naegel S, Roesner M, Nsaka M, Scheffler A, Kleinschnitz C, Holle D, Obermann M. Sensitized rotatory motion perception and increased susceptibility to motion sickness in vestibular migraine: A cross-sectional study. Eur J Neurol 2021; 28:2357-2366. [PMID: 33914990 DOI: 10.1111/ene.14889] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND PURPOSE Vestibular migraine (VM) patients are ictally and interictally hypersensitive for self-motion and visual perception. Increased cortical excitability of the vestibular system represented by lowered motion perception thresholds might play an important role in the pathophysiology of VM. We aimed to compare motion perception thresholds and the vegetative response to rotatory motion, as well as the vestibulo-ocular reflex (VOR) during rotation in VM patients compared to healthy controls (HC). METHODS In this cross-sectional study, 28 female VM patients in the interictal state and 33 age- and gender-matched HC were investigated sitting in a motorized rotary chair shielded regarding visual and acoustic stimuli for 20 min with slowly increasing velocity (maximum = 72°/s). The motion perception threshold was indicated by the participants by pushing a button. During and after rotation, participants rated the presence and extent of motion sickness using a sickness rating scale. RESULTS We detected lower motion perception thresholds (7.54°/s vs. 23.49°/s; p < 0.001) in VM patients compared to HC but no difference at the basic VOR thresholds. Furthermore, the patients showed enhanced susceptibility to motion sickness during and after the rotation. CONCLUSIONS We provide evidence for decreased motion perception thresholds and pronounced susceptibility to motion sickness in VM patients in the interictal state, which could indicate alterations in higher levels of vestibular processing. Future studies should determine whether this could be the pathophysiological hallmark of VM either as a unique disease entity or in differentiation from other forms of migraine.
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Affiliation(s)
- Sebastian Wurthmann
- Department of Neurology, Dizziness and Vertigo Center Essen, West German Headache Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Steffen Naegel
- Department of Neurology, Dizziness and Vertigo Center Essen, West German Headache Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Department of Neurology, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Miriam Roesner
- Department of Neurology, Dizziness and Vertigo Center Essen, West German Headache Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Michael Nsaka
- Department of Neurology, Dizziness and Vertigo Center Essen, West German Headache Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Armin Scheffler
- Department of Neurology, Dizziness and Vertigo Center Essen, West German Headache Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology, Dizziness and Vertigo Center Essen, West German Headache Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Dagny Holle
- Department of Neurology, Dizziness and Vertigo Center Essen, West German Headache Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Mark Obermann
- Department of Neurology, Weser-Egge Hospital Höxter, University of Duisburg-Essen, Essen, Germany
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21
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Clauss K, Witte TK, Bardeen JR. Examining the Factor Structure and Incremental Validity of the Barkley Deficits in Executive Functioning Scale - Short Form in a Community Sample. J Pers Assess 2021; 103:777-785. [PMID: 33687295 DOI: 10.1080/00223891.2021.1887879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The Barkley Deficits in Executive Functioning Scale - Short Form (BDEFS-SF; Barkley, 2011) was developed to assess deficits in five facets of executive functioning. Theoretical assumptions surrounding the BDEFS-SF presume that executive dysfunction is an overarching construct that consists of five domain-specific factors (i.e., a hierarchical model; Barkley, 2011). Prior research has supported a correlated five-factor model, but the tenability of hierarchical or bifactor models of the BDEFS-SF have not yet been tested. In the present study (N = 1,120 community adults), confirmatory factor analysis was used to compare four theoretically relevant models of the BDEFS-SF (i.e., one-factor, correlated five-factor, hierarchical, and bifactor models). The bifactor model provided the best fit to the data. However, the general factor accounted for the overwhelming majority of variance in BDEFS-SF scores and none of the domain-specific factors exhibited adequate construct replicability or factor determinancy. Further, the general factor accounted for the overhelming majority of variance in criterion variables (i.e., executive attention and health anxiety); the Organization and Emotion factors accounted for a small amount of unique variance in executive attention and the Emotion factor accounted for a small amount of unique variance in health anxiety. Taken together, study findings suggest that the BDEFS-SF has a strong general factor and independent use of the domain-specific factors is contraindicated.
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Affiliation(s)
- Kate Clauss
- Department of Psychological Sciences, Auburn University, Auburn, AL
| | - Tracy K Witte
- Department of Psychological Sciences, Auburn University, Auburn, AL
| | - Joseph R Bardeen
- Department of Psychological Sciences, Auburn University, Auburn, AL
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22
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Modelling the contribution of the Big Five personality traits, health anxiety, and COVID-19 psychological distress to generalised anxiety and depressive symptoms during the COVID-19 pandemic. J Affect Disord 2021; 279:578-584. [PMID: 33152562 PMCID: PMC7598311 DOI: 10.1016/j.jad.2020.10.053] [Citation(s) in RCA: 155] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/29/2020] [Accepted: 10/25/2020] [Indexed: 11/20/2022]
Abstract
In the current study we sought to extend our understanding of vulnerability and protective factors (the Big Five personality traits, health anxiety, and COVID-19 psychological distress) in predicting generalised anxiety and depressive symptoms during the COVID-19 pandemic. Participants (n = 502), who were United States residents, completed a variety of sociodemographic questions and the following questionnaires: Big Five Inventory-10 (BFI-10), Whitley Index 7 (WI-7), Coronavirus Anxiety Scale (CAS), COVID-19 Anxiety Syndrome Scale (C19-ASS), and Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS). Results showed that extraversion, agreeableness, conscientiousness, and openness were negatively correlated with generalised anxiety and depressive symptoms and that neuroticism, health anxiety and both measures of COVID-19 psychological distress were positively correlated with generalised anxiety and depressive symptoms. We used path analysis to determine the pattern of relationships specified by the theoretical model we proposed. Results showed that health anxiety, COVID-19 anxiety, and the COVID-19 anxiety syndrome partially mediated the relationship between the Big Five personality traits and generalised anxiety and depressive symptoms. Specifically, extraversion, agreeableness, and conscientiousness were negatively associated with the three mediators, which, in turn, were positively associated with generalised anxiety and depressive symptoms, with COVID-19 anxiety showing the strongest effect. Conversely, neuroticism and openness were positively associated with COVID-19 anxiety and the COVID-19 anxiety syndrome, respectively. These relationships were independent of age, gender, employment status and risk status. The model accounted for a substantial variance of generalised anxiety and depression symptoms (R2 = .75). The implications of these findings are discussed.
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23
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Bailey R, Wells A. The contribution of metacognitive beliefs and dysfunctional illness beliefs in predicting health anxiety: An evaluation of the metacognitive versus the cognitive models. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12078] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Robin Bailey
- Department of Clinical Psychology, University of Manchester, Manchester, UK,
- School of Health, University of Central Lancashire, Preston, UK,
| | - Adrian Wells
- Department of Clinical Psychology, University of Manchester, Manchester, UK,
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24
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Carstensen TBW, Ørnbøl E, Fink P, Pedersen MM, Jørgensen T, Dantoft TM, Benros ME, Frostholm L. Detection of illness worry in the general population: A specific item on illness rumination improves the Whiteley Index. J Psychosom Res 2020; 138:110245. [PMID: 32950761 DOI: 10.1016/j.jpsychores.2020.110245] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 08/21/2020] [Accepted: 09/07/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The Whiteley Index (WI) is the most widely used screening tool for health anxiety/illness worry. Diverse versions (different number of items and factors) have been used. We aimed to examine psychometric properties of 7 items of the WI besides adding a new item on obsessive illness rumination for better future detection of health anxiety. METHODS Data from a large population-based study in Denmark (N = 9656). Construct validity was examined by exploratory (EFA) and confirmatory factor analysis (CFA) plus hypothesis testing. Criterion validity was evaluated via Receiver Operating Characteristic curves and area under the curve (AUC) using a diagnostic criterion as gold standard. RESULTS Factor loadings of EFA revealed viable one-factor models (6, 7, or 8 items) and two-factor models (7 or 8 items). Factor one indicated a dimension of illness worry. Factor two indicated a somatic symptoms dimension. The new item on obsessive illness rumination merged well with the existing items. EFA of two-factor models and one-factor 6-item model showed good fit. CFA resembles these findings. A one-factor 6-item model (including the item on obsessive illness rumination and excluding two items concerning somatic symptoms) was chosen as the optimal model and presented good criterion validity: AUC 0.88 (95%CI(0.84;0.92)). Main hypotheses concerning associations with somatic symptoms, anxiety, and depression were met. CONCLUSIONS We found good psychometric properties for a new one-factor 6-item version of the WI. Through elimination of items concerning somatic symptoms and inclusion of obsessive illness rumination, we propose a clear, unidimensional and improved measure of illness worry: Whiteley-6-R.
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Affiliation(s)
- Tina Birgitte Wisbech Carstensen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.
| | - Eva Ørnbøl
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.
| | - Per Fink
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.
| | - Majbritt Mostrup Pedersen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Capital Region, Denmark; Department of Public Health, Faculty of Medical Sciences, University of Copenhagen, Denmark; Faculty of Medicine, Aalborg University, Denmark.
| | - Thomas Meinertz Dantoft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Capital Region, Denmark.
| | - Michael Eriksen Benros
- Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Denmark.
| | - Lisbeth Frostholm
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.
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25
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Veddegjærde KEF, Sivertsen B, Skogen JC, Smith ORF, Wilhelmsen I. Long-term effect of cognitive-behavioural therapy in patients with Hypochondriacal Disorder. BJPsych Open 2020; 6:e42. [PMID: 32345417 PMCID: PMC7189575 DOI: 10.1192/bjo.2020.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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 Cognitive-behavioural therapy (CBT) is an effective treatment for Hypochondriacal Disorder, but the long-term effect has not been examined extensively. AIMS To investigate the long-term effect of CBT on Hypochondriacal Disorder using several mental health measures. Follow-up time was at least 10 years. METHOD A total of 50 patients with a long history of Hypochondriacal Disorder, diagnosed according to ICD-10, received 16 sessions of individual CBT and were followed up with an uncontrolled design. All participants were assessed before and after the intervention period, and 10 years later. Intention-to-treat mixed-model repeated-measures analysis were conducted. The study has been registered at clinicaltrials.gov: NCT00959452. RESULTS Patients displayed significant improvements across all outcomes, including level of health anxiety, somatisation, symptoms of anxiety and depression, quality of life, somatisation at treatment completion. Treatment gains were well maintained 10 years later. CONCLUSIONS This uncontrolled treatment study suggests that patients treated with CBT for Hypochondriacal Disorder have significantly reduced health anxiety 1 year after treatment completion and the results are maintained 10 years later. The results indicate that CBT has a lasting effect, but the lack of a control group and use of only one therapist, means that care should be taken when generalising the findings.
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Affiliation(s)
- Kari-Elise Frøystad Veddegjærde
- Department of Clinical Science, University of Bergen; and Department of Psychiatry and Drug Abuse, Ålesund Hospital, Møre og Romsdal Health Trust, Norway
| | - Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health; Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU); and Department of Research and Innovation, Helse-Fonna HF Haugesund Hospital, Norway
| | - Jens Christoffer Skogen
- Department of Health Promotion, Norwegian Institute of Public Health; and Alcohol and Drug Research Western Norway, Stavanger University Hospital, Norway
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Kosic A, Lindholm P, Järvholm K, Hedman-Lagerlöf E, Axelsson E. Three decades of increase in health anxiety: Systematic review and meta-analysis of birth cohort changes in university student samples from 1985 to 2017. J Anxiety Disord 2020; 71:102208. [PMID: 32172210 DOI: 10.1016/j.janxdis.2020.102208] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/05/2020] [Accepted: 03/02/2020] [Indexed: 01/20/2023]
Abstract
Health anxiety can be defined as a multifaceted trait that is primarily characterised by a fear of, or preoccupation with, serious illness. Whereas low levels of health anxiety can be helpful, clinically significant levels are associated with personal suffering and substantial societal costs. As general anxiety is probably on the rise, and the Internet has increased access to health-related information, it is commonly speculated that health anxiety has increased over the past decades. We tested this hypothesis based on a systematic review and meta-analysis of birth cohort mean health anxiety in Western university student samples from 1985 to 2017. Sixty-eight studies with 22 413 student participants were included. The primary analysis indicated that the mean score on the Illness Attitudes Scales had increased by 4.61 points (95 % CI: 1.02, 8.20) from 1985 to 2017. The percentage of general population Internet users in the study year of data collection was not predictive of student mean health anxiety. In conclusion, this study corroborates the hypothesis of an increase in health anxiety, at least in the student population, over the past decades. However, this increase could not be linked to the introduction of the Internet.
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Affiliation(s)
- Amanda Kosic
- Department of Psychology, Lund University, Lund, Sweden
| | - Peo Lindholm
- Department of Psychology, Lund University, Lund, Sweden
| | | | - Erik Hedman-Lagerlöf
- Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erland Axelsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
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Fergus TA, Kelley LP, Griggs JO. Examining the Whiteley Index-6 as a screener for DSM-5 presentations of severe health anxiety in primary care. J Psychosom Res 2019; 127:109839. [PMID: 31677549 DOI: 10.1016/j.jpsychores.2019.109839] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/04/2019] [Accepted: 09/21/2019] [Indexed: 01/06/2023]
Abstract
Psychological screening is essential within primary care settings, with growing evidence that health anxiety could be important to screen for in such settings. Brief screeners in primary care settings are considered most viable for routine use. This study provided the first known examination of a version of the Whiteley Index (WI; Pilowksy, 1967) as a screener for primary care patients who are experiencing DSM-5 presentations of severe health anxiety (i.e., somatic symptom disorder, illness anxiety disorder). A six-item short form of the WI (i.e., WI-6), with item responses made using an ordered-category response option, was examined. Consecutively enrolled U.S. patients presenting for treatment at a community health center (N = 202) completed the WI-6 and a semi-structured interview assessing clinically severe health anxiety in the form of somatic symptom disorder and illness anxiety disorder. A total of 61 participants met criteria for clinically severe health anxiety and were compared to patients who did not meet criteria for clinically severe health anxiety. Results from a receiver operating characteristic (ROC) analysis indicated that a cutoff score of 18 on the WI-6 adequately balanced sensitivity (75%) and specificity (77%). The area under the curve (AUC) indicated the WI-6 did a reasonable job discriminating between the two groups (AUC = 0.83, p < .001, 95% confidence interval = 0.77-0.89). Study results offer preliminary support for the WI-6 as a practical screener for identifying cases of severe health anxiety in U.S. primary care settings that may warrant further evaluation.
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Affiliation(s)
- Thomas A Fergus
- Baylor University, Department of Psychology and Neuroscience, Waco, TX, USA.
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Foroughi AA, Mohammadpour M, Khanjani S, Pouyanfard S, Dorouie N, Parvizi Fard AA. Psychometric properties of the Iranian version of the Anxiety Sensitivity Index-3 (ASI-3). TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2019; 41:254-261. [PMID: 31644692 DOI: 10.1590/2237-6089-2018-0078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/07/2019] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Anxiety sensitivity plays a prominent role in the etiology of anxiety disorders. This construct has attracted widespread interest from experts and researchers. The Anxiety Sensitivity Index (ASI-3) is the most common scale for measuring anxiety sensitivity. OBJECTIVE To analyze the psychometric properties and factor structure of the ASI-3 in Iranian student samples. METHODS 220 students (135 women, 85 men) from Kermanshah University of Medical Sciences were selected by the convenience sampling method to evaluate the psychometric properties and analyze the factor structure of the ASI-3. The subjects were also asked to complete the Acceptance and Action Questionnaire-II (AAQ-II), Whiteley Index, Intolerance of Uncertainty, and Neuroticism scales. LISREL and SPSS were used to analyze the data. Cronbach's alpha and correlation coefficients were calculated and confirmatory factor analysis was conducted. RESULTS The results of the confirmatory factor analysis revealed a three-factor structure with physical, cognitive, and social components (comparative fit index = 0.94; normed fit index = 0.91; root mean square error of approximation = 0.09). The ASI-3 had positive and significant correlations with health anxiety (0.59), intolerance of uncertainty (0.29), and neuroticism (0.51). Furthermore, the ASI-3 had a negative and significant correlation with the AAQII (-0.58). Cronbach's alpha coefficients for the whole scale and for the physical, cognitive, and social concerns factors were 0.90, 0.74, 0.79, and 0.78, respectively. The invariance of the index was significant compared to the original English version. CONCLUSION In general, the results support the adequacy of the psychometric properties of the Persian version of the ASI-3. Theoretical and applied implications will be discussed.
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Affiliation(s)
- Ali Akbar Foroughi
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Mohammadpour
- Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sajad Khanjani
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health, Tehran Psychiatric Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Sahar Pouyanfard
- Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nadia Dorouie
- Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Akbar Parvizi Fard
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Bati AH, Mandiracioglu A, Govsa F, Çam O. Health anxiety and cyberchondria among Ege University health science students. NURSE EDUCATION TODAY 2018; 71:169-173. [PMID: 30290320 DOI: 10.1016/j.nedt.2018.09.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 09/04/2018] [Accepted: 09/25/2018] [Indexed: 06/08/2023]
Abstract
It is common among health science students to incorrectly believe that they have contracted certain diseases they have recently studied. This can also be seen in the form of health anxiety and investigating health-related information via the internet. Health anxiety, cyberchondria and affecting factors are determined among health science students. The study was conducted at the faculties of Medicine, Pharmacy, Dentistry and Nursing in 2016-2017 with the participation of 874 students. The data were gathered using a questionnaire as well as health anxiety and cyberchondria severity scales. In the presence of a health problem, 14.2% of students seek health information via the internet. 83.7% use mobile phone to access the internet, ¼ of students conduct health scanning once a week or more. To 65.4%, internet information is correct at medium and above level. No statistically significant difference was found with respect to students' gender, high school, places they lived before, parents' education and scales' scores. The cyberchondria scores of students with health problems are higher in the whole scale and in "distress and mistrust of medical professional" subscales. As the frequency of scanning on the internet increases, the scores of cyberchondria also increase significantly. Medical students had significantly higher scores in "distress, excessiveness and reassurance" subscales. Male students' "mistrust of medical professional and compulsion" subscales scores were also higher. It was determined that the presence of the health problem was effective on the cyberchondria. Identification of somatoform problems like health anxiety and cyberchondria may help to regulate the education program.
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Affiliation(s)
- Ayse Hilal Bati
- Department of Medical Education, Faculty of Medicine, Ege University, Izmir, Turkey.
| | - Aliye Mandiracioglu
- Department of Public Health, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Figen Govsa
- Department of Anatomy, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Olcay Çam
- Olcay Çam, Department of Psychiatry, Faculty of Nursing, Ege University, İzmir, Turkey
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Fergus TA, Spada MM. Moving toward a metacognitive conceptualization of cyberchondria: Examining the contribution of metacognitive beliefs, beliefs about rituals, and stop signals. J Anxiety Disord 2018; 60:11-19. [PMID: 30317062 DOI: 10.1016/j.janxdis.2018.09.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/16/2018] [Accepted: 09/28/2018] [Indexed: 02/01/2023]
Abstract
Cyberchondria refers to the repeated use of the Internet to search for health information that leads to negative consequences. The present set of studies examined the tenability of a proposed metacognitive conceptualization of cyberchondria that includes metacognitive beliefs about health-related thoughts, beliefs about rituals, and stop signals. The contribution of those variables to cyberchondria was examined among 330 undergraduate students from a U.S. university in Study 1 and 331 U.S. community respondents in Study 2. All participants reported using the Internet to search for health information. Across both studies, metacognitive beliefs, beliefs about rituals, and stop signals shared positive bivariate associations with cyberchondria and accounted for unique variance in cyberchondria scores in multivariate analyses. Beliefs about rituals and stop signals emerged as relatively specific to cyberchondria versus health anxiety in multivariate analyses. Results provide preliminary support for a metacognitive conceptualization of cyberchondria, with extensions of the present findings discussed.
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Affiliation(s)
- Thomas A Fergus
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA.
| | - Marcantonio M Spada
- Division of Psychology, School of Applied Sciences, London South Bank University, London, UK
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Zvolensky MJ, Garey L, Fergus TA, Gallagher MW, Viana AG, Shepherd JM, Mayorga NA, Kelley LP, Griggs JO, Schmidt NB. Refinement of anxiety sensitivity measurement: The Short Scale Anxiety Sensitivity Index (SSASI). Psychiatry Res 2018; 269:549-557. [PMID: 30199696 PMCID: PMC6207458 DOI: 10.1016/j.psychres.2018.08.115] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/09/2018] [Accepted: 08/28/2018] [Indexed: 12/26/2022]
Abstract
Anxiety sensitivity, defined as the fear of anxiety and arousal-related sensations, has been among the most influential cognitive-based transdiagnostic risk and maintenance factors in the study and treatment of emotional and related disorders. The currently available anxiety sensitivity measures are limited by their length. Specifically, the length of these instruments discourages the adoption of routine anxiety sensitivity assessment in clinical or medical settings (e.g., primary care). The goals of this study were to develop and assess the validity and reliability of a short version of the Anxiety Sensitivity Index-3 (ASI-3; Taylor et al., 2007), entitled the Short Scale Anxiety Sensitivity Index (SSASI), using three independent clinical samples. Results indicated that the abbreviated five-item version of the SSASI had good internal consistency and a robust association with the ASI-3. Further, across the samples, there was evidence of unidimensionality and excellent convergent and discriminant validity. There also was evidence of partial measurement invariance across sex and full measurement invariance across time. Overall, the five-item scale offers a single score that can be employed to measure anxiety sensitivity. Use of the SSASI may facilitate screening efforts and symptom tracking for anxiety sensitivity, particularly within clinical settings where practical demands necessitate the use of brief assessment instruments.
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Affiliation(s)
- Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX 77004, USA,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA,Correspondence concerning this article should be addressed to Michael J. Zvolensky, Ph.D. Dept. of Psychology 3695 Cullen Blvd., Room 126. University of Houston, Houston, TX, 77204. (713) 743-8056.
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX 77004, USA
| | - Thomas A. Fergus
- Department of Psychology and Neuroscience, Baylor University, Waco, TX 76706, USA
| | | | - Andres G. Viana
- Department of Psychology, University of Houston, Houston, TX 77004, USA
| | | | - Nubia A. Mayorga
- Department of Psychology, University of Houston, Houston, TX 77004, USA
| | - Lance P. Kelley
- Waco Family Medicine Residency Program, Heart of Texas Community Health Center, Waco, TX 76706, USA
| | - Jackson O. Griggs
- Waco Family Medicine Residency Program, Heart of Texas Community Health Center, Waco, TX 76706, USA
| | - Norman B. Schmidt
- Department of Psychology, Florida State University, Tallahassee, Florida 32306, USA
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Behavioral Health of Gulf Coast Residents 6 Years After the Deepwater Horizon Oil Spill: The Role of Trauma History. Disaster Med Public Health Prep 2018; 13:497-503. [PMID: 30253814 DOI: 10.1017/dmp.2018.84] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the associations between oil spill exposure, trauma history, and behavioral health 6 years after the Deepwater Horizon oil spill (DHOS). We hypothesized that prior trauma would exacerbate the relationship between oil spill exposure and behavioral health problems. METHODS The sample included 2,520 randomly selected adults in coastal areas along the Gulf of Mexico. Participants reported their level of oil spill exposure, trauma history, depression, anxiety/worry, illness anxiety, and alcohol use. RESULTS Individuals with more traumatic experiences had a significantly higher risk for all measured behavioral health problems after controlling for demographic factors and DHOS exposure. Those with higher levels of DHOS exposure were not at greater risk for behavioral health problems after controlling for prior trauma, with the exception of illness anxiety. There was no evidence that trauma history moderated the association between DHOS exposure and behavioral health. CONCLUSIONS Findings suggest that trauma exposure may be a better indicator of long-term behavioral health risk than DHOS exposure among disaster-prone Gulf Coast residents. DHOS exposure may be a risk factor for illness anxiety but not more general behavioral health concerns. Trauma history did not appear to exacerbate risk for behavioral health problems among Gulf residents exposed to the DHOS. (Disaster Med Public Health Preparedness. 2019;13:497-503).
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Fergus TA, Kelley LP, Griggs JO. The combination of health anxiety and somatic symptoms: a prospective predictor of healthcare usage in primary care. J Behav Med 2018; 42:217-223. [PMID: 30043146 DOI: 10.1007/s10865-018-9956-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/19/2018] [Indexed: 01/18/2023]
Abstract
Extant research provides equivocal conclusions if the combined presentation of health anxiety with severe somatic symptoms confers risk for greater future primary care usage. The present study further examined the combination of health anxiety and somatic symptoms as a predictor of healthcare usage in primary care. Using a prospective longitudinal design, a large sample (N = 530) of patients presenting for treatment at a community health center completed self-report measures assessing health anxiety and somatic symptom severity. A medical record review at the time of questionnaire administration and 1 year following that administration was completed to assess the frequency of medical visits during the preceding and subsequent year. As expected, the interactive effect between health anxiety and somatic symptom severity predicted greater subsequent year medical visits. Covariates included preceding year medical visits, sociodemographic variables, body mass index, smoking status, and depressive symptom severity. Simple effects indicated that health anxiety predicted greater subsequent year medical visits when coupled with relatively severe, but not mild, somatic symptoms. Assessing health anxiety and somatic symptom severity in primary care settings could be important for identifying individuals at risk for future frequent healthcare visits and who may benefit from intervention.
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Affiliation(s)
- Thomas A Fergus
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, 76798, 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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Fergus TA, Griggs JO, Cunningham SC, Kelley LP. Health anxiety and medical utilization: The moderating effect of age among patients in primary care. J Anxiety Disord 2017; 51:79-85. [PMID: 28689676 DOI: 10.1016/j.janxdis.2017.06.002] [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: 02/01/2017] [Revised: 06/05/2017] [Accepted: 06/11/2017] [Indexed: 11/27/2022]
Abstract
Health anxiety is commonly seen in medical clinics and is related to the overutilization of primary care services, but existing studies have not yet considered the possible moderating effect of age. We examined if age moderated the association between health anxiety and medical utilization. A secondary aim was to examine potential racial/ethnic differences in health anxiety. An ethnoracially diverse group of patients (N=533) seeking treatment from a primary care clinic completed a self-report measure of health anxiety. Three indices of medical utilization were assessed using medical records, including the number of: (a) clinic visits over the past two years, (b) current medications, and (c) lab tests over the past two years. Age moderated the effect of health anxiety on multiple indices of medical utilization. Supplemental analyses found that the moderating effect of age was specific to a somatic/body preoccupation, rather than health worry, dimension of health anxiety. Mean-level differences in health anxiety were either not supported (health anxiety composite, somatic/body preoccupation) or were small in magnitude (health worry) among self-identifying Black, Latino, and White participants. Results indicate that assessing for health anxiety could be particularly important for older adult patients who frequently seek out medical services.
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Affiliation(s)
- Thomas A Fergus
- Department of Psychology and Neuroscience, Baylor University, Waco, 76798 TX, USA.
| | - Jackson O Griggs
- Waco Family Medicine Residency Program, Heart of Texas Community Health Center, Waco, TX, USA
| | | | - Lance P Kelley
- Waco Family Medicine Residency Program, Heart of Texas Community Health Center, Waco, TX, USA
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35
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Fergus TA, Limbers CA, Griggs JO, Kelley LP. Somatic symptom severity among primary care patients who are obese: examining the unique contributions of anxiety sensitivity, discomfort intolerance, and health anxiety. J Behav Med 2017; 41:43-51. [PMID: 28710565 DOI: 10.1007/s10865-017-9873-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/06/2017] [Indexed: 01/04/2023]
Abstract
Prior research indicates the common presentation of somatic symptoms and obesity in primary care settings, as well as links between obesity and somatic symptoms. Anxiety sensitivity, discomfort intolerance, and health anxiety are three variables relevant to somatic symptoms. How those three variables relate to somatic symptom severity among individuals who are obese and the unique variance accounted for by each variable in somatic symptom severity remains unexamined. Among a large sample of primary care patients who are obese (N = 342), anxiety sensitivity, discomfort intolerance, and health anxiety collectively accounted for 35% of variance in somatic symptom severity beyond the effects of sociodemographic variables, body mass index, medical morbidity, and depression severity. Health anxiety accounted for the largest amount of unique variance in somatic symptom severity, potentially supporting the relevance of health anxiety to the presentation of increased somatic symptoms among patients who are obese.
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Affiliation(s)
- Thomas A Fergus
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, 76798, USA.
| | - Christine A Limbers
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, 76798, USA
| | - Jackson O Griggs
- Waco Family Medicine Residency Program, Heart of Texas Community Health Center, Waco, TX, USA
| | - Lance P Kelley
- Waco Family Medicine Residency Program, Heart of Texas Community Health Center, Waco, TX, USA
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36
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Fergus TA, Spada MM. Cyberchondria: Examining relations with problematic Internet use and metacognitive beliefs. Clin Psychol Psychother 2017. [PMID: 28621035 DOI: 10.1002/cpp.2102] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Cyberchondria refers to the repeated use of the Internet to search for health-related information, which leads to negative consequences. This two-part study provides the first known examination of how cyberchondria relates to (a) problematic Internet use and (b) metacognitive beliefs. Participants were U.S. community adults who reported using the Internet to search for health-related information (Study 1: N = 337, Study 2: N = 260). In Study 1, cyberchondria shared a strong association with problematic Internet use, and that association was unaccounted for by age, gender, current reported medical status, negative affect, or health anxiety. In Study 2, cyberchondria was found to share moderate to strong associations with metacognitive beliefs. The association between cyberchondria and metacognitive beliefs about the uncontrollability of thoughts remained intact after accounting for the Study 1 covariates, as well as anxiety sensitivity and intolerance of uncertainty. Neither anxiety sensitivity nor intolerance of uncertainty shared unique associations with cyberchondria. These results provide a preliminary indication that a metacognitive conceptualization of problematic Internet use may be applicable to cyberchondria.
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Affiliation(s)
- Thomas A Fergus
- Psychology and Neuroscience, Baylor University, Waco, Texas, USA
| | - Marcantonio M Spada
- Division of Psychology, School of Applied Sciences, London South Bank University, 103 Borough Road, London, SE10AA
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Fergus TA, Bardeen JR. The Metacognitions Questionnaire-30: An Examination of a Bifactor Model and Measurement Invariance Among Men and Women in a Community Sample. Assessment 2017; 26:223-234. [PMID: 28043161 DOI: 10.1177/1073191116685807] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Metacognitions Questionnaire-30 (MCQ-30) is a self-report measure that assesses metacognitive beliefs (i.e., beliefs about thinking). Prior research has supported a correlated five-factor model, but no known published study has examined the tenability of second-order or bifactor models of the MCQ-30. Results supported a bifactor model of the MCQ-30 in a sample of community adults from the United States ( N = 785), as well as separately among men ( n = 372) and women ( n = 413). Multiple-groups confirmatory factor analysis supported the configural and metric/scalar invariance of the bifactor model among men and women. Results further supported the incremental validity of one of the MCQ-30 domain-specific factors in accounting for unique variance in an index of health anxiety beyond the general metacognition factor. Results provide support for a bifactor conceptualization of the MCQ-30 and the invariance of that model across men and women.
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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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Fergus TA, Kelley LP, Griggs JO. The Whiteley Index-6: An Examination of Measurement Invariance Among Self-Identifying Black, Latino, and White Respondents in Primary Care. Assessment 2016; 25:247-258. [PMID: 27121080 DOI: 10.1177/1073191116645908] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Brief measures that are comparable across disparate groups are particularly likely to be useful in primary care settings. Prior research has supported a six-item short form of the Whiteley Index (WI), a commonly used measure of health anxiety, among English-speaking respondents. This study examined the measurement invariance of the WI-6 among Black ( n = 183), Latino ( n = 173), and White ( n = 177) respondents seeking treatment at a U.S. community health center. Results supported a bifactor model of the WI-6 among the composite sample ( N = 533), suggesting the presence of a general factor and two domain-specific factors. Results supported the incremental validity of one of the domain-specific factors in accounting for unique variance in somatic symptom severity scores beyond the general factor. Multiple-groups confirmatory factor analysis supported the configural, metric, ands scalar invariance of the bifactor WI-6 model across the three groups of respondents. Results provide support for the measurement invariance of the WI-6 among Black, Latino, and White respondents. The potential use of the WI-6 in primary care, and broader, settings is discussed.
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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: 34] [Impact Index Per Article: 4.3] [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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Fergus TA. Anxiety sensitivity and intolerance of uncertainty as potential risk factors for cyberchondria: A replication and extension examining dimensions of each construct. J Affect Disord 2015; 184:305-9. [PMID: 26141807 DOI: 10.1016/j.jad.2015.06.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/08/2015] [Accepted: 06/11/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Preliminary findings suggest that anxiety sensitivity (AS) and intolerance of uncertainty (IU) may confer vulnerability for cyberchondria, defined as repeated internet searches for medical information that exacerbates health anxiety. Prior studies are limited because it remains unclear whether specific AS or IU dimensions differentially relate to certain cyberchondria dimensions. METHODS The present study examined associations among AS, IU, and cyberchondria dimensions using a sample of community adults (N = 578) located in the United States. RESULTS As predicted, physical AS and inhibitory IU were the only AS or IU dimensions to share unique associations with the distress cyberchondria dimension after controlling for the overlap among the AS dimensions, IU dimensions, and health anxiety. Cognitive AS and social AS unexpectedly evidenced unique associations with cyberchondria dimensions. LIMITATIONS The results are limited by the cross-sectional study design and use of a community, rather than clinical, sample. CONCLUSIONS This study provides evidence that specific AS and IU dimensions may confer vulnerability to certain cyberchondria dimensions. Further clarifying associations among AS, IU, and cyberchondria may lead to improvements in our conceptualization and, ultimately, treatment of cyberchondria.
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Affiliation(s)
- Thomas A Fergus
- Department of Psychology and Neuroscience, Baylor University Waco, TX 76798, United States.
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Metacognitive beliefs moderate the relationship between catastrophic misinterpretation and health anxiety. J Anxiety Disord 2015; 34:8-14. [PMID: 26093824 DOI: 10.1016/j.janxdis.2015.05.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 05/15/2015] [Accepted: 05/15/2015] [Indexed: 12/20/2022]
Abstract
Catastrophic misinterpretations of bodily symptoms have a central role in cognitive-behavioural models of health anxiety. However, the metacognitive (S-REF) model postulates that psychological disturbance is linked more to beliefs about thinking i.e., metacognition. Equally the relationship between catastrophic misinterpretation and health anxiety should be moderated by metacognition, in particular negative beliefs about the uncontrollability and danger of thinking (MCQNeg). Participants (N = 351) completed measures to examine the relationship between these variables. Results indicated positive relationships between metacognition, catastrophic misinterpretation, and health anxiety. Moderation analysis showed that the effect of catastrophic misinterpretations on health anxiety was explained by the proposed interaction with metacognition. Follow-up regression analysis demonstrated the interaction term explained variance in health anxiety when controlling for other variables, and was a stronger unique predictor of health anxiety than catastrophic misinterpretation. Metacognition appears to be an important factor in the relationship between catastrophic misinterpretation and health anxiety, and would have important implications for existing models and treatment.
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Hedman E, Lekander M, Ljótsson B, Lindefors N, Rück C, Andersson G, Andersson E. Optimal cut-off points on the health anxiety inventory, illness attitude scales and whiteley index to identify severe health anxiety. PLoS One 2015; 10:e0123412. [PMID: 25849477 PMCID: PMC4388630 DOI: 10.1371/journal.pone.0123412] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 02/28/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Health anxiety can be viewed as a dimensional phenomenon where severe health anxiety in form of DSM-IV hypochondriasis represents a cut-off where the health anxiety becomes clinically significant. Three of the most reliable and used self-report measures of health anxiety are the Health Anxiety Inventory (HAI), the Illness Attitude Scales (IAS) and the Whiteley Index (WI). Identifying the optimal cut-offs for classification of presence of a diagnosis of severe health anxiety on these measures has several advantages in clinical and research settings. The aim of this study was therefore to investigate the HAI, IAS and WI as proximal diagnostic instruments for severe health anxiety defined as DSM-IV hypochondriasis. METHODS We investigated sensitivity, specificity and predictive value on the HAI, IAS and WI using a total of 347 adult participants of whom 158 had a diagnosis of severe health anxiety, 97 had obsessive-compulsive disorder and 92 were healthy non-clinical controls. Diagnostic assessments were conducted using the Anxiety Disorder Interview Schedule. RESULTS Optimal cut-offs for identifying a diagnosis of severe health anxiety was 67 on the HAI, 47 on the IAS, and 5 on the WI. Sensitivity and specificity were high, ranging from 92.6 to 99.4%. Positive and negative predictive values ranged from 91.6 to 99.4% using unadjusted prevalence rates. CONCLUSIONS The HAI, IAS and WI have very good properties as diagnostic indicators of severe health anxiety and can be used as cost-efficient proximal estimates of the diagnosis.
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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
| | - Mats Lekander
- Karolinska Institutet, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Stockholm, Sweden
- Stockholm University, Stress Research Institute, Stockholm, Sweden
| | - Brjánn Ljótsson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden
| | - Nils Lindefors
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden
| | - Christian Rück
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, 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
| | - Erik Andersson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden
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Hedman E, Ljótsson B, Andersson E, Andersson G, Lindefors N, Rück C, Axelsson E, Lekander M. Psychometric properties of Internet-administered measures of health anxiety: an investigation of the Health Anxiety Inventory, the Illness Attitude Scales, and the Whiteley Index. J Anxiety Disord 2015; 31:32-7. [PMID: 25723780 DOI: 10.1016/j.janxdis.2015.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/24/2015] [Accepted: 01/30/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND The Health Anxiety Inventory (HAI), the Illness Attitude Scales (IAS), and the Whiteley Index (WI) are three of the most widely used health anxiety measures, but their psychometric properties have not been investigated when administered via the Internet. METHODS We investigated the three instruments' test-retest reliability, internal consistency, convergent, and discriminant validity and sensitivity to change using one sample (n=111) of participants with severe health anxiety and one sample of healthy controls (n=92). RESULTS The HAI, IAS, and WI showed high test-retest reliability (rs≥.80), good convergent, and discriminant validity and were sensitive to detect change. The HAI and IAS (αs≥.85), but not the WI (αs≤.60) demonstrated high internal consistency. CONCLUSIONS The HAI, IAS, and WI have good psychometric properties, except for the low internal consistency of WI, when used as Internet-administered measures of health anxiety. Using these measures over the Internet offers highly important advantages such as increased ease of administration, reduced attrition, and cost-efficient treatment evaluation.
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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; Linköping University, Department of Behavioural Sciences and Learning, Linköping, Sweden.
| | - Brjánn Ljótsson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden; Linköping University, Department of Behavioural Sciences and Learning, Linköping, Sweden
| | - Erik Andersson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden; Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden; Linköping University, Department of Behavioural Sciences and Learning, Linköping, Sweden
| | - Gerhard Andersson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden; Linköping University, Department of Behavioural Sciences and Learning, Linköping, Sweden; Stockholm University, Stress Research Institute, Stockholm, Sweden
| | - Nils Lindefors
- 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; Linköping University, Department of Behavioural Sciences and Learning, Linköping, Sweden
| | - Erland Axelsson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden; Linköping University, Department of Behavioural Sciences and Learning, Linköping, Sweden
| | - Mats Lekander
- Karolinska Institutet, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Stockholm, Sweden; Linköping University, Department of Behavioural Sciences and Learning, Linköping, Sweden; Stockholm University, Stress Research Institute, Stockholm, Sweden
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Veddegjærde KEF, Sivertsen B, Wilhelmsen I, Skogen JC. Confirmatory factor analysis and item response theory analysis of the Whiteley Index. Results from a large population based study in Norway. The Hordaland Health Study (HUSK). J Psychosom Res 2014; 77:213-8. [PMID: 25149031 DOI: 10.1016/j.jpsychores.2014.06.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 06/20/2014] [Accepted: 06/22/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The Whiteley Index (WI) is a widely used screening instrument for health anxiety/hypochondriasis. Several studies have previously explored the psychometric properties of the WI, but with mixed findings concerning both item composition and factor structure. The main aim of the current study was to examine different factor structures as identified from previous studies using data from a large general population based study. We also wanted to provide gender specific norms. METHODS Data were taken from a large population-based study in Norway, the Hordaland Health Study (HUSK N=7274). Confirmatory factor analysis (CFA) of several models of the WI was conducted. Item response theory (IRT) analysis was performed on the model with the best goodness-of-fit. RESULTS CFA of all previously proposed factor models of the WI revealed clearly inadequate model fits. The IRT analysis suggested that a six-item model best described the data, and CFA confirmed an adequate goodness-of-fit across indices. CONCLUSION The current study found evidence for a six-item, single-factor model of the WI. Our findings suggest that this abbreviated version has the best factor structure compared to previously proposed factor models. We recommend that the factor structure identified in this study should be investigated further in independent samples.
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Affiliation(s)
- Kari-Elise Frøystad Veddegjærde
- Department of Clinical Science, University of Bergen, Bergen, Norway; Division of Mental Health, Norwegian Institute of Public Health, Bergen, Norway; Department of Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway.
| | - Børge Sivertsen
- Division of Mental Health, Norwegian Institute of Public Health, Bergen, Norway; Uni Health, Uni Research, Bergen, Norway; Department of Psychiatry, Helse Fonna HF, Haugesund, Norway
| | - Ingvard Wilhelmsen
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Jens Christoffer Skogen
- Division of Mental Health, Norwegian Institute of Public Health, Bergen, Norway; Uni Health, Uni Research, Bergen, Norway; Alcohol and Drug Research Western Norway, Stavanger University, Hospital Stavanger, Stavanger, Norway
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Fetzner MG, Asmundson GJG, Carey C, Thibodeau MA, Brandt C, Zvolensky MJ, Carleton RN. How do elements of a reduced capacity to withstand uncertainty relate to the severity of health anxiety? Cogn Behav Ther 2014; 43:262-74. [PMID: 24961385 DOI: 10.1080/16506073.2014.929170] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Intolerance of uncertainty (IU)--a multidimensional cognitive vulnerability factor--is associated with a variety of anxiety disorders and health anxiety (HA). To date, few studies have assessed whether IU dimensions (prospective and inhibitory IU) are differentially associated with HA and whether their contributions are independent of anxiety sensitivity (AS). This study addressed these issues using independent community (n = 155; 81% women) and undergraduate (n = 560; 86% women) samples. Results indicated that prospective IU, but not inhibitory IU, had significant positive associations with HA in community dwellers and undergraduate students. AS somatic and cognitive concerns were also significant predictors among both samples. In addition, severity of IU dimensions among individuals reporting elevated HA were compared against individuals diagnosed with generalized anxiety disorder, social anxiety disorder, panic disorder, and obsessive-compulsive disorder. Results indicated minimal differences between those with elevated HA and each of the anxiety disorder diagnoses. Findings lend support to the unique transdiagnostic nature of IU and support commonalities between HA and anxiety disorders.
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Bardeen JR, Fergus TA. An examination of the incremental contribution of emotion regulation difficulties to health anxiety beyond specific emotion regulation strategies. J Anxiety Disord 2014; 28:394-401. [PMID: 24726241 DOI: 10.1016/j.janxdis.2014.03.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 03/04/2014] [Accepted: 03/05/2014] [Indexed: 11/26/2022]
Abstract
Given the potential transdiagnostic importance of emotion dysregulation, as well as a lack of research examining emotion dysregulation in relation to health anxiety, the present study sought to examine associations among specific emotion regulation strategies (cognitive reappraisal and expressive suppression), emotion regulation difficulties, and health anxiety in a physically healthy sample of adults (N=482). As hypothesized, results of a series of hierarchical multiple regression analyses showed that emotion regulation difficulties provided a significant incremental contribution, beyond the specific emotion regulation strategies, in predicting each of the three health anxiety variables. Among the six dimensions of emotion regulation difficulties, the dimension representing perceived access to effective emotion regulation strategies was the only emotion regulation difficulty dimension that predicted all three health anxiety variables beyond the effects of the specific emotion regulation strategies. Results indicate that emotion regulation difficulties, and particularly one's subjective appraisal of his/her ability to effectively regulate emotions, may be of importance to health anxiety. Clinical implications are discussed.
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Affiliation(s)
- Joseph R Bardeen
- University of Mississippi Medical Center, Jackson, MS, United States.
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Metacognitive Therapy in the Treatment of Hypochondriasis: A Systematic Case Series. COGNITIVE THERAPY AND RESEARCH 2014. [DOI: 10.1007/s10608-014-9615-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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49
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Fergus TA, Bardeen JR. Anxiety sensitivity and intolerance of uncertainty: Evidence of incremental specificity in relation to health anxiety. PERSONALITY AND INDIVIDUAL DIFFERENCES 2013. [DOI: 10.1016/j.paid.2013.05.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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50
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Diagnostik der Hypochondrie. PSYCHOTHERAPEUT 2013. [DOI: 10.1007/s00278-013-1011-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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