A Case Study of Individually Delivered Mindfulness-Based Cognitive Behavioral Therapy for Severe Health Anxiety☆

https://doi.org/10.1016/j.cbpra.2016.10.001Get rights and content

Highlights

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    Mindfulness-Based Cognitive Therapy (MBCT) has evidence to reduce health anxiety

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    MBCT has only been examined as a group therapy for health anxiety

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    This case study is the first to examine individual MBCT for health anxiety

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    It was feasible to treat health anxiety symptoms with individual MBCT

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    Controlled trials of individual MBCT for health anxiety are warranted

Abstract

Health anxiety involves persistent worry about one's physical health, despite medical reassurance. Cognitive-behavioral therapy (CBT) is currently the most widely used, evidence-based treatment for health anxiety. Mindfulness-based cognitive therapy (MBCT) is an evidence-based cognitive-behavioral treatment approach that may be useful for health anxiety due to its focus on nonjudgmental awareness and acceptance of physical and emotional events. MBCT has largely been evaluated in a group format; however, the majority of outpatient CBT providers rely also on individual treatments. No research to date has examined the utility of MBCT delivered as an individual therapy for patients with health anxiety. The purpose of the current case study is to describe the delivery, acceptability, and effects of an individually delivered mindfulness-based cognitive-behavioral intervention on health anxiety symptoms for a young woman with severe health anxiety referred to outpatient behavioral medicine by her primary care provider. The treatment was a 16-session, patient-centered intervention largely delivered using MBCT techniques, supplemented by traditional cognitive-behavioral techniques. The patient completed a validated self-report measure of health anxiety symptoms (SHAI) at the beginning of each session. The treatment was found to be acceptable, as evidenced by high treatment attendance and patient feedback. The patient reported significant cognitive, affective, and behavioral improvements, including a 67% reduction in medial visits. Health anxiety scores on the SHAI showed a 52% decrease from the first to last session, reliable change index score of 12.11, and fell below the clinical cutoff at the final session, demonstrating clinical significance. These results suggest that it is feasible to adapt MBCT for the individual treatment of health anxiety, and that controlled trials of individual MBCT are warranted.

Section snippets

Patient Characteristics

The patient’s identifying information has been altered to protect confidentiality. “Brooke,” a married Caucasian woman in her early 30s from the Midwestern United States with no prior psychiatric history and no current medical comorbidities, self-referred to therapy, with encouragement from her family and primary care provider (PCP), for the treatment of health anxiety symptoms that were negatively impacting her mood, interpersonal relationships, and overall psychosocial functioning. Specific

Acceptability

The current treatment was highly acceptable to Brooke as evidenced by high treatment attendance and patient feedback. Brooke participated in 16 sessions of treatment over approximately a 5-month period, with consistent and on-time attendance throughout, and only one missed session. Brooke was regularly engaged in the treatment, completing almost all of her assigned homework and independently seeking out ways to facilitate her mindfulness practice (e.g., downloading her own smartphone

Discussion

The current study is the first to report the implementation of an individually delivered mindfulness-based intervention for the treatment of health anxiety in an individual therapy setting. Results suggest that the current treatment was acceptable and feasible for reducing health anxiety symptoms in a young woman with severe health anxiety. These findings are congruent with prior pilot studies that examined the group MBCT protocol for health anxiety, and they extend previous research by

References (45)

  • J.S. Abramowitz et al.

    The short health anxiety inventory: Psychometric properties and construct validity in a non-clinical sample

    Cognitive Therapy and Research

    (2007)
  • American Psychiatric Association

    Diagnostic and statistical manual of mental disorders

    (2000)
  • American Psychiatric Association

    Diagnostic and statistical manual of mental disorders

    (2013)
  • J. Bailer et al.

    Health anxiety and hypochondriasis in the light of DSM-5

    Anxiety, Stress, & Coping

    (2016)
  • A.J. Barsky et al.

    Cognitive behavior therapy for hypochondriasis. A randomized trial

    Journal of the American Medical Association

    (2004)
  • A.J. Barsky et al.

    Resource utilization of patients with hypochondriacal health anxiety and somatization

    Medical Care

    (2001)
  • E.S. Behar et al.

    Psychotherapy Outcome Research

  • S.R. Bishop et al.

    Mindfulness: A proposed operational definition

    Clinical Psychology: Science and Practice

    (2004)
  • S. Bowen et al.

    Mindfulness-based relapse prevention for additive behaviors: A clinician’s guide

    (2011)
  • M. Faramarzi et al.

    A RCT of psychotherapy in women with nausea and vomiting of pregnancy

    Human Reproduction

    (2015)
  • G.G. Ferszt et al.

    The impact of a mindfulness based program on perceived stress, anxiety, depression and sleep of incarcerated women

    International Journal of Environmental Research and Public Health

    (2015)
  • A. Greeven et al.

    Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a randomized controlled trial

    American Journal of Psychiatry

    (2007)

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    The authors have no conflicts of interest to disclose.

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    © 2016 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd.