Illness Anxiety Disorder

In simple terms, socialization in the context mentioned means helping patients understand
and accept that their health problems may have psychological explanations rather than being
solely physical. Here are some ways they try to do this:
1. Tracking Symptom Patterns:
 They ask patients to keep a record of when their symptoms occur.
 If patterns emerge (like symptoms happening more during certain times), they
discuss possible non-disease explanations.
For example, if dizziness occurs more in the morning during workdays, they
question why it happens at specific times and explore factors like stress or low
blood sugar.
2. Reviewing the Impact of Reassurance:
 They look at how verbal reassurance or medical test results affect the patients'
worry and symptoms.
 If reassurance makes symptoms better, they use it to support the idea that the
issue might be more psychological.
 They might ask questions like, "If reassurance makes you feel better, does that
mean your symptoms are not caused by a serious illness?"
3. The 'Intelligent Disease' Metaphor:
 They use metaphors to explain the concept further.
 For example, if symptom patterns are identified, they might suggest that the
illness "thinks for itself."
 If reassurance works, they may ask questions like, "How would a serious
illness know when it's being reassured?"
4. Selective Attention Experiments:
 They conduct experiments to make patients notice normal bodily sensations.
 By focusing on regular sensations, patients might become more aware of their
bodies and understand that what they feel is not necessarily a sign of a serious
illness.
 This helps patients differentiate between normal sensations and what they
might interpret as new symptoms.
5. Education:
 They explain in detail how misinterpretation and related behaviors can
contribute to maintaining health anxiety.
 They provide information and use metaphors to help patients grasp the
psychological aspects of their condition.
  The goal is to educate patients about the role of their thoughts and
interpretations in their health anxiety.
In summary, socialization in this context involves guiding patients to see their health issues
from a psychological perspective, helping them understand alternative explanations, and
using various strategies to shift their focus from a purely physical viewpoint to a more
balanced understanding.
Reattribution
strategies are ways to help people with health anxiety (excessive worry about being
seriously ill) understand their symptoms differently and reduce their belief in having a
physical illness. Here are some methods used:
1. Testing Patient Predictions:
 If someone believes they have a serious health issue, the therapist challenges
those beliefs.
 For example, if a person thinks they have a muscle-wasting disease, the
therapist suggests testing their legs by doing exercises.
 By doing this, the person can see that their muscles may feel weak, but it
doesn't necessarily mean they have a serious illness.
2. Survey Method:
 Involves observing and asking other people about their experiences with
similar symptoms.
 This helps challenge the belief that certain symptoms are always signs of a
severe illness.
 For instance, interviewing people without heart problems to see how common
irregular heartbeats are.
3. Paradoxical Procedures:
 Instructing patients to increase behaviors that contribute to their health
anxiety, like checking their body for symptoms.
 This helps demonstrate how these behaviors can intensify awareness of
symptoms and emotions.
 For example, asking patients to pay extra attention to their body sensations to
show the impact of excessive focus.
4. Medical Consultation during Cognitive Therapy:
 Ensures patients don't have physical illnesses causing their symptoms before
addressing psychological aspects.
 If further medical tests are planned, they can be turned into experiments to test
how symptoms respond to reassurance.
  Also, predictions about how patients will interpret negative test results can be
discussed to highlight biased thinking.
5. Reducing Reassurance Seeking:
 Discusses the problems caused by seeking reassurance from medical
professionals.
 Repeated reassurance seeking can lead to conflicting explanations, increase
anxiety, and create a distrust of doctors.
 Patients are encouraged to postpone or avoid seeking reassurance as a step
towards reducing health anxiety.
6. Developing a Plan for Medical Consultation:
 Involves creating a more reasonable and less anxiety-inducing approach to
seeking medical advice.
 Encourages patients to introduce delays before checking symptoms or seeking
medical help.
 Patients are taught to make a note of their symptoms and decide whether
consultation is necessary after a week.
7. Self-Monitoring:
 Involves keeping track of various factors like stress levels, caffeine intake, and
sleep quality along with symptom monitoring.
 This helps identify potential triggers for symptoms, and manipulating these
triggers can challenge the belief in having a severe illness.
In essence, reattribution strategies aim to shift the focus from a purely physical explanation of
symptoms to considering other factors, helping individuals realize that their symptoms might
have different, non-life-threatening explanations.
Generalized Anxiety Disorder
The cognitive model of Generalized Anxiety Disorder (GAD) talks about how people who
experience excessive worrying may have different types of worries. There are two main
types: Type 1 worries are about everyday things like the well-being of loved ones, and Type
2 worries are about the nature of worrying itself, like worrying that worrying will make them
go crazy.
The model suggests that people with GAD often have negative thoughts about their worrying
(Type 2 worries), such as believing that worrying is uncontrollable or harmful. On the other
hand, they also tend to see some positive side to worrying, like thinking it helps them cope or
be prepared for potential problems.
For example, someone might constantly worry about getting mugged when walking alone
because they believe that worrying helps them be "always prepared." However, this constant
worry can actually make them feel more vulnerable and generate more negative scenarios in
their mind.
The model explains that over time, people with GAD may develop a habit of using worrying
as a way to deal with problems or prevent bad things from happening. This could be
influenced by their upbringing or learning from someone close to them. However, at some
point, this worrying becomes the main focus of negative thoughts, possibly due to personal
experiences or the disruptive impact it has on their life.
The model also mentions that once worry about worrying is established, other factors come
into play in making the problem worse and keeping it going. These include behavioral
responses (how a person acts in response to worry), thought control attempts (trying to stop
or control the worrying thoughts), and emotional symptoms (how worrying makes the person
feel).
In summary, the model explains how GAD can develop over time, involving a mix of
negative and positive beliefs about worrying, and how this habit can escalate with various
behaviors and attempts to control the thoughts.
In simpler terms, this model is like a map that helps us understand how people with
Generalized Anxiety Disorder (GAD) think and behave. Let's break it down:
1. What the Model Shows:
 The model is like a plan that therapists use to understand why someone has
GAD and how their thoughts and actions are connected.
2. How GAD Patients Use Worry:
 People with GAD use worrying as a way to deal with things that bother them.
This worrying is triggered by different things like hearing bad news, having
upsetting thoughts, or being in situations that feel risky or unsafe.
3. Why Worry is Chosen:
 When faced with these triggers, someone with GAD picks worrying as a way
to handle them. This choice comes from their hidden positive beliefs about
worrying — they might believe, for example, that worrying helps them be
prepared for problems.
4. Negative Beliefs About Worrying:
 However, once they start worrying, negative thoughts kick in. They start to
believe that worrying is uncontrollable and dangerous. These negative beliefs
get activated early in the worrying process, maybe as soon as an upsetting
thought pops into their head.
5. Meta-Worry (Negative Appraisal of Worry):
 The negative beliefs about worrying lead to another layer of thinking called
"meta-worry." This is when they start to worry about the act of worrying itself.
They feel that worrying is out of control and dangerous.
6. Strategies to Reduce Appraised Dan ger:
  To deal with this feeling of danger, they start using strategies to lessen the
worry. These strategies could include things like trying to suppress the
worrying thoughts or doing something specific to feel safer.
So, in a nutshell, this model helps us see that people with GAD use worrying as a way to
cope, but this leads to more negative thoughts about worrying, creating a cycle of anxiety.
Therapists can use this understanding to help individuals break this cycle and find healthier
ways to cope with their worries.
Behavioral Responses: People with Generalized Anxiety Disorder (GAD) often show two
important types of behavior: avoidance and reassurance seeking.
 Avoidance: GAD patients avoid various situations, like social events or disturbing
news. They may also avoid worrying itself because they see it as dangerous.
Avoidance is connected to both types of worries (Type 1 and Type 2).
Example: A person avoided coming home after their partner to prevent worrying about their
partner's safety.
 Reassurance Seeking: Some GAD patients seek reassurance to stop worrying or
prevent continuous worrying. However, seeking reassurance can sometimes make the
anxiety worse.
Thought Control: People with GAD try to control their thoughts in different ways. They
may practice controlled worrying as a coping strategy, trying to benefit from it while
avoiding the dangers. On the other hand, they may also try to suppress worrying thoughts, but
this can sometimes backfire, making the unwanted thoughts come back more often. Some use
worry as a way to distract themselves from more distressing thoughts.
Emotion: Both types of worrying (Type 1 and Type 2) lead to emotional responses. Type 1
worry can cause anxiety initially, but it may decrease if the person feels they are achieving
their worrying goals. Type 2 worry, however, increases anxiety and may lead to symptoms
like a racing mind or difficulty relaxing. In some cases, extreme worry can even trigger panic
attacks. This explains why GAD and panic disorders can overlap.
Verbal Retribution Made Easy:
Questioning the Evidence: When the therapist wants to challenge the patient's belief about
something bad happening due to worrying, they ask questions like, "What makes you think
worrying can make you go crazy?" The patient might share reasons, and the therapist then
questions the quality of that evidence, asking if feeling unpleasant is proof of going crazy.
Questioning the Mechanism: If the patient believes that worrying can cause a catastrophe,
the therapist might ask, "How does worrying actually cause this?". This aims to make the
patient think about the process. If the patient suggests stress as a mechanism, the therapist
could discuss evidence showing that stress doesn't always lead to a breakdown, challenging
the patient's beliefs.
Challenging Uncontrollability Appraisals: When a patient thinks they have no control over
worrying, the therapist may ask about instances when the worry was interrupted. For
example, "When was the last time you were seriously worried? Was that worry controllable?"
The goal is to show that worry can be interrupted, challenging the belief in its
uncontrollability.
Education (Normalizing Worry): The therapist educates the patient about the normalcy of
worrying. They might say, "Worry is a common thing. In a study, 79% of people reported
worrying over two weeks. So, worrying is not unusual, and many people do it." This helps
normalize the experience of worrying.
Dissonance Techniques: The therapist highlights conflicting beliefs in the patient. For
instance, "You believe worrying is harmful, but you also think it helps you cope. Which one
do you think is more accurate?" By inducing this mental conflict, the therapist aims to
weaken the patient's negative beliefs about worrying.
Imagery Techniques: The therapist explores the role of images in the patient's worries. They
might ask, "Do you see pictures in your mind when you worry?" If so, the therapist can guide
the patient to imagine coping effectively with negative scenarios, offering an alternative to
verbal problem-solving. However, it's important not to use imagery as a way to avoid feared
events associated with worrying.
In simpler terms, the therapist asks questions to challenge why the patient thinks worrying is
so bad and helps them see that worrying can be controllable. They also share information to
show that worrying is a common thing and sometimes use imagination to change the patient's
perspective.

DTRs, or Daily Thought Records, serve various purposes in therapy. In the early stages of
treatment, they help in keeping track of negative thoughts linked to emotional changes.
Essentially, they provide information about the content of these negative thoughts and help
individuals understand the connections between their thoughts and feelings. Thought records
and diary measures also give insights into patterns of symptoms. Detecting these patterns can
sometimes reinforce the cognitive understanding of emotional issues. For instance, in cases of
health anxiety, it can challenge the patient's belief in a physical illness.
Specifically designed DTRs should be used when negative thoughts are linked to identifiable
bodily sensations or specific triggers. For example, in treating panic disorder, a DTR might
include extra columns to note bodily sensations and a column for recording the negative
interpretation of these sensations. Disorder-specific cognitive models help create DTRs that
evaluate the key negative automatic thoughts (NATs) related to these models.
In obsessive-compulsive disorder, where the negative appraisal of intrusive thoughts is
crucial, the DTR should include columns for monitoring these thoughts and noting the
negative interpretations associated with them. The cognitive model of social phobia suggests
that negative self-evaluation is as significant as the fear of negative evaluation by others in
problem maintenance. Therefore, DTRs may include columns for recording negative thoughts
about oneself and for recording negative thoughts related to how others might evaluate
oneself in anxiety-inducing situations.
Pie charts are like a helpful tool that we use to explore different reasons for things happening,
especially when we're worried about something really bad happening. Imagine you're feeling
sick, and you start thinking it's because of a serious illness like a brain tumor. In therapy,
we'd make a list of all the possible reasons for feeling sick, like eye strain, a headache, stress,
or even just being tired.
The therapist would draw a circle (the pie chart) and divide it into slices, each representing
one of the reasons on the list. We'd put the less serious reasons in the chart first and save the
really scary one, like the brain tumor, for last. By the time we consider all the less frightening
possibilities, that big scary one doesn't seem as likely.
For example, let's say someone thinks their boss believes they're stupid because of one small
incident. The therapist helps them think of other reasons the boss might seem annoyed, like
having a bad day, feeling stressed, or being unwell. Each reason gets a slice in the pie chart
with a percentage representing how likely it is.
When the chart is done, and you see that the original scary thought takes up only a small part
of the pie, it helps you realize that it's not as likely as you first thought. It's like looking at
things from a different perspective. So, after considering all the possibilities, the therapist
might ask, "Now, how much do you really believe your boss thinks you're stupid?" It often
turns out that the original worry doesn't seem as believable anymore.