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from Part I - Principles and practice of CBT for health anxiety
Published online by Cambridge University Press: 01 January 2018
Please note: This may be done over two sessions if needed, but it is best to complete it in one.
Introducing the patient to the therapy
Patients with health anxiety are usually sceptical about the value of psychological intervention. They may also have a diagnosed medical condition independent of their health anxiety, so you must make it clear that you are acknowledging this, even though their anxiety may be excessive. At the initial consultation they should be warmly welcomed and made comfortable. You then make a brief introduction about the reason they have been referred to you and the nature of CBT.
For example, you might begin the interview with:
‘Your doctor has asked me to see you about some of the worries you have had over your health. The extent to which you worry over your health can contribute to your problems and make them more difficult to cope with. Cognitive–behavioural therapy, or CBT as it is also known [you can use the CBT abbreviation quite early on in the interview as everyone now tends to know this], helps you explore some of these fears and worries. This can help you come to terms with, and in some cases, solve some of your difficulties.’
It might be appropriate at this stage to ask whether the doctor explained the reason for the referral and also to ask whether the patient has any questions at this point. It should be stressed that the CBT treatment is an additional intervention only and will not interfere with their normal medical care. An outline of the likely number of sessions could be made at this stage.
Helping the patient feel understood
Taking a history
The assessment interview continues by emphasising the physiological concomitants of the problem and the patient's beliefs about their physical state.
Continue the interview by saying:
‘I'd like to begin by finding out what's been happening recently about your health.’
Patients have often come prepared to say various things they feel you may need to know, and it is important to let them explain these. This need not take long, but often these patients have become accustomed to being cut short, and they often feel that unless the doctor has listened to every tiny aspect of their problem they will miss a vital clue to the correct diagnosis.
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