Review of Treating Health Anxiety: A Cognitive-Behavioral Approach.

Abstract

STEVEN TAYLOR and GORDON J. G. ASMUNDSON Treating Health Anxiety: A Cognitive-Behavioral Approach New York: Guilford Press, 2004, 307 pages (ISBN 1-57230-998-9, US$35.00 Hardcover) Health anxiety had been somewhat neglected for years as it by nature evades clear diagnostic boundaries, wavering between a somatoform disorder, an anxiety disorder, and in some cases, a delusional disorder. Recently, the topic of health anxiety has received increasing attention, primarily from leaders in the anxiety disorders field, as reflected in the growing literature on the topic. Treating Health Anxiety: A Cognitive-Behavioral Approach is a timely and much needed addition to this area that will appeal to both clinicians and researchers alike. Taylor and Asmundson, both well published in this area, have done a fine job producing a comprehensive book on health anxiety that is well written, interesting, and provides broad coverage of the nature, assessment, and treatment of health anxiety. The use of case examples throughout and the relatively short chapters certainly make this an interesting and quick read. Although there are several theoretical perspectives on health anxiety in the literature, Taylor and Asmundson have grounded their approach in empirical research. This book will be especially useful for clinicians treating the full range of health anxiety, including hypochondriasis, disease phobia, somatic delusion, or any disorder characterized by excessive anxiety about one's health. The book is very well organized and the chapters follow a logical order. The first part of the book presents a thorough review of the literature on health anxiety in terms of descriptive features, assessment issues, and a conceptual model for the development and maintenance of health anxiety. Chapter 1 presents an interesting discussion of the nature of health anxiety. Given that health anxiety exists on a continuum, useful guidelines for distinguishing adaptive and maladaptive presentations are provided. Clinical features for the various forms of health anxiety are well described and there is attention to the issues pertinent to diagnostic assessment and conceptualization. Useful descriptive information on health anxiety is also provided, including the personal and economic costs, prevalence, onset, course, and cultural considerations. In Chapter 2, Taylor and Asmundson present a comprehensive model for understanding the various components (biological, environmental, cognitive, and behavioural) that play a role in the perpetuation and maintenance of excessive health anxiety. They review the empirical research for each of these factors. The schematic diagram of the model is very useful for the clinician although it may be somewhat busy and confusing to present directly to patients. Chapter 3 nicely brings together the research on behavioural factors and their consequences in the maintenance of health anxiety. Specific focus is placed on four common maladaptive coping strategies: reassurance seeking, checking, reliance on safety cues, and avoidance, as well as how these maladaptive strategies persist and perpetuate health anxiety. Of particular importance is the role the physician may play in iatrogenic worsening of health anxiety. Interesting and relevant phenomenon associated with health anxiety such as cyberchondria (internet checking) and the nocebo effect (expectation-induced negative side effects in response to medication) are highlighted. Chapter 4 reviews evidence for the role of environmental and biological factors in the etiology and maintenance of health anxiety. The second part of the book is focused on assessment and treatment. Chapter 5 presents a review of the treatment outcome literature, including psychological and pharmacological treatments. Taylor and Asmundson supplement their review with presentation of their own preliminary metaanalysis of treatments for health anxiety. Chapter 6 focuses on clinical strategies for thorough assessment and case formulation. …