Contents of It's not All in Your Head by Asmundson and Taylor

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elow the ribs (Kellner 1986). Hundreds of years later, in 1968, hypochondriacal neurosis was first introduced in the Diagnostic and Statistical Manual of Mental Disorders-Second Edition (DSM-II; American Psychiatric Association [APA], 1968). Until the previous decade, health anxiety was regarded as a chronic, self-perpetuating, and self-validating disorder that was resistant to treatment, and resulted in a poor prognosis or disability (Avia et al., 1996; Barsky et al., 1988; Barsky et al., 2000). Recently, there has been argument that the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision (DSM-IV-TR; APA, 2000) diagnostic criteria for hypochondriasis are too stringent and result in few correct diagnoses (Creed & Barsky, 2004; Looper & Kiramayer, 2001). Due to this issue, the DSM-IV-TR criteria are often not used in hypochondriasis research and an abridged or subclinical definition of health anxiety is employed instead (Creed, 2006; Creed & Barsky, 2004). This latter approach is used in the current study. Strict use of the DSM-IV-TR criteria represents a categorical view of hypochondriasis wherein one either does or does not have the disorder (Furer & Walker, 2005). In comparison, a dimensional view of health anxiety that conceptualizes health anxiety symptoms on a normal continuum of severity, allows for the identification of individuals who may endorse fewer symptoms but nonetheless have clinically significant levels of distress and disability (Furer & Walker, 2005). New dimensional diagnoses and diagnostic criteria have been proposed to replace hypochondriasis in the upcoming fifth edition of the DSM. The Somatic Symptoms 3
Disorders Draft (APA, 2010) proposes the new diagnosis of complex somatic symptom disorder (CSSD) with predominant health anxiety to replace hypochondriasis. A brand new diagnosis of illness anxiety disorder (IAD) is proposed for health anxiety with mild somatic symptoms. 1.1.1. Cognitive-behavioural model of health anxiety The constellation of cognitive, somatic, affective, and behavioural symptoms of health anxiety prompted development of a comprehensive explanatory model. Beck‘s cognitive theory of anxiety (1985) was used to create the cognitive-behavioural formulation of health anxiety and to guide theory and treatment development specific to health anxiety (see Figure 1; Salkovskis, Warwick, & Deale, 2003; Wattar et al., 2005). For example, when one notices bodily sensations, they are usually perceived to be unpleasant (Asmundson et al., 2005; Asmundson, Taylor, Bovell, & Collimore, 2006). This unpleasantness sometimes leads to worry or anxiety about what the sensations mean. The worry and anxiety experienced are associated with physiological arousal. Individuals may also increase bodily checking and avoidance behaviours. This increases the likelihood of noticing unpleasant bodily sensations and the vicious cycle begins again. The cognitive-behavioural model of health anxiety is the most established, comprehensive, and useful model of the cycle of health anxiety symptom development and maintenance (Asmundson & Taylor, 2005). 4
Page 1 and 2: RANDOMIZED CONTROLLED FEASIBILITY T
Page 3 and 4: Abstract The purpose of this feasib
Page 5 and 6: Acknowledgement This research was f
Page 7 and 8: Table of Contents Abstract………
Page 9 and 10: 3.2.1. Content analysis…………
Page 11 and 12: List of figures Figure 1. The cogni
Page 13 and 14: Table C7. Comparison of WLC pre- an
Page 15: this study will inform a future, la
Page 19 and 20: The cognitive symptoms of health an
Page 21 and 22: somatosensory amplification have a
Page 23 and 24: clients with health anxiety from cl
Page 25 and 26: Interview Schedule [Robins, Helzer,
Page 27 and 28: Today, effective clinically-support
Page 29 and 30: decreased disease conviction, witho
Page 31 and 32: identification and reattribution of
Page 33 and 34: within treatment sessions and as ho
Page 35 and 36: more efficacious than wait-list con
Page 37 and 38: participants‘ functioning. The CB
Page 39 and 40: at follow-up (e.g., Bouman, 2002, a
Page 41 and 42: et al., 2003). Self-help treatments
Page 43 and 44: 1.2. Statement of purpose The purpo
Page 45 and 46: an Internet format because it was m
Page 47 and 48: � Do you carry things to use in t
Page 49 and 50: dimensional scales: (a) affective s
Page 51 and 52: severe (15 - 19), and extremely sev
Page 53 and 54: 86 indicate a poor alliance. The HA
Page 55 and 56: included depression symptoms, gener
Page 57 and 58: mailed Part 1, Part 2, and Part 3 o
Page 59 and 60: equests were honored. All randomize
Page 61 and 62: literature; therefore, we had reaso
Page 63 and 64: 3. RESULTS 3.1. Quantitative data a
Page 65 and 66: Table 2 Demographic statistics Mean
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Table 3 Comparison of SHB pre- and
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was no significant change (t = 1.28
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subscale (n = 5); T1 M = 16.80 (SD
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treatment participants would have o
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At T2 there were significant differ
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Table 7 SHB and WLC effect size and
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sample size or greater effect size
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3.2.1. Content analysis 3.2. Qualit
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analysis resulted in the descriptio
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During the creating subcategories a
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coded the entire data set. There we
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anxiety. After ethical clearance wa
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SHB group symptoms when compared to
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pain, fatigue, and poor health, tha
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3.4. Limitations The results of thi
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usy schedules, worry about reading
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attery of tests is not recommended
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ecommended that the program is exte
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4. REFERENCES American Psychiatric
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Barsky, A. J., Geringer, E., & Wool
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Coull, G, & Morris, P. G. (2011). T
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Furer, P., Walker, J. R., & Freesto
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Lidbeck, J. (1997). Group therapy f
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Nguyen, T. D., Attkisson, C. C., &
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Salkovskis, P. M., Rimes, K. A., Wa
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Taylor, S., Thordarson, D. S., Jang
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5. APPENDICIES Appendix A Contents
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o Week 4 o Week 5 o Things to Remem
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Appendix B SELF-HELP PROGRAM FOR HE
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Table C2 Comparison of SHB complete
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Table C4 Comparison of SHB and WLC
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Table C6 Comparison of WLC pre- and
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Appendix D Draft of unconstrained c
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Questionnaires the questionnaires T
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