CBT for health anxiety

Domain II · Behavioural & cognitive · Helen Tyrer, Paul Salkovskis, Warwick · 1986

What it is

CBT-HA treats persistent, excessive worry about having or developing serious illness. This includes people who also have real medical conditions, seen in or near medical clinics (cardiology, respiratory, gastroenterology, neurology, endocrine, genitourinary).

Format

• Format (CHAMP version).
• Individual sessions, planned at 5–10 × 60 min. In practice the range was 4–10 sessions over 2–4 months, with a mean of about six.

Who practises it, and how they are trained or regulated

• Therapists in the trials were nurses, graduate research workers, trainee psychologists and other health professionals. Training was two all-day workshops plus a written handout of the essentials, then fortnightly supervision from a CBT-HA-trained practitioner.

Evidence status, as the guide reports it

• Core idea of change: the bodily sensations are real. Health anxiety comes from misreading normal or benign sensations, signs and medical information as evidence of serious disease. Several processes then keep the anxiety going:

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• the same issues as the pie chart. Working: a shift in where the client places themselves.
• goals that are really requests for more reassurance. Working: goals are observable and are being met step by step.
• splitting between clinicians, and clinicians ordering tests to settle anxiety. Working: fewer unplanned contacts and a consistent message.
• tasks done but carried out with safety behaviours, and tasks not done at all (see section 5). Working: homework is completed and generates surprises.
• the client wanting certainty before trying. Point out that 100% certainty is not available about anyone's health. Working: belief in B rises and behaviour shifts.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.