The essence of CBT is to encourage patients to identify their dysfunctional thoughts, beliefs and unhelpful behaviours, enable them to generate less threatening alternatives and then test them out. With health anxiety there is a tendency to overestimate the possibility of ill health, accompanied by the need to monitor health excessively in all the various forms that may take. The next sessions of treatment should include guidance on specific techniques to address these problems, particularly exploring how health anxiety is generated and fuelled, encouraging ways to achieve a more normal perspective on health and to put in place ways of maintaining this.

Techniques that help to alter distorted perceptions

Pie charts

The pie chart technique is helpful in two ways. First, it helps to generate non-serious, less threatening, alternative explanations for the patient's particular complaint, and it also helps put that complaint in perspective by working out the frequency of non-serious conditions.

The pie chart can be introduced by saying:

Thus, for example, if a patient's main cause for concern is an intermittent dry throat/cough, and they conclude that they have untreatable lung cancer, you jointly make a list of all the causes of a dry cough (remember, in this exercise we try to get the patient, not the therapist, to make most of the suggestions), which will of course include lung cancer, but should also include many less serious or non-serious causes; some basic medical knowledge can be helpful here. The severe, potentially life-threatening causes are best incorporated under one heading, avoiding the generation of a long list of severe illnesses. An example of such a list is given in Box 5.1. The idea is to generate so many innocuous causes in addition to the serious ones that it becomes apparent that the most serious outcome is the least likely.

The pie chart is then filled up by asking, of all the people in a certain locality (usually the patient's local town) who have a cough, what proportion would be affected by the particular causes itemised on the list.