Hypochondria Treatments

Hypochondria, known as illness anxiety disorder (according to DSM-5), implies worry and fear of having or the conviction of having a serious illness based on the personal interpretation of symptoms. This concern persists despite the medical examinations performed and lasts at least 6 months – a necessary requirement for diagnosis. It is estimated that between 1-5% of the population suffers from hypochondria, according to DSM-5 data.

Hypochondria treatments from a psychotherapeutic perspective (that is, psychological treatments), focus on working on the bodily sensations that the patient experiences, their erroneous interpretation and the experience of them.

The best known authors in the field of hypochondria treatment are: Barsky et al, who focused on a component called “somatic amplifiers” (when the person fixes on a sensation and amplifies it) and Warwick and Salkovskis, who are very focused in the cognitive perspective of the disorder.

In this article, we will list the most effective psychological treatments for hypochondria according to the Guide to effective psychological treatments  by M. Pérez (2010), one of the reference manuals in mental health. We have classified them according to their work orientation / typology.

As we will see, most hypochondria treatments, from a psychological perspective, focus on working on the patient’s dysfunctional beliefs and thoughts associated with their health / disease state. On the other hand, most of them share the following two elements as part of the therapy: techniques to reduce anxiety and reattribution of symptoms (such as exercise / technique).

Treatments for cognitive-behavioral hypochondria

Cognitive-behavioral treatments for hypochondria are the most used for this psychological disorder. According to the Guide to effective psychological treatments  by M. Pérez (2010), these present a type 2 efficacy, which means that they are “probably effective” in treating said problem. Next, we are going to know the most important treatments that we find within the cognitive-behavioral sphere:

Warwick and Salkovskis treatment

Warwick and Salkovskis (1989, 1990) propose one of the most widely used hypochondria treatments from a cognitive-behavioral perspective.

Its main purpose is to teach the patient to formulate his problem according to the theoretical model that supports said treatment; on the other hand, the patient will have to identify his erroneous beliefs and automatic thoughts about illness and health. The core elements of Warwick and Salkovskis cognitive-behavioral treatment are as follows:

• Obtaining the commitment of the patient.
• Self-observation of health anxiety episodes.
• Reattribution of symptoms.
• Changing maladaptive behaviors through behavioral procedures (eg, response prevention).
• Modification of dysfunctional beliefs about health / disease.

Treatment of Martínez and Botella (1997)

Another of the most validated hypochondria treatments to date is the one proposed by Martínez and Botella (1997) from a cognitive-behavioral perspective as well.

These authors developed a treatment protocol structured in 10 sessions, weekly and one hour long. The treatment program they propose is developed in three well differentiated phases:

• In phase one, the formulation of the model is carried out and the patient’s commitment is obtained (sessions 1 and 2).

• In the second phase of treatment, intervention strategies are used (sessions 3-8).
• Finally, in phase three the prevention of relapses is worked (sessions 9 and 10).

Hypochondria treatments focused on cognitive-perceptual deficits

In the first place, it is worth mentioning that this type of hypochondria treatment, as its name suggests, is focused on the cognitive-perceptual deficits that the person manifests during the disorder and that to a large extent are the cause of its symptoms (according to some theories). Within this group of treatments, the one proposed by Barsky et al. (1988).

It is a brief group treatment (6-8 patients), focused on the here and now and directive typology. Its objective is to enhance the possible dynamic understanding of the origins of the syndrome. In this way, the following elements or factors are worked on:

• Attention and relaxation.
• Thoughts and reattribution.
• The situational context.
• The role of mood.

Behavioral hypochondria treatments

As a validated behavioral treatment of hypochondria, we find that of Avia (1993). Through this treatment, the patient (and their family members) are offered precise information about their problem and about the treatment to follow (psychoeducation). In addition, the treatment includes another series of elements and techniques:

• Task scheduling and prohibitions.
• Live exposure to bodily sensations.
• Training in anxiety management techniques.
• In vivo and imagined flooding with the possibility of serious illness or death.
• Improved self-esteem.
• Training in assertion techniques.
• Addressing conflictive areas of the patient’s life.

Programs focused on attitudes

Finally, we have the programs focused on attitudes. In this group of hypochondria treatments we find the House program (1989), in which a series of objectives are worked on. These objectives are worked on jointly with the patient and these focus on their dysfunctional beliefs and their bodily sensations and experiences. Its about:

• Identification of attributional errors.
• Confrontation with those mistakes.
• Reattribution of perceived bodily experience.

Other treatments for hypochondria

We have listed the most effective hypochondria treatments to date. However, they are not the only ones: psychodynamic therapy is also used to combat this disorder (according to M. Pérez, it consists of a treatment in an experimental phase, with type 3 efficacy) and pharmacotherapy (the same happens as with the previous one). In the pharmacotherapy part, psychotropic drugs such as anxiolytics are often used, for example.

Finally, we also find another treatment, not listed above: the treatment of Kellner and Marks disease phobia. Through their method, the authors propose a treatment to treat hypochondria in the same way that a multiple phobic disorder would be treated.

Hypochondria: a possible explanation

As we have seen, there are many treatment options when dealing with an anxiety disorder due to illness, better known as hypochondria. This problem affects 1-5% of the population, which is a figure to take into account. In addition, this figure increases in the outpatient population, standing at 2-7%. On the other hand, the prevalence is the same in men and women. 

But why do hypochondria treatments affect so much the reattribution of symptoms and dysfunctional thoughts associated with physical sensations? This has a lot to do with the origin of the disorder; Thus, regarding its etiology, although it is true that there are several theories that explain its origin, one of the best known is the cognitive model of the development of hypochondria by Warwick and Salkovskis (1990), authors already mentioned.

According to this model, hypochondria would begin with a previous experience of own illness, family or medical error ; As a result of living such a situation, the person would begin to form a series of dysfunctional mental assumptions.

Subsequently, when a critical incident occurs (for example: a symptom that suggests “X” disease), the previous dysfunctional assumptions would automatically be activated. Once these assumptions are activated, and always according to the model, negative automatic thoughts and images would appear in the person’s mind that would cause said anxiety about health (and therefore, about getting sick).