Academic journal article Journal of Cognitive Psychotherapy

Interoceptive Exposure in the Treatment of Health Anxiety and Hypochondriasis

Academic journal article Journal of Cognitive Psychotherapy

Interoceptive Exposure in the Treatment of Health Anxiety and Hypochondriasis

Article excerpt

The experience of health anxiety is seen in a range of different anxiety and somatoform disorders. Bodily sensations are often cues for anxiety or emotional distress in persons with problems with health anxiety and hypochondriasis. In treating these problems, there are advantages to including interoceptive exposure (IE) as a component of treatment. We explore the frequency of problems with bodily symptoms in community and clinical populations, the assessment of physical symptoms, and the theoretical rationale for the use of IE in treatment. This exposure strategy involves deliberately and repeatedly producing feared bodily sensations. Given that some of the anxiety-producing symptoms commonly seen in health anxiety are difficult to produce voluntarily, we also have clients use strategies involving deliberately focusing on existing bothersome sensations and using imaginal techniques to simulate body sensations. The goal of IE is to help the individual to be more accepting of and less distressed by the uncomfortable bodily symptoms. The integration of this approach with other treatment components for health anxiety, such as cognitive reappraisal, exposure to feared thoughts and behaviors, and reducing avoidance, is emphasized. Detailed guidelines for the application of IE with health anxiety are provided.

Keywords: health anxiety; exposure; cognitive-behavior therapy; somatic symptoms

Historically, health anxiety has been viewed as resistant to treatment. Research over the past 20 years, however, suggests that cognitive-behavioral approaches for this problem are effective and durable. Interventions for health anxiety that focus on exposure may be particularly important for several reasons (Furer & Walker, 2005). First, exposure approaches are straightforward and relatively easy to teach to clients and clinicians. They work well even with adults with limited education or verbal skills and with children. Second, extinction, which is facilitated by exposure, has been found to be an important part of the anxiety reduction process. Third, the basic research on processes involved in fear, fear reduction, and the return of fear suggests that exposure to a wide range of the cues and contexts where anxiety has been experienced may have some advantage in reducing relapse rates over the long run (Bouton, 2002).

Interoceptive exposure (IE) is a strategy with particularly interesting potential in the treatment of health anxiety. We use a broader application of this procedure to incorporate not just the classic IE exercises (e.g., hyperventilation, spinning) but also strategies involving deliberately focusing on existing bothersome sensations and using imaginal techniques to simulate body sensations that occur infrequently and are difficult to produce voluntarily. These approaches are outlined here. Our group incorporates IE as part of a comprehensive treatment approach to health anxiety (Furer, Walker, & Stein, 2007). Taylor and Asmundson (2004) also advocate the use of IE in their book on treating health anxiety. In this article, we consider the rationale for the use of this exposure technique with health anxiety, describe practical approaches to the use of IE, and consider future research that might clarify the contribution made by this component of treatment.

UNDERSTANDING HEALTH ANXIETY

Health is one of the most important sources of security in life, affecting our ability to work and to care for ourselves and our families. Health anxiety may be triggered by experiences such as everyday symptoms (a skipped heartbeat, a headache, or the illness associated with common cold and gastrointestinal viruses), a threatening experience such as finding a breast lump, or coping with the illness or death of a loved one (Barsky & Klerman, 1983). Anxiety may also be triggered by stories about health issues in the community or media. Worries may be mild and transient (Kellner, 1987), or they may have a more severe and chronic course, waxing and waning over time. …

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