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Cognitive therapy versus exposure therapy for hypochondriasis (health anxiety): A randomized controlled trial

Excessive health anxiety is associated with high levels of distress, disability and increased health care use.  It is common.  A recent study - "Health anxiety in Australia: prevalence, comorbidity, disability and service use" - reported "Health anxiety affects approximately 5.7% of the Australian population across the lifespan and 3.4% met criteria for health anxiety at the time of the interview ... Health anxiety was associated with significantly more distress, impairment, disability and health service utilisation than that found in respondents without health anxiety.

Maximizing exposure therapy

Michelle Craske & colleagues from the Anxiety Disorders Research Center of UCLA have, for many years, been publishing careful, challenging research on underlying mechanisms & on ways of boosting the effectiveness of exposure therapies for different forms of anxiety.  Craske's list of publications & research presentations runs to 31 pages and begins with a study on musical performance anxiety published in 1984.  As the presentation titles on her list show, for some years the majority of her many lectures at prestigious conferences all over the world have revolved around the theme of how to take evolving scientific findings about fear learning and use them to optimize exposure treatments for anxiety disorders.

Recent research: mindfulness (mechanisms & practice), prevalence (abuse & suicidality), health anxiety imagery & CBT for kids

Here are half a dozen recent research studies - two on aspects of mindfulness, two on sobering prevalence rates, one on imagery in health anxiety, and one on CBT with children.  Fuller details, links and abstracts for all studies are listed further down this page.  Willem Kuyken and colleagues looked at "How does mindfulness-based cognitive therapy (MBCT) work?" in helping recurrent depression sufferers.  They came up with some fascinating and provocative findings.  For example it appears that MBCT acts differently from standard CBT, although they are both helpful in reducing risk of depressive relapse.  Standard CBT (and maintenance antidepressants too) reduce cognitive reactivity to experiences of induced low mood, and this appears important in how they lessen relapse risk.  MBCT however seems to act not by reducing cognitive reactivity so much as by decoupling the reactivity from a tendency then to slide into depression.  It appears this decoupling is mediate

Handouts & questionnaires for increasing access to psychological therapies (IAPT) outcomes toolkit, an upgrade

Over nearly 35 years of practice as a doctor and psychotherapist I've assembled a collection of 300 to 400 handouts and questionnaires that I use in my work.  I'm gradually uploading most of these handouts to this website so people can use any that they'd like to.  The collection is searchable in the Good Knowledge section of the site at Handouts, questionnaires and other leaflets.  Of the twenty two subsections on this part of the website, one of the more frequently visited areas is the Increasing access to psychological therapies (IAPT) outcomes toolkit.  This is a pretty full hand of cards for the recommended IAPT assessment measures.  I've recently updated the list of downloadable questionnaires available by including:

Handouts & questionnaires for health anxiety disorder

Here are the two main questionnaires currently used to assess Health Anxiety Disorder - the HAI and the HAQ.  The HAI is the one recommended by the NHS Improving Access to Psychological Therapies (IAPT) initiative.  I've also added a scale put together by Adrian Wells that assesses safety behaviours and extent of disease belief.  Finally there is a classic CBT thoughts record.  I don't use these kinds of records much any more, but I've added it for 'completeness'.

Health anxiety inventory (HAI) - the 18 item (short form) HAI is the disorder specific scale recommended by the IAPT initiative.  The third page of the download gives typical scores for a Health Anxiety group, a more general anxiety group, a control group, and so on.   

Health anxiety questionnaire (HAQ) - this 21 item health anxiety questionnaire yields four subscales, which can make it easier therapeutically to target specific behaviours like reassurance seeking.  The third page of the download gives some idea of likely scores in different disorders.

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