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Tackling Health Anxiety: A CBT Handbook. By Helen Tyrer. RCPsych Publications. 2013. £18.00 (pb). 150pp. ISBN: 9781908020901

Published online by Cambridge University Press:  02 January 2018

Alexander Keith*
Affiliation:
Edinburgh Substance Misuse Directorate, 22–24 Spittal Street, Edinburgh EH3 9PU, UK. Email: alexander.keith@nhslothian.scot.nhs.uk
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Abstract

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Copyright © Royal College of Psychiatrists, 2014 

This slim and efficient book is in two parts. The first introduces the concept and features of health anxiety and a rationale for it replacing hypochondria as a diagnosis, while acknowledging overlap with somatoform disorders and medically unexplained symptoms. It argues the importance of recognition and appropriate treatment (by the right people in the correct setting) in reducing morbidity, reducing healthcare costs and improving overall outcomes for patients. The theory, techniques and practice of modified cognitive-behavioural therapy (CBT) for health anxiety are described.

Part two details the process of tackling common manifestations of health anxiety by ‘systems’ (cardiology, gastroenterology etc.). Fictionalised case presentations (sometimes including dialogue between therapist and patient) are used throughout to illustrate concepts and the practicalities of modified CBT.

This book is not written for psychiatrists, clinical psychologists or mental health nurse therapists. The stated aim is to encourage clinicians within general healthcare settings to provide CBT-informed interventions to patients with health anxiety. While accepting the arguments for this approach, it is uncertain that clinicians untrained in CBT would find the book sufficiently detailed to successfully deliver modified CBT; failure to mention clinical supervision of therapists is surprising. The explicit rejection of psychoanalytic mechanisms as having any role in the aetiology of health anxiety may be undermined by clinical examples that appear to show symptom resolution after ‘catharsis’. It was disappointing that the concept of pathologically low anxiety about one’s health (e.g. in people engaging in high-risk behaviours), mentioned in the introduction, is not developed. Little evidence is presented to support the clinical efficacy of the intervention or its tolerability to patients. A few errors of editing and proof-reading persist.

Nevertheless, there is much to recommend here. The patient group will be familiar to most psychiatrists, clinical psychologists and psychiatric nurses. The writing is clear, readable and memorable with suitably detailed and easily generalised examples. The useful descriptions of therapeutic strategies make them widely and immediately applicable; pitfalls or sticking points in therapy are anticipated, with strategies for tackling them clearly laid out. Various patients I have seen were brought vividly to mind while reading and I am hopeful that my approach to similar individuals in the future will be positively enhanced by this book and more efficacious.

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