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Guthrie AJ, Paredes-Echeverri S, Bleier C, Adams C, Millstein DJ, Ranford J, Perez DL. Mechanistic studies in pathological health anxiety: A systematic review and emerging conceptual framework. J Affect Disord 2024; 358:222-249. [PMID: 38718945 DOI: 10.1016/j.jad.2024.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 04/02/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Pathological health anxiety (PHA) (e.g., hypochondriasis and illness anxiety disorder) is common in medical settings and associated with increased healthcare costs. However, the psychological and neurobiological mechanisms contributing to the development and maintenance of PHA are incompletely understood. METHODS We performed a systematic review to characterize the mechanistic understanding of PHA. PubMed, PsycINFO, and Embase databases were searched to find articles published between 1/1/1990 and 12/31/2022 employing a behavioral task and/or physiological measures in individuals with hypochondriasis, illness anxiety disorder, and PHA more broadly. RESULTS Out of 9141 records identified, fifty-seven met inclusion criteria. Article quality varied substantially across studies, and was overall inadequate. Cognitive, behavioral, and affective findings implicated in PHA included health-related attentional and memory recall biases, a narrow health concept, threat confirming thought patterns, use of safety-seeking behaviors, and biased explicit and implicit affective processing of health-related information among other observations. There is initial evidence supporting a potential overestimation of interoceptive stimuli in those with PHA. Neuroendocrine, electrophysiology, and brain imaging research in PHA are particularly in their early stages. LIMITATIONS Included articles evaluated PHA categorically, suggesting that sub-threshold and dimensional health anxiety considerations are not contextualized. CONCLUSIONS Within an integrated cognitive-behavioral-affective and predictive processing formulation, we theorize that sub-optimal illness and health concepts, altered interoceptive modeling, biased illness-based predictions and attention, and aberrant prediction error learning are mechanisms relevant to PHA requiring more research. Comprehensively investigating the pathophysiology of PHA offers the potential to identify adjunctive diagnostic biomarkers and catalyze new biologically-informed treatments.
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Affiliation(s)
- Andrew J Guthrie
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sara Paredes-Echeverri
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cristina Bleier
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Caitlin Adams
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel J Millstein
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica Ranford
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Occupational Therapy, Massachusetts General Hospital, Boston, MA, USA
| | - David L Perez
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Gessner J, Schulz JO, Melzig CA, Benke C. Role of interoceptive fear and maladaptive attention and behaviors in the escalation of psychopathology-a network analysis. Cogn Behav Ther 2024:1-20. [PMID: 38593025 DOI: 10.1080/16506073.2024.2336036] [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: 12/11/2023] [Accepted: 03/22/2024] [Indexed: 04/11/2024]
Abstract
The complex interplay of fear, attention, and behavior toward bodily sensations with psychopathological symptoms and how they mutually influence and potentially reinforce one another remains to be fully elucidated. In this study, we used a network analytical approach to unravel these complex interactions. Specifically, we aimed to identify central symptoms and etiologically relevant factors that might be associated with anxiety and depressive core symptoms. To this end, the following clusters were assessed in 791 adults: interoceptive fear, interoceptive attention, maladaptive behaviors related to bodily sensations, and core symptoms of anxiety and depression. This network was modeled using a Gaussian Graphical Model. Central variables (nodes) were identified using centrality indices and bridge analysis. Self-examination and attention to bodily sensations emerged as central nodes. Moreover, time spent paying attention to bodily sensations, fear of anxiety-related sensations, and self-examination were identified as central bridge nodes, that is, central nodes connecting psychopathologically relevant symptom clusters. The present study indicates that fear of bodily sensations, the amount of attention and time spent focusing on somatic sensations, and self-examination are central factors. The findings suggest potential targets for future longitudinal studies on the impact of these factors for the escalation of anxiety and depressive symptoms.
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Affiliation(s)
- Jana Gessner
- Department of Clinical Psychology, Experimental Psychopathology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Jan-Ole Schulz
- Department of Clinical Psychology, Experimental Psychopathology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Christiane A Melzig
- Department of Clinical Psychology, Experimental Psychopathology and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior, CMBB, Philipps University Marburg and Justus Liebig University Giessen, Gießen, Germany
| | - Christoph Benke
- Department of Clinical Psychology, Experimental Psychopathology and Psychotherapy, University of Marburg, Marburg, Germany
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Wang Z, Hu Y, Huang B, Zheng G, Li B, Liu Z. Is There a Relationship Between Online Health Information Seeking and Health Anxiety? A Systematic Review and Meta-Analysis. HEALTH COMMUNICATION 2023:1-15. [PMID: 37919837 DOI: 10.1080/10410236.2023.2275921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
The internet has revolutionized how we live, providing unprecedented convenience and up-to-date information. Consequently, an increasing number of individuals are turning to the internet for health-related information, despite research suggesting a correlation between this behavior and health anxiety. Therefore, drawing on cognitive - behavioral theory, we explore the link between online health information seeking and health anxiety via a systematic review and meta-analysis of cross-sectional studies. Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis, we ran searches in multiple databases, including PubMed, Web of Science, Embase, Elsevier/Science Direct, Cochrane Database, China National Knowledge Infrastructure, VIP Chinese Database, and Wanfang Data. Our searches identified 16 studies eligible for review, involving 4,920 participants across seven countries. The random-effects meta-analysis revealed a significant positive correlation between online health information seeking and health anxiety (r = 0.28, 95% confidence interval [0.16, 0.41], p < .0001), despite considerable heterogeneity. Furthermore, meta-regression analysis demonstrated that the identity characteristics of the sample, female percentage, sample size, and country all contributed to the heterogeneity across studies. Overall, this meta-analysis provides support for the association between online health information seeking and health anxiety, and helps to elucidate the cognitive - behavioral theory underpinning this phenomenon.
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Affiliation(s)
- Zhenyu Wang
- School of Government, Sun Yat-sen University
| | - Yi Hu
- Research Department III, Shenzhen Health Development Research and Data Management Center
| | - Bohan Huang
- School of Public Administration, Guangdong University of Finance
| | | | - Bei Li
- School of Health Management, Southern Medical University
| | - Zhihan Liu
- School of Public Administration, Central South University
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4
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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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Axelsson E, Hedman-Lagerlöf E. Unwanted outcomes in cognitive behavior therapy for pathological health anxiety: a systematic review and a secondary original study of two randomized controlled trials. Expert Rev Pharmacoecon Outcomes Res 2023; 23:1001-1015. [PMID: 37614181 DOI: 10.1080/14737167.2023.2250915] [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: 05/11/2023] [Accepted: 08/18/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION Cognitive behavior therapy (CBT) is effective for pathological health anxiety, but little is known about unwanted outcomes. AREAS COVERED We investigated unwanted outcomes in the form of adverse events, overall symptom deterioration, and dropouts in CBT for pathological health anxiety based on a systematic review of 19 randomized controlled trials (PubMed, PsycInfo, and OATD; last updated 2 June 2023; pooled N = 2188), and then a secondary original study of two randomized controlled trials (pooled N = 336). In the systematic review, 10% of participants in CBT reported at least one adverse event and 17% dropped out. Heterogeneity was substantial. In the original investigation, 17% reported at least one adverse event, 0-10% met criteria for overall symptom deterioration, and 10-19% dropped out. In guided Internet-delivered CBT, dropouts were more common with lower education and lower credibility/expectancy ratings. Higher adherence was associated with a larger reduction in health anxiety. EXPERT OPINION Unwanted effects are routinely seen in CBT for pathological health anxiety, but, under typical circumstances, appear to be acceptable in light of the treatment's efficacy. There is a need for more consistent methods to improve our understanding adverse events, dropouts, and overall symptom deterioration, and how these outcomes can be prevented.
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Affiliation(s)
- Erland Axelsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Liljeholmen Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Solna, Sweden
- Gustavsberg Primary Health Care Center, Region Stockholm, Gustavsberg, Sweden
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Lee J, Cho IK, Lee D, Kim K, Ahn MH, Chung S. Mediating Effects of Reassurance-Seeking Behavior or Obsession With COVID-19 on the Association Between Intolerance of Uncertainty and Viral Anxiety Among Healthcare Workers in Korea. J Korean Med Sci 2022; 37:e157. [PMID: 35638193 PMCID: PMC9151989 DOI: 10.3346/jkms.2022.37.e157] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/12/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This study explores whether the intolerance of uncertainty among healthcare workers prompts viral anxiety, and whether this association is mediated by their reassurance-seeking behavior and preoccupation with the coronavirus disease 2019 (COVID-19) in Korea. METHODS An online survey was conducted among healthcare workers in Asan Medical Center, on November 29, 2021. Demographic characteristics and responses to items from rating scales were collected, including Stress and Anxiety to Viral Epidemics-9, Coronavirus Reassurance-Seeking Behaviors Scale (CRBS), Obsession with COVID-19 Scale (OCS), Patient Health Questionnaire-9, Insomnia Severity Scale, and Intolerance of Uncertainty-12 (IUS-12). RESULTS Among the 329 participants, viral anxiety of healthcare workers was predicted by being female (β = 0.14, P = 0.002), CRBS (β = 0.30, P < 0.001), OCS (β = 0.32, P < 0.001), and IUS-12 (β = 0.15, P = 0.002) scores (adjusted R² = 0.43, F = 31.1, P < 0.001). Mediation analysis showed that the intolerance of uncertainty directly influenced viral anxiety, and reassurance-seeking behavior and obsession with COVID-19 partially mediated the association. CONCLUSION The intolerance of uncertainty among healthcare workers directly influenced their viral anxiety, and reassurance-seeking behavior and obsession with COVID-19 mediated this association in this era of "living with coronavirus" in Korea.
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Affiliation(s)
- Joohee Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Inn-Kyu Cho
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dongin Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyumin Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myung Hee Ahn
- Division of Psychiatry, Health Screening and Promotion Center, Asan Medical Center, Seoul, Korea.
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Church LD, Bounoua N, Rodriguez SN, Bredemeier K, Spielberg JM. Longitudinal relationships between COVID-19 preventative behaviors and perceived vulnerability to disease. J Anxiety Disord 2022; 88:102561. [PMID: 35378369 PMCID: PMC8959657 DOI: 10.1016/j.janxdis.2022.102561] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/19/2022] [Accepted: 03/23/2022] [Indexed: 01/12/2023]
Abstract
Engagement in infection-preventing behaviors (e.g., mask wearing) has become crucial in the context of the COVID-19 pandemic, and health-related anxiety may be an important determinant of individual compliance with recommended guidelines. However, little is known about transactional associations between health anxiety and preventative behaviors, particularly with respect to COVID-19. The present study aimed to longitudinally examine the links between preventative behaviors and both emotion-driven (Germ Aversion) and belief-based (Perceived Infectability) aspects of health anxiety during the COVID-19 pandemic. We hypothesized that greater health anxiety at Time 1 (early in the pandemic) would predict future compliance with preventative behaviors six months later. Two hundred and ninety-six adults (M/SDage= 30.9/10.9 years, 42.2% female) completed two online assessments during the COVID-19 pandemic (Time 1 =June 2020; Time 2 =December 2020). Longitudinal cross-lagged analyses revealed that initial Germ Aversion predicted greater engagement in preventative behaviors at follow-up (β = 0.16; p = <.001), over and above initial engagement in such behaviors. Similarly, initial engagement in preventative behaviors predicted increases in Germ Aversion at follow-up (β = .23; p = <.001), over and above initial Germ Aversion. The present findings indicate that affect-driven aspects of health anxiety have a complex transactional relationship with engagement in behaviors aimed at curbing the spread of the COVID-19 pandemic. Clinical and public health implications are discussed.
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Affiliation(s)
- Leah D. Church
- University of Delaware, Department of Psychological and Brain Sciences, 108 Wolf Hall, Newark, DE 19176, USA,Correspondence to: Leah D. Church, University of Delaware, Department of Psychological and Brain Sciences, 108 Wolf Hall, Newark, DE 19716, USA
| | - Nadia Bounoua
- University of Delaware, Department of Psychological and Brain Sciences, 108 Wolf Hall, Newark, DE 19176, USA
| | - Samantha N. Rodriguez
- University of New Mexico, Department of Psychology, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Keith Bredemeier
- University of Pennsylvania, Perelman School of Medicine, 3535 Market St., Philadelphia, PA 19104, USA
| | - Jeffrey M. Spielberg
- University of Delaware, Department of Psychological and Brain Sciences, 108 Wolf Hall, Newark, DE 19176, USA
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ASGHARİ M, MASOUMİ F, SHİRKHOUİİ S. The Evaluation of body dysmorphic disorder in adult orthodontic patients. CUMHURIYET DENTAL JOURNAL 2022. [DOI: 10.7126/cumudj.986021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Gorday JY, Bardeen JR. Problematic Smartphone Use Influences the Relationship Between Experiential Avoidance and Anxiety. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2022; 25:72-76. [PMID: 34652220 DOI: 10.1089/cyber.2021.0062] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Experiential avoidance (EA), an unwillingness to stay in contact with unwanted inner experiences (e.g., emotions, thoughts, and bodily sensations), has been implicated in the development and maintenance of anxiety. Individuals with high levels of EA are more likely to employ maladaptive coping strategies (i.e., avoidance behaviors), which exacerbates emotional distress and anxious arousal. As smartphone ownership has become increasingly common in recent years, problematic smartphone use (PSU) has been suggested to serve as a "safety behavior" in situations in which individuals believe that they might experience emotional discomfort. That is, individuals experiencing emotional distress and/or anxious arousal may overengage in the use of technology to relieve emotional distress. As such, the purpose of this study was to examine PSU as a moderator of the relationship between EA and anxiety. Adult participants (N = 294) recruited through Amazon's Mechanical Turk (MTurk), an online labor market, completed an online battery of self-reported measures. Results indicated that the relationship between EA and anxiety became significantly stronger as PSU increased, thereby suggesting that PSU may exacerbate the effect of EA on anxiety. These findings are a first step toward the development of risk profiles that incorporate EA and PSU. Such risk profiles may be beneficial for early identification and intervention for individuals at high risk for the development of anxiety.
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Affiliation(s)
- Julia Y Gorday
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| | - Joseph R Bardeen
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
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10
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Watt S, Salway T, Gómez-Ramírez O, Ablona A, Barton L, Chang HJ, Pedersen H, Haag D, LeMoult J, Gilbert M. Rumination, risk, and response: a qualitative analysis of sexual health anxiety among online sexual health chat service users. Sex Health 2022; 19:182-191. [DOI: 10.1071/sh21198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/23/2022] [Indexed: 11/23/2022]
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11
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Shabahang R, Aruguete MS, Rezaei S, McCutcheon LE. Psychological Determinants and Consequences of COVID-19 Anxiety: A Web-Based Study in Iran. Health Psychol Res 2021; 9:24841. [PMID: 35106395 PMCID: PMC8801565 DOI: 10.52965/001c.24841] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 09/21/2023] Open
Abstract
Pandemic illnesses such as COVID-19 can provoke negative emotions, including anxiety and depression, in addition to compulsive behaviors. Clarifying the psychosocial antecedents and consequences of COVID-19 anxiety can inform successful psychological support and treatment. This study investigated psychological predictors and consequences of COVID-19 anxiety during the outbreak of COVID-19 in Iran. University students (N = 398) completed a web-based survey measuring COVID-19 anxiety, general health anxiety, uncertainty intolerance, interpersonal trust, depression, and COVID-19-related panic shopping. The participants also responded to two additional questions: "Do you personally know of anyone who was suspected of having been infected with COVID-19?" and "Did you get sick in the past year?" Exploratory factor analysis, confirmatory factor analysis, Pearson correlation, multiple regression analysis, multivariate regression analysis, and 2 × 2 factorial ANOVA were used to analyze data. Health anxiety, uncertainty intolerance, and interpersonal trust were significantly associated with COVID-19 anxiety. COVID-19 anxiety was a significant predictor of depression and panic shopping. Participants who knew someone with COVID-19 and those who reported being sick in the past year experienced more COVID-19 anxiety. COVID-19 anxiety appears to be more severe among people with a low tolerance for uncertainty and low interpersonal trust. Understanding these risk factors can inform individualized therapeutic approaches to address the maladaptive outcomes of depression and false safety behaviors, such as panic buying.
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Barron Millar E, Singhal D, Vijayaraghavan P, Seshadri S, Smith E, Dixon P, Humble S, Rodgers J, Sharma AN. Health anxiety, coping mechanisms and COVID 19: An Indian community sample at week 1 of lockdown. PLoS One 2021; 16:e0250336. [PMID: 33882109 PMCID: PMC8059846 DOI: 10.1371/journal.pone.0250336] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 04/05/2021] [Indexed: 12/16/2022] Open
Abstract
It is critical to gain an understanding of the impact of the COVID 19 pandemic and the associated lockdown restrictions on the psychological, social and behavioural functioning of the general public, in order to inform public health promotion and future health service resource allocation. This cross-sectional study, completed during week 1 of lockdown in India, reports on data from 234 participants using an online survey. Data regarding health anxiety, coping mechanisms and locus of control was collected. Structural equation modelling was used to assess the relationship between locus of control, coping mechanisms, health anxiety and age. Age related differences in both locus of control and coping strategies were found. Younger people experienced more health-related anxiety and were more likely to engage with social media as a coping mechanism. Mindfulness-based strategies may reduce health anxiety by increasing tolerance of uncertainty experienced during the COVID 19 pandemic.
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Affiliation(s)
- Evelyn Barron Millar
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | | | | | - Shekhar Seshadri
- National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Eleanor Smith
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom.,Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Pauline Dixon
- School of Education, Communication and Language Sciences, Faculty of Humanities and Social Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Steve Humble
- School of Education, Communication and Language Sciences, Faculty of Humanities and Social Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Jacqui Rodgers
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Aditya Narain Sharma
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom.,Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
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Mousavi SM, Yazdanirad S, Jahadi Naeini M, Abbasi M, Sadeghian M. The role of individual factors on corona-induced hypochondriasis and job stress: A case study in workplace. Med J Islam Repub Iran 2021; 35:11. [PMID: 33996662 PMCID: PMC8111638 DOI: 10.47176/mjiri.35.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Given the importance of maintaining the mental health of workers, the present study was conducted to determine the effect of the individual factors on hypochondriasis and job stress under the corona epidemic condition in a company.
Methods: This cross-sectional study was performed on 275 workers in 2020 in one of the industries in southern Iran. To gather the data, demographic, researcher-made, standard hypochondria, and job stress questionnaires were sent electronically along with a guide and study objectives. The participants completed the questionnaires during 2 weeks and send them electronically to the research team. Finally, data were analyzed using tests of one-way ANOVA and linear regression in SPSS software version 22.
Results: The results showed that the mean score of hypochondriasis in different groups of variables, including age, work experience, use of personal protective equipment, corona experience, and attention to preventive measures was significantly different (p<0.05). Based on the results, the mean score of job stress significantly differed in different groups of variables of personal protective equipment use, corona experience, and awareness on corona (p<0.05). Moreover, based on the regression relationships, hypochondriasis could be predicted by variables of personal protective equipment, corona experience, awareness on corona, and attention to preventive measures; and job stress could be predicted by variables of awareness on corona and attention to preventive measures.
Conclusion: Regarding the importance of providing the physical and mental health of employees, the implementation of measures to reduce stress and hypochondriasis of employees, particularly in identified groups, is helpful.
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Affiliation(s)
- Seyed Mahdi Mousavi
- Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeid Yazdanirad
- School of Public Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mahsa Jahadi Naeini
- Department of Occupational Health Engineering, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Milad Abbasi
- Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Sadeghian
- Department of Occupational Health Engineering, School of Public Health, Ahvaz Jundi Shapour University of Medical Sciences, Ahvaz, Iran
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Trust and elderly users' continuance intention regarding mobile health services: the contingent role of health and technology anxieties. INFORMATION TECHNOLOGY & PEOPLE 2021. [DOI: 10.1108/itp-11-2019-0602] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeMobile health (mHealth) services are considered an important means of relieving the problems of the aging population. The efficiency of mHealth services can be enhanced by engaging more elderly users and guaranteeing their continued use. However, limited attention has been directed toward investigating elderly users' continuance intention regarding mHealth services. The purpose of this paper is to explain elderly users' continuance intention by investigating the contingent role of technology anxiety and health anxiety on affective trust and cognitive trust.Design/methodology/approachSurvey data were collected from 232 elderly users to verify the research model and hypotheses based on structural equation modeling (SEM).FindingsThis study revealed that both affective and cognitive trust enhance elderly users' continuance intention regarding their use of mHealth services. Health anxiety strengthens the effect of cognitive trust but weakens the effect of affective trust with regard to continuance intention. Furthermore, technology anxiety strengthens the effect of affective trust but not the effect of cognitive trust with regard to continuance intention.Originality/valueThis study is one of the first to examine elderly users' continuance intention regarding mHealth services use from the perspective of affective and cognitive trust, thus enriching the extant literature on the use of mHealth services. Additionally, this study sheds light on the contingent effects of technology anxiety and health anxiety on affective and cognitive trust, which have been neglected by previous research.
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Waqas M, Hania A, Hongbo L. Psychological Predictors of Anxious Responses to the COVID-19 Pandemic: Evidence from Pakistan. Psychiatry Investig 2020; 17:1096-1104. [PMID: 33190456 PMCID: PMC7711115 DOI: 10.30773/pi.2020.0167] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/30/2020] [Accepted: 09/20/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE COVID-19 epidemic can be associated with a variety of anxious responses and safety behaviors. The present research explored the psychological implications associated with COVID-19 during the outbreak in 2020 to date. Pakistani media has given particular attention to this outbreak in the region. METHODS Three hundred and forty-seven undergraduate university students from Pakistan completed a battery of questionnaires focusing fear of COVID-19, associated safety behaviors, factual knowledge of COVID-19, and other psychological pointers hypothesized to be as predictors of anxious responses to COVID-19 threat and associated safety behaviors. RESULTS The sample appeared to be fearful of COVID-19 and this fear was related to disgust sensitivity, anxiety sensitivity-related physical concerns, body vigilance, contamination cognitions, and general distress. Results suggested that the tendency of overestimating the severity of contamination and anxiety sensitivity towards physical concerns are significant predictors of COVID-19 related fear and consequent safety behaviors. CONCLUSION It is suggested that people with a greater concern of contamination are likely to respond fearfully to COVID-19 and that people with higher fear of COVID-19 are likely to feel contamination concerns.
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Affiliation(s)
- Muhammad Waqas
- School of Management, Jiangsu University, Zhenjiang, China
| | - Alishba Hania
- Department of Psychology, Institute of Southern Punjab, Multan, Pakistan
| | - Li Hongbo
- School of Management, Jiangsu University, Zhenjiang, China
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Katz DE, Laposa JM, Rector NA. Excessive reassurance seeking in depression versus obsessive-compulsive disorder: Cross-sectional and cognitive behavioural therapy treatment comparisons. J Anxiety Disord 2020; 75:102280. [PMID: 32805518 DOI: 10.1016/j.janxdis.2020.102280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 07/06/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
UNLABELLED Excessive reassurance seeking (ERS) has been hypothesized as an important maintenance factor in depression and obsessive compulsive disorder (OCD). The present study examined the types of ERS in depression and OCD, the effects of CBT on ERS, predictors of ERS reduction, and the relation between ERS reduction and symptom change. METHOD Treatment-seeking participants diagnosed with a depressive disorder (N = 361) or OCD (N = 156) completed the Reassurance Seeking Scale (RSS) and symptom measures before and following CBT treatment. Measures of intolerance of uncertainty and distress tolerance were completed pre-treatment as potential predictors of ERS change. RESULTS Individuals with depression demonstrated higher pre-treatment ERS related to social attachment compared to those with OCD. ERS significantly decreased over treatment in both groups and change in ERS predicted symptom change among both OCD and depression groups. Higher pre-treatment intolerance of uncertainty significantly predicted less ERS change regardless of diagnosis. Distress tolerance was not associated with ERS changes. CONCLUSION ERS is significantly related to symptom severity cross-sectionally as well as over treatment in depression and OCD, though types of ERS may differ. Higher intolerance of uncertainty may impede the reduction of ERS in CBT.
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Affiliation(s)
- Danielle E Katz
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Department of Psychiatry, Toronto, Ontario, Canada
| | - Judith M Laposa
- University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada; Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Neil A Rector
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Department of Psychiatry, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada.
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Brown RJ, Skelly N, Chew-Graham CA. Online health research and health anxiety: A systematic review and conceptual integration. ACTA ACUST UNITED AC 2020. [DOI: 10.1111/cpsp.12299] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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18
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Exploring the impact of safety behaviour use on cognitive, psychophysiological, emotional and behavioural responses during a speech task. Behav Cogn Psychother 2020; 48:557-571. [PMID: 32301412 DOI: 10.1017/s135246582000017x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND There is a debate among researchers and clinicians regarding whether the judicious use of safety behaviours (SBs) during exposure therapy is helpful or detrimental. Central to this debate is the premise that SBs may interfere with one's ability to gather disconfirmatory evidence. AIMS No study to date has assessed how SB use may impact cognitive mechanisms implicated during an exposure-like task. We investigated multiple cognitive, emotional, psychophysiological and behavioural underpinnings of exposure with and without SBs. METHOD Speech anxious participants (n = 111) were randomly assigned to deliver an evaluated speech with or without SBs. Self-reported anxiety ratings and psychophysiological arousal measures were recorded at baseline, in anticipation of the speech, and following the speech. Measures of working memory, ability to gather disconfirmatory evidence, speech duration, objective and subjective speech performance, and speech task acceptability were administered. RESULTS There were no differences between conditions on working memory, self-reported anxiety, psychophysiological arousal, ability to gather disconfirmatory evidence, speech duration, or objective and subjective speech performance. All participants were able to gather disconfirmatory evidence. However, condition did influence willingness to deliver future speeches. Our sample was largely female undergraduate students, and we offered only a small number of specific safety behaviours. CONCLUSIONS Judicious SB use may not necessarily be detrimental, but clients may believe them to be more helpful than they actually are.
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Axelsson E, Hesser H, Andersson E, Ljótsson B, Hedman-Lagerlöf E. Mediators of treatment effect in minimal-contact cognitive behaviour therapy for severe health anxiety: A theory-driven analysis based on a randomised controlled trial. J Anxiety Disord 2020; 69:102172. [PMID: 31864217 DOI: 10.1016/j.janxdis.2019.102172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/25/2019] [Accepted: 12/05/2019] [Indexed: 02/03/2023]
Abstract
Cognitive behaviour therapy (CBT) is efficacious for severe health anxiety, but little is known about mechanisms. We analysed putative mediators of change based on 13 weekly assessments in a randomised controlled trial (N = 132) of exposure-based minimal-contact CBT (guided Internet-delivered CBT, unguided Internet-delivered CBT and bibliotherapy) vs. a waitlist control for severe health anxiety. We hypothesised that the effect of CBT on health anxiety would be mediated by non-reactivity to inner experiences, health anxiety behaviours and perceived competence. We also explored somatosensory amplification. In parallel process growth models, non-reactivity, health anxiety behaviours and perceived competence - but not somatosensory amplification - were influenced by CBT and associated with health anxiety. Random intercepts cross-lagged panel models were used to study within-individual ordering of change. None of the putative mediators systematically predicted subsequent changes in health anxiety. Rather, changes in health anxiety predicted subsequent changes in all putative mediators. In summary, CBT influenced health anxiety behaviours, non-reactivity to inner experiences and perceived competence, and these variables were associated with the outcome. However, their role as mediators was not corroborated because we found no evidence that changes in these variables predicted subsequent changes in health anxiety. We encourage further research into mediators of CBT for health anxiety.
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Affiliation(s)
- Erland Axelsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Hugo Hesser
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; Center for Health and Medical Psychology, Örebro University, Örebro, Sweden
| | - Erik Andersson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; 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; Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Axelsson E, Hedman-Lagerlöf E. Cognitive behavior therapy for health anxiety: systematic review and meta-analysis of clinical efficacy and health economic outcomes. Expert Rev Pharmacoecon Outcomes Res 2019; 19:663-676. [DOI: 10.1080/14737167.2019.1703182] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Erland Axelsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Rector NA, Katz DE, Quilty LC, Laposa JM, Collimore K, Kay T. Reassurance seeking in the anxiety disorders and OCD: Construct validation, clinical correlates and CBT treatment response. J Anxiety Disord 2019; 67:102109. [PMID: 31430610 DOI: 10.1016/j.janxdis.2019.102109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/17/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Reassurance seeking has been hypothesized to be a key factor in the maintenance of anxiety and obsessive-compulsive disorders according to contemporary cognitive-behavioural therapy (CBT) approaches. The present study sought to examine the structure, clinical correlates, and malleability of reassurance seeking in the context of CBT treatment. METHODS Treatment-seeking participants (N = 738) with DSM-IV-TR (American Psychiatric Association, 2000) panic disorder with agoraphobia (PD/A), social anxiety disorder (SAD), generalized anxiety disorder (GAD), and obsessive compulsive disorder (OCD) completed the Reassurance Seeking Scale (RSS) with other symptom measures prior to and following CBT treatment. RESULTS A confirmatory factor analysis supported a three factor solution: the need to seek excessive reassurance regarding decisions, attachment and the security of relationships, and perceived general threat and anxiety. The RSS was moderately correlated with general measures of anxiety and depression as well as disorder-specific symptom scales. Further, CBT was found to produce changes in reassurance seeking across CBT treatments and these reductions were significantly associated with disorder-specific clinical improvement. CONCLUSION Reassurance seeking appears to be a common factor across anxiety disorders and its reduction in CBT treatment is associated with improved clinical outcomes.
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Affiliation(s)
- Neil A Rector
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite F327, M4N 3M5, Toronto, Canada; University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada.
| | - Danielle E Katz
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite F327, M4N 3M5, Toronto, Canada
| | - Lena C Quilty
- University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Judith M Laposa
- University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kelsey Collimore
- University of Ottawa, Department of Psychiatry, Ottawa, Ontario, Canada; The Royal Ottawa Health Care Group, Ottawa, Ontario, Canada
| | - Tatjana Kay
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite F327, M4N 3M5, Toronto, Canada
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Hartmann AS, Cordes M, Hirschfeld G, Vocks S. Affect and worry during a checking episode: A comparison of individuals with symptoms of obsessive-compulsive disorder, anorexia nervosa, bulimia nervosa, body dysmorphic disorder, illness anxiety disorder, and panic disorder. Psychiatry Res 2019; 272:349-358. [PMID: 30599438 DOI: 10.1016/j.psychres.2018.12.132] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/04/2018] [Accepted: 12/23/2018] [Indexed: 11/27/2022]
Abstract
Checking behavior (CB) occurs in a variety of disorders such as obsessive-compulsive (OCD), body dysmorphic (BDD), illness anxiety (IA), and panic disorder (PD), as well as anorexia (AN) and bulimia nervosa (BN). Etiological models of these disorders - with the exception of those for PD - postulate that CB mainly occurs in situations characterized by negative affect and serves to regulate it. We aimed to test these assumptions: N = 386 individuals with a self-reported diagnosis of one of the disorders rated their affect at baseline, directly before a remembered CB episode, during, immediately afterwards, and 15 and 60 minutes afterwards, and rated their endorsement of different functions of CB. The results show that transdiagnostically negative affect is significantly higher before CB compared to baseline, and is significantly reduced from before CB to all post-CB assessments. Reduction of negative affect and Attainment of certainty were the sole functions predicting the affective course during CB, and most prominently reported transdiagnostically. Assumptions of the etiological models were confirmed, suggesting that exposure and ritual prevention should be examined across disorders. As attainment of certainty seems to be predictive for the course of CB, this might be targeted in cognitive interventions.
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Affiliation(s)
- Andrea S Hartmann
- Faculty of Human Sciences, Department of Psychology, Division of Clinical Psychology and Psychotherapy, Osnabrück University, Knollstr. 15, 49069 Osnabrück, Germany.
| | - Martin Cordes
- Faculty of Human Sciences, Department of Psychology, Division of Clinical Psychology and Psychotherapy, Osnabrück University, Knollstr. 15, 49069 Osnabrück, Germany
| | - Gerrit Hirschfeld
- Faculty of Economics and Health, Department of Applied Psychology, Division of Research Methods and Diagnostics, University of Applied Sciences Bielefeld, Interaktion 1, 33619 Bielefeld, Germany
| | - Silja Vocks
- Faculty of Human Sciences, Department of Psychology, Division of Clinical Psychology and Psychotherapy, Osnabrück University, Knollstr. 15, 49069 Osnabrück, Germany
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Laposa JM, Hawley LL, Grimm KJ, Katz DE, Rector NA. What Drives OCD Symptom Change During CBT Treatment? Temporal Relationships Among Obsessions and Compulsions. Behav Ther 2019; 50:87-100. [PMID: 30661569 DOI: 10.1016/j.beth.2018.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 03/16/2018] [Accepted: 03/22/2018] [Indexed: 01/04/2023]
Abstract
Cognitive behavior therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD). However, less is known about how obsessions and compulsions change during treatment, either in tandem, sequentially, or independently. The current study used latent difference score analysis to show path-analytic dynamic modeling of OCD symptom change during CBT. Four competing models of the temporal relationship between obsessions and compulsions were examined: no coupling (obsessions and compulsions are not dynamically related), goal directed (obsessions lead to subsequent changes in compulsions), habit driven (compulsions lead to subsequent changes in obsessions), and reciprocal. Treatment seeking participants (N = 84) with a principal diagnosis of OCD completed 12 weeks of CBT group therapy and completed measures assessing obsession and compulsion severity at pretreatment, Sessions 4 and 8, and end of treatment. Bivariate results supported the goal directed traditional CBT model, where obsession scores are temporally associated with subsequent changes in compulsion scores. These results have implications for theoretical and treatment modelling of obsessions and compulsions in OCD treatment.
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Affiliation(s)
- Judith M Laposa
- Centre for Addiction and Mental Health, Toronto; University of Toronto.
| | - Lance L Hawley
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto; University of Toronto
| | | | - Danielle E Katz
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto
| | - Neil A Rector
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto; University of Toronto
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Horenstein A, Rogers AH, Bakhshaie J, Zvolensky MJ, Heimberg RG. Examining the Role of Anxiety Sensitivity and Intolerance of Uncertainty in the Relationship Between Health Anxiety and Likelihood of Medical Care Utilization. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9980-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Fernández-Rodríguez C, Paz-Caballero D, González-Fernández S, Pérez-Álvarez M. Activation vs. Experiential Avoidance as a Transdiagnostic Condition of Emotional Distress: An Empirical Study. Front Psychol 2018; 9:1618. [PMID: 30233461 PMCID: PMC6129770 DOI: 10.3389/fpsyg.2018.01618] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/13/2018] [Indexed: 12/21/2022] Open
Abstract
Background: From a contextual transdiagnostic approach, this study focuses on the importance of the processes of Experiential Avoidance and Activation in explaining and treating psychological problems. There exists widespread empirical evidence to suggest that the response pattern known as Experiential Avoidance, a general unwillingness to remain in contact with particular private experiences through the use of maladaptive avoidance strategies, acts as a functional dimension in various psychological problems. Activation, that is, maintaining contact with experiences/conditions of life and consequently with associated sources of reward, is a condition present in most therapeutic processes. Although a great deal of research has analyzed the relationship of the value of reward with the etiology and maintenance of psychological problems, Activation, as a transdiagnostic factor, has been studied less. The aim of this paper is to carry out an empirical study of the relationship between Activation, EA and emotional state and analyze the capacity of these two conditions to discriminate the intensity and symptomatology type in subjects with emotional distress. Methods: The Hospital Anxiety and Depression Scale (HADS), Environmental Reward Observation Scale (EROS) and Behavioral Activation for Depression Scale (BADS) were completed by 240 health center users. Results: Of the participants, 55% showed clinically relevant emotional distress. All cases of depression showed clinical anxiety. To discriminate between subjects without (n = 109) and with emotional distress (n = 131), analyses of the ROC curves and logistic regression analysis identified the BADS-Avoidance/Rumination followed by the EROS. To discriminate between subjects with anxiety but without depression (n = 61) and with anxiety and depression (n = 70), the most efficient scales were EROS followed by BADS-Social Impairment. Conclusion: It was shown that people with no emotional complaints maintained greater contact with life experiences and with environmental sources of reward than those with emotional distress. Response patterns showing Experiential Avoidance and a reduction in Activation responses were associated with clinical distress. A reduction in Activation was the condition which distinguished those people with the greatest distress and also the greatest comorbidity of symptoms of depression and anxiety. These data support the transdiagnostic nature of Activation and suggest greater attention should be paid to this concept.
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Goetz AR, Lee HJ. The continuous vs discontinuous use of restorative safety behaviors on symptoms of contamination fear: An experimental investigation. J Behav Ther Exp Psychiatry 2018; 60:53-60. [PMID: 29587170 DOI: 10.1016/j.jbtep.2018.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 03/06/2018] [Accepted: 03/18/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Cognitive-behavioral theorists posit that safety behaviors (SBs) interfere with important exposure processes and should be removed from therapy. However, there is growing evidence to suggest that restorative SBs (RSB; those that allow for full confrontation with a core threat) do not adversely affect exposure outcomes, and their implementation during exposure should be further examined. METHODS The current study evaluated exposure with the continuous use of RSB (E + CONT) versus discontinuation of RSB (E + DISC), in comparison to exposure with no RSB (ERP). Sixty-seven nonclinical participants completed 15 trials of exposure in which they touched a potentially contaminated stimulus with or without RSB. Behavioral approach tasks were completed at pretreatment, post-treatment, and two-week follow-up to examine changes in subjective distress and degree of behavioral approach. RESULTS The three conditions were not different on clinical symptoms and behavioral approach at post-treatment and follow-up, indicating that the hypothesized superiority effect of E + DISC was not supported. However, ratings obtained during repeated exposure trials indicated that E + DISC evidenced greater symptom reduction following the removal of RSB. LIMITATIONS The use of a healthy undergraduate sample and standardization of the exposure procedure. CONCLUSIONS Although findings were contrary to hypotheses, these data provide added support for the benign role of RSB as compared to conventional exposure. Furthermore, the removal of RSB may lead to more favorable process outcomes during exposure. The theoretical and clinical implications of these findings are discussed, and future directions are provided.
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Affiliation(s)
- Amy R Goetz
- University of Wisconsin-Milwaukee, 2441 E. Hartford Avenue, Milwaukee, WI 53211, United States
| | - Han-Joo Lee
- University of Wisconsin-Milwaukee, 2441 E. Hartford Avenue, Milwaukee, WI 53211, United States.
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Is Reassurance Seeking Specific to OCD? Adaptation Study of the Turkish Version of Reassurance Seeking Questionnaire in Clinical and Non-Clinical Samples. Behav Cogn Psychother 2018; 47:363-385. [PMID: 30132422 DOI: 10.1017/s1352465818000462] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND Reassurance seeking in obsessive compulsive disorder (OCD) is a kind of neutralization behaviour that causes considerable interpersonal conflicts. AIMS The purpose of this study was to conduct the adaptation of the Reassurance Seeking Questionnaire (ReSQ; Kobori and Salkovskis, 2013) into the Turkish language, and to examine its psychometric properties. Moreover, we aimed to identify the specificity of reassurance seeking to OCD, as opposed to other anxiety disorders and depression. METHOD Five groups of participants (OCD, anxiety disorders, depression, healthy control groups, and a university student sample) were administered ReSQ, Obsessive Beliefs Questionnaire, Obsessive-Compulsive Inventory-Revised Form, State and Trait Anger Expression Inventory, Guilt Inventory, Beck Depression Inventory and State Trait Anxiety Inventory-Trait Form. RESULTS The findings revealed acceptable test-retest and internal consistency coefficients, and also good construct, convergent, discriminant and criterion validity information for the Turkish version of the ReSQ scales. Results also revealed some aspects of reassurance seeking specific to OCD as opposed to other anxiety disorders and depression. CONCLUSION The results of the present study indicated a good reliability and validity information for the Turkish version of the ReSQ, supporting the cross-cultural nature of the scale.
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Leonidou C, Panayiotou G. How do illness-anxious individuals process health-threatening information? A systematic review of evidence for the cognitive-behavioral model. J Psychosom Res 2018; 111:100-115. [PMID: 29935741 DOI: 10.1016/j.jpsychores.2018.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/29/2018] [Accepted: 06/01/2018] [Indexed: 01/17/2023]
Abstract
UNLABELLED According to the cognitive-behavioral model, illness anxiety is developed and maintained through biased processing of health-threatening information and maladaptive responses to such information. OBJECTIVE This study is a systematic review of research that attempted to validate central tenets of the cognitive-behavioral model regarding etiological and maintenance mechanisms in illness anxiety. METHODS Sixty-two studies, including correlational and experimental designs, were identified through a systematic search of databases and were evaluated for their quality. RESULTS Outcomes were synthesized following a qualitative thematic approach under categories of theoretically driven mechanisms derived from the cognitive-behavioral model: attention, memory and interpretation biases, perceived awareness and inaccuracy in perception of somatic sensations, negativity bias, emotion dysregulation, and behavioral avoidance. CONCLUSIONS Findings partly support the cognitive-behavioral model, but several of its hypothetical mechanisms only receive weak support due to the scarcity of relevant studies. Directions for future research are suggested based on identified gaps in the existing literature.
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Affiliation(s)
| | - Georgia Panayiotou
- Department of Psychology, University of Cyprus, Cyprus; Center of Applied Neuroscience, University of Cyprus, Cyprus
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Abstract
This study describes treatment of an adult woman, referred to as “Carla,” who was referred for psychological intervention following bariatric surgery due to recurrent nausea and vomiting along with food avoidance. Carla evinced symptoms including dietary range restriction, failure to progress to recommended caloric intake, fear of vomiting, and body dissatisfaction. She was diagnosed with generalized anxiety disorder, along with comorbidities including dysthymia, body dysmorphia, and subsyndromal specific phobia of vomiting (SPOV). Treatment included 20 weekly sessions utilizing a transdiagnostic approach to treatment, which has been shown to be efficacious in management of multiple comorbidities. The limited body of research and results of this case suggest expansion of the criteria for avoidant restrictive food intake disorder (ARFID) to allow for inclusion of this constellation of symptoms within bariatric patients.
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Optimizing Exposure Therapy for Pathological Health Anxiety: Considerations From the Inhibitory Learning Approach. COGNITIVE AND BEHAVIORAL PRACTICE 2018. [DOI: 10.1016/j.cbpra.2017.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gropalis M, Bailer J, Weck F, Witthöft M. Optimierung von Expositionstherapie bei pathologischen Krankheitsängsten. PSYCHOTHERAPEUT 2018. [DOI: 10.1007/s00278-018-0285-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Clarifying a Construct: An Integrative Functional Model of Reassurance-Seeking Behaviors. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2018. [DOI: 10.1007/s10942-018-0291-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Abstract
Emotion reactivity, defined as heightened sensitivity, intensity, and persistence of emotional states, has been shown to contribute to the exacerbation of anxiety. However, the association between emotion reactivity and health anxiety has yet to be examined. The aim of the present investigation was to examine the unique predictive ability of emotion reactivity in terms of health anxiety in a sample of medically healthy undergraduates ( n = 194; 59.3% female, Mage = 19.42, SD = 1.51, range = 18-26 years; 84.0% Caucasian). Findings indicated that, after controlling for the effects of gender, age, and anxiety sensitivity, greater emotion reactivity significantly predicted greater overall health anxiety (3.1% variance), as well as higher levels of affective (4.1% unique variance) and behavioral (4.8% unique variance) components. Findings suggest that experiencing emotions more frequently, intensely, and for longer durations of time prior to returning to baseline are associated with greater health preoccupations.
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Thorisdottir AS, Villadsen A, LeBouthillier DM, Rask CU, Wright KD, Walker JR, Feldgaier S, Asmundson GJG. Measurement invariance across Genders on the Childhood Illness Attitude Scales (CIAS). J Psychosom Res 2017; 98:34-39. [PMID: 28554370 DOI: 10.1016/j.jpsychores.2017.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/04/2017] [Accepted: 05/05/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The Childhood Illness Attitude Scales (CIAS) were created as a developmentally appropriate measure for symptoms of health anxiety (HA) in school-aged children. Despite overall sound psychometric properties reported in previous studies, more comprehensive examination of the latent structure and potential response bias in the CIAS is needed. The purpose of the present study was to cross-validate the latent structure of the CIAS across genders and to examine gender-specific variations in CIAS scores. METHODS The sample comprised data from 602 Canadian and Danish school-aged children (Mage=10.54, SD=0.99; 52.5% girls). Confirmatory factor analyses were conducted to test 3-, modified 3-, and 4-factor models in both samples. Multigroup confirmatory factor analysis was performed to test factor structure invariance across boys and girls in a combined sample. Differential Item Functioning (DIF) was assessed using test characteristic curves. RESULTS A modified 3-factor solution (i.e., fears=11 items, help-seeking=6 items, and symptom effects=4 items) provided the best fit to the data (χ2 (364, N=602)=681.7, p<0.001; χ2/df=1.803; RMSEA=0.037; CFI=0.926). The factor structure was stable, well-fitting, and indicated measurement invariance across groups. DIF analyses revealed no gender-based response bias at the scale level. CONCLUSION Results support a revised 3-factor version of the CIAS that can be used with confidence to assess symptoms of HA in school-aged boys and girls.
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Affiliation(s)
| | - Anna Villadsen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Charlotte Ulrikka Rask
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Denmark
| | - Kristi D Wright
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - John R Walker
- Department of Clinical Health Psychology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Steven Feldgaier
- Department of Clinical Health Psychology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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An Examination of the Indirect Effect of Intolerance of Uncertainty on Health Anxiety Through Anxiety Sensitivity Physical Concerns. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2017. [DOI: 10.1007/s10862-017-9613-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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36
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Tully S, Wells A, Morrison AP. An exploration of the relationship between use of safety-seeking behaviours and psychosis: A systematic review and meta-analysis. Clin Psychol Psychother 2017. [PMID: 28636201 DOI: 10.1002/cpp.2099] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Safety-seeking behaviours are responses employed to protect against perceived threat. In relation to anxiety disorders, safety-seeking behaviours have been implicated in both the formation and maintenance of distress. Several studies have highlighted similar findings in relation to psychosis; however, this literature has not yet been synthesized. This review is, therefore, being conducted in order to synthesize the literature on safety seeking in people with psychosis to increase the understanding of this relationship. A systematic search identified and included 43 studies comprising 2,592 participants, published between 1995 and 2015. The results indicated that people experiencing psychosis commonly respond to their experiences with behavioural and cognitive strategies intended to manage their difficulties. In relation to safety seeking, avoidance, and resistance, there was a pattern that these responses are associated with increased distress and appraisals of threat. The results relating to engagement response styles showed the opposite pattern. These results provide support for cognitive models of safety seeking and psychosis with many of the meta-analyses reported here showing a clear pattern of association between behavioural responses and distress. However, the results reported within individual studies are mixed. This appears to be particularly true with the response style of distraction, with our analyses unable to clarify this relationship. It is possible that the mixed results could reflect the complexities in defining safety seeking and distinguishing it from coping in this population. The clinical implications of this are discussed.
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Affiliation(s)
- Sarah Tully
- The University of Manchester, Manchester, UK.,The Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Prestwich, UK
| | | | - Anthony P Morrison
- The University of Manchester, Manchester, UK.,The Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Prestwich, UK
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Halldorsson B, Salkovskis PM. Why Do People with OCD and Health Anxiety Seek Reassurance Excessively? An Investigation of Differences and Similarities in Function. COGNITIVE THERAPY AND RESEARCH 2017; 41:619-631. [PMID: 28751797 PMCID: PMC5504131 DOI: 10.1007/s10608-016-9826-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Excessive reassurance seeking (ERS) is commonly reported in patients who have OCD or health anxiety. Despite its prevalence and associated risk of ongoing difficulties, little is known about the function of ERS. It has been conceptualised as a type of compulsive checking behaviour, but could also be seen as being a supportive maneuver. This study offers a new approach towards defining ERS and support seeking (SS), and similarities between these two constructs in a sample of OCD and health anxious patients. A semi-structured interview was employed. Participants reflected on the nature and goals of their reassurance and support seeking-its impact on themselves and other people. Twenty interviews were conducted, transcribed and analysed in accordance to framework thematic analysis. Six overarching themes were identified in terms of ERS and five for SS. Results revealed limited diagnosis specificity of ERS. Strikingly, participants with health anxiety did not report seeking support.
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Affiliation(s)
- Brynjar Halldorsson
- Department of Psychology, University of Bath, Bath, UK
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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38
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Villadsen A, Thorgaard MV, Hybel KA, Jensen JS, Thomsen PH, Rask CU. Health anxiety symptoms in children and adolescents diagnosed with OCD. Eur Child Adolesc Psychiatry 2017; 26:241-251. [PMID: 27357512 DOI: 10.1007/s00787-016-0884-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/21/2016] [Indexed: 11/30/2022]
Abstract
Health anxiety (HA) is an overlooked area in paediatric research. Little is known about the occurrence of HA symptoms in a child and adolescent psychiatric setting, and there are no age-appropriate diagnostic criteria and only limited number of assessment tools. It is therefore likely that HA is seen as part of obsessive-compulsive disorder (OCD) due to construct overlap and the diagnostic uncertainty of HA in this age group. In the present study, the extent of HA symptoms was investigated in 94 children and adolescents with a primary ICD-10 diagnosis of OCD. Self-reported HA symptoms were assessed using the Childhood Illness Attitude Scales. Clinician-rated OCD symptoms and severity were measured using the Children's Yale Brown Obsessive Compulsive Scale. Information on socio-demographics was obtained from the child's/adolescent's medical record. The distribution of HA symptoms resembled a normal curve shifted to the right compared with a normal population of Danish children, and 30 % presented with high HA symptoms. Chi-squared tests were used to examine the proportion of children and adolescents with high HA symptoms in relation to various clinical characteristics. Clinician-rated illness worries and comorbid anxiety disorder were associated with high self-reported HA symptoms. The results contribute to the understanding of how HA and OCD overlap conceptually in young patients and bring attention to the need for improved recognition of OCD patients dominated by illness worries. Further research in the description of childhood HA is important in order to understand whether HA is a distinct disorder early in life.
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Affiliation(s)
- Anna Villadsen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus C, Denmark. .,Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus C, Denmark.
| | - Mette V Thorgaard
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus C, Denmark
| | - Katja A Hybel
- Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus C, Denmark
| | - Jens Søndergaard Jensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus C, Denmark
| | - Per H Thomsen
- Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus C, Denmark
| | - Charlotte U Rask
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus C, Denmark.,Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus C, Denmark
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Doherty-Torstrick ER, Walton KE, Barsky AJ, Fallon BA. Avoidance in hypochondriasis. J Psychosom Res 2016; 89:46-52. [PMID: 27663110 DOI: 10.1016/j.jpsychores.2016.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 07/07/2016] [Accepted: 07/17/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED The DSM-5 diagnosis of illness anxiety disorder adds avoidance as a component of a behavioral response to illness fears - one that was not present in prior DSM criteria of hypochondriasis. However, maladaptive avoidance as a necessary or useful criterion has yet to be empirically supported. METHODS 195 individuals meeting DSM-IV criteria for hypochondriasis based on structured interview completed a variety of self-report and clinician-administered assessments. Data on maladaptive avoidance were obtained using the six-item subscale of the clinician-administered Hypochondriasis - Yale Brown Obsessive Compulsive Scale - Modified. To determine if avoidance emerged as a useful indicator in hypochondriasis, we compared the relative fit of continuous latent trait, categorical latent class, and hybrid factor mixture models. RESULTS A two-class factor mixture model fit the data best, with Class 1 (n=147) exhibiting a greater level of severity of avoidance than Class 2 (n=48). The more severely avoidant group was found to have higher levels of hypochondriacal symptom severity, functional impairment, and anxiety, as well as lower quality of life. CONCLUSION These results suggest that avoidance may be a valid behavioral construct and a useful component of the new diagnostic criteria of illness anxiety in the DSM-5, with implications for somatic symptom disorder.
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Affiliation(s)
| | | | - Arthur J Barsky
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
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40
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The curious case of cyberchondria: A longitudinal study on the reciprocal relationship between health anxiety and online health information seeking. J Anxiety Disord 2016; 43:32-40. [PMID: 27497667 DOI: 10.1016/j.janxdis.2016.07.009] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 07/20/2016] [Accepted: 07/28/2016] [Indexed: 11/21/2022]
Abstract
The current study is the first to longitudinally investigate the reciprocal relationship between online health information seeking and health anxiety, i.e., cyberchondria. Expectations were that health anxious individuals who go online to find health information, experience an increase in health anxiety, which in turn will reinforce online seeking. A 4-wave longitudinal survey study among 5322 respondents aged 16-93 was conducted. Our results showed that individuals who are more health anxious than others, search online for health information more. Moreover, the results provided initial evidence for the expected reciprocal relationship between health anxiety and online health information seeking in respondents with non-clinical levels of health anxiety at the start of the study. However, this reciprocal relationship could not be found in a subsample of clinically health anxious individuals. Although for these individuals online health information seeking did not seem to exacerbate health anxiety levels, it might still serve as a maintaining factor of clinical health anxiety.
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Roberts-Collins C. A Case Study of an Adolescent With Health Anxiety and OCD, Treated Using CBT: Single-Case Experimental Design. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2016; 29:95-104. [PMID: 27222495 DOI: 10.1111/jcap.12136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PROBLEM The sparse research evidence base for adolescents with health anxiety proposes a challenge in the treatment of such mental health difficulties. Similarities are drawn between health anxiety and obsessive-compulsive disorder (OCD) in terms of their development and maintenance. The literature is reviewed and discussed in relation to the referral, assessment, formulation, cognitive behavioral intervention, and treatment outcome. METHODS The case of an adolescent girl (aged 15 years) who presented with significant levels of health anxiety and OCD is described. An adult cognitive behavioral model of health anxiety was adapted and integrated with evidence-based cognitive behavioral therapy (CBT) for children and adolescents with OCD. These models were used to collaboratively conceptualize the young person's presenting difficulties. A single-case experimental design was employed to assess the effectiveness of the intervention. FINDINGS AND CONCLUSION Routine outcome measures demonstrated the effectiveness of the OCD intervention, and the need for further research in health anxiety in young people, including the development of disorder and age-specific measures. The implications for the use of CBT to treat health anxiety for young people are discussed.
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Bardeen JR, Fergus TA. The interactive effect of cognitive fusion and experiential avoidance on anxiety, depression, stress and posttraumatic stress symptoms. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2016. [DOI: 10.1016/j.jcbs.2016.02.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Goetz AR, Davine TP, Siwiec SG, Lee HJ. The functional value of preventive and restorative safety behaviors: A systematic review of the literature. Clin Psychol Rev 2015; 44:112-124. [PMID: 26776082 DOI: 10.1016/j.cpr.2015.12.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 12/23/2015] [Accepted: 12/25/2015] [Indexed: 11/19/2022]
Abstract
Safety behaviors are unnecessary actions used to prevent, escape from, or reduce the severity of a perceived threat. Most cognitive-behavioral theorists posit that the use of safety behaviors during exposure is maladaptive because they interfere with fear reduction. However, there is growing evidence suggesting that the use of safety behaviors can facilitate exposure. In general, the findings are mixed as to whether safety behaviors should be made available during exposure-based interventions. The aim of the current review was to evaluate whether safety behaviors should be made accessible during exposure, and whether under certain circumstances, they facilitate or hinder important exposure outcomes. We examined two functional types of safety behaviors: preventive and restorative. A thorough review of the safety behavior literature from the last three decades was conducted. The evidence suggests (restorative) safety behaviors that allow for full confrontation with a core threat do not interfere with meaningful indicators of successful exposure, whereas (preventive) safety behaviors that hinder engagement with the stimulus or experience may weaken exposure outcomes. The theoretical and clinical implications of these findings are discussed and future directions in the investigation of safety behaviors are suggested.
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Affiliation(s)
- Amy R Goetz
- University of Wisconsin-Milwaukee, United States
| | | | | | - Han-Joo Lee
- University of Wisconsin-Milwaukee, United States.
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44
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Kraus N, Lindenberg J, Zeeck A, Kosfelder J, Vocks S. Immediate Effects of Body Checking Behaviour on Negative and Positive Emotions in Women with Eating Disorders: An Ecological Momentary Assessment Approach. EUROPEAN EATING DISORDERS REVIEW 2015; 23:399-407. [DOI: 10.1002/erv.2380] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 04/24/2015] [Accepted: 05/24/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Nicole Kraus
- Department of Clinical Psychology and Psychotherapy; University of Osnabrück; Germany
| | - Julia Lindenberg
- Department of Psychiatry and Psychotherapy; University Medical Center Freiburg; Germany
| | - Almut Zeeck
- Department of Psychiatry and Psychotherapy; University Medical Center Freiburg; Germany
| | - Joachim Kosfelder
- Department of Social and Cultural Sciences; University of Applied Sciences Düsseldorf; Germany
| | - Silja Vocks
- Department of Clinical Psychology and Psychotherapy; University of Osnabrück; Germany
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Tracing "Fearbola": Psychological Predictors of Anxious Responding to the Threat of Ebola. COGNITIVE THERAPY AND RESEARCH 2015; 39:816-825. [PMID: 32214559 PMCID: PMC7088101 DOI: 10.1007/s10608-015-9701-9] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Serious illnesses such as Ebola are often highly publicized in the mass media and can be associated with varying levels of anxiety and compensatory safety behavior (e.g., avoidance of air travel). The present study investigated psychological processes associated with Ebola-related anxiety and safety behaviors during the outbreak in late 2014. Between October 30 and December 3, 2014, which encompassed the peak of concerns and of the media’s attention to this particular outbreak, 107 university students completed a battery of measures assessing fear of Ebola, performance of safety behaviors, factual knowledge of the virus, and psychological variables hypothesized to predict Ebola-related fear. We found that while our sample was generally not very fearful of contracting Ebola, the fear of this disease was correlated with general distress, contamination cognitions, disgust sensitivity, body vigilance, and anxiety sensitivity-related physical concerns. Regression analyses further indicated that anxiety sensitivity related to physical concerns and the tendency to overestimate the severity of contamination were unique predictors of both Ebola fear and associated safety behaviors. Implications for how concerns over serious illness outbreaks can be conceptualized and clinically managed are discussed.
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47
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Olatunji BO. Selective effects of excessive engagement in health-related behaviours on disgust propensity. Cogn Emot 2014; 29:882-99. [DOI: 10.1080/02699931.2014.951314] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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48
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Olatunji BO, Kauffman BY, Meltzer S, Davis ML, Smits JAJ, Powers MB. Cognitive-behavioral therapy for hypochondriasis/health anxiety: a meta-analysis of treatment outcome and moderators. Behav Res Ther 2014; 58:65-74. [PMID: 24954212 DOI: 10.1016/j.brat.2014.05.002] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/12/2014] [Accepted: 05/16/2014] [Indexed: 10/25/2022]
Abstract
The present investigation employed meta-analysis to examine the efficacy of cognitive-behavioral therapy (CBT) for hypochondriasis/health anxiety as well as potential moderators that may be associated with outcome. A literature search revealed 15 comparisons among 13 randomized-controlled trials (RCTs) with a total sample size of 1081 participants that met inclusion criteria. Results indicated that CBT outperformed control conditions on primary outcome measures at post-treatment (Hedges's g = 0.95) and at follow-up (Hedges's g = 0.34). CBT also outperformed control conditions on measures of depression at post-treatment (Hedges's g = 0.64) and at follow-up (Hedges's g = 0.35). Moderator analyses revealed that higher pre-treatment severity of hypochondriasis/health anxiety was associated with greater effect sizes at follow-up visits and depression symptom severity was significantly associated with a lower in effect sizes at post-treatment. Although effect size did not vary as a function of blind assessment, smaller effect sizes were observed for CBT vs. treatment as usual control conditions than for CBT vs. waitlist control. A dose response relationship was also observed, such that a greater number of CBT sessions was associated with larger effect sizes at post-treatment. This review indicates that CBT is efficacious in the treatment of hypochondriasis/health anxiety and identifies potential moderators that are associated with outcome. The implications of these findings for further delineating prognostic and prescriptive indicators of CBT for hypochondriasis/health anxiety are discussed.
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Affiliation(s)
| | | | - Sari Meltzer
- Department of Psychology, Vanderbilt University, United States
| | - Michelle L Davis
- Department of Psychology, University of Texas-Austin, United States
| | - Jasper A J Smits
- Department of Psychology, University of Texas-Austin, United States
| | - Mark B Powers
- Department of Psychology, University of Texas-Austin, United States
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Bardeen JR, Fergus TA, Orcutt HK. The Moderating Role of Experiential Avoidance in the Prospective Relationship Between Anxiety Sensitivity and Anxiety. COGNITIVE THERAPY AND RESEARCH 2014. [DOI: 10.1007/s10608-014-9614-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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50
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Abstract
Hypochondriasis is characterized by intensive fears of serious disease. Most patients with hypochondriasis worry about physical diseases like cancer, although in rare cases, patients report severe fears of mental disorders (e.g., schizophrenia), a phenomenon described in the literature as mental hypochondriasis. However, little is known about this rare subtype of hypochondriasis and experts have questioned whether mental hypochondriasis has much in common with the type of hypochondriasis in which somatic diseases are the focus of preoccupation. This paper presents, a case report of a woman with a fear of schizophrenia, which was treated with cognitive therapy. This patient fulfills the DSM-IV criteria of hypochondriasis and exhibits many characteristics (e.g., selective attention, safety behavior) considered to be maintaining factors in well-established cognitive-behavioral models of hypochondriasis. Cognitive treatment strategies for hypochondriasis (e.g., attention training, behavioral experiments) also proved effective in this case of mental hypochondriasis.
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