Essay Example on Accurate estimates are Difficult









Accurate estimates are difficult however it has been estimated that between 30 80 of patients consult physicians for symptoms for which there is no physical basis Hypochondriasis is estimated at approximately 1 2 of the population based on primary care clinics and as many as 20 of people in medical clinics are found to have health anxiety Tyrer et al 2011 Linking this to client Sally it can be seen how she would have contributed 30 80 of patients presenting in primary care with symptoms for which there is little or no evidence of physical health problems Hypochondriasis is presently classified as illness anxiety or somatoform disorder and until recently the treatment of this was not considered to be an important separate issue and classed as being secondary to depression or anxiety For instance Kenyon s influential study of patients with hypochondriacal views found that hypochondriasis was been regarded as secondary to another primary disorder such as depression However with client Sally her focus of treatment as requested by her is the hypochondriasis or IA be the main focus of treatment as it causes her the most distress and for her the anxiety and depressive aspects as products of the IA This approach has been beneficial to Sally because as her IA reduced it was seen to have a positive affect on her mood and general anxiety as captured in the questionnaires PHQ 9 and GAD 7 Hence studies have highlighted that a primary disorder in which false concerns about health are identified as the main problem the affective symptoms such as depression are found to be secondary Bianchi 1971 

This was further supported by Barsky and Klerman 1983 who identified hypochondriasis as an important research topic and recognisable clinical condition Therefore this development and reignition hypochondriasis as a separate standalone disorder has promoted or at least recognised the importance of the use CBT treatment to allow focus on those issue alone and perhaps validating the concerns or difficulties patients have Therefore over the years hypochondriasis has featured in the DSM but its name has changed Hence health anxiety or hypochondriasis was split into Illness Anxiety IA disorder and somatic symptom disorder in the Diagnostic and Statistical Manual of Mental Disorders 5 DSM 5 American Psychiatric Association APA 2013 Cognitive behavioural theories of hypochondriasis have been described as leading to treatment strategies which have been tested in randomised controlled studies The evidence from this type of research show as engaging the patients and improving any clinical symptoms It is regarded that cognitive behavioural theory of hypochondriasis offers a comprehensive account of the psychological processes involved in the disorder such as origins causative and maintenance factors Salkovskis Warwick and Deale 2003 Reassurance seeking behaviours can be seen as maintaining the problem for patients in the long term but short term relief is gained and that patient may feel at ease for a short period of time thus not resolving the initial problem Some authors Kellner 1983 suggest for treating hypochondriasis repeated reassurance should be a component However further to this it has been found Salkovskis Warwick 1986 Warwick Salkovskis 1985 that repeated reassurance containing no new information may lead to increase to anxiety in the long term and short term decrease in health anxiety hence reassurance will always be needed 

This is evident with the case of Sally as she would regularly seek reassurance from her GP or even the internet and the gain to her was always short term and never helped her feelings of IA in the long term Literature has highlighted the importance of value of behavioural experiments such as for the client to decrease checking reassurance seeking medical information and so on to see what the effects are Also a patient could delay visit to GP for 2 weeks and then consider whether they still need the appointment or even to conduct surveys for normality of sensations For patients it can be considered to be vital that they face their fears in order to practice new skills as desensitisation Attention training techniques Wells 1998 aim to reduce self focus and preoccupation which would require regular practice Conceptualisation Hypochondriasis is highlighted in Salkovski s work namely his paper on CBT for hypochondriasis Salkovski s et al s 2003 paper on CBT for hypochondriasis This paper informed the treatment protocol This paper works on the principle that an individual has false belief that they are physically ill which is an assumption due to catastrophic misinterpretation of bodily symptoms For treatment it is suggested a shared understanding be developed to construct a psychological formulation This should enable the client to consider a possible non catastrophic psychological alternative explanation for their problem To begin with a cross sectional formulation was developed with Sally to help understand the processes with regards to her thoughts feelings and behaviours when she tried to interpret possible triggers which lead her to worry about her health The diagram below outlines the identified Situation Thoughts Images Physiological Sensations Feelings and Behaviour Sally was able to grasp and understand the connections between the different areas

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