Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-10T20:03:57.811Z Has data issue: false hasContentIssue false
  • English
  • Français

Dysfunctional beliefs as mediators between illness-related intrusive thoughts and health anxiety symptoms

Published online by Cambridge University Press:  10 October 2019

Sandra Arnáez ,
Gemma García-Soriano ,
Jose López-Santiago  and
Amparo Belloch
Sandra Arnáez
Affiliation:
Departmento de Personalidad, Evaluación y Tratamientos Psicológicos, Research Unit for Obsessive-Compulsive and Related Disorders (I’TOC), Faculty of Psychology, University of Valencia, Avda. Blasco Ibáñez 21, Valencia-46010, Spain
Gemma García-Soriano*
Affiliation:
Departmento de Personalidad, Evaluación y Tratamientos Psicológicos, Research Unit for Obsessive-Compulsive and Related Disorders (I’TOC), Faculty of Psychology, University of Valencia, Avda. Blasco Ibáñez 21, Valencia-46010, Spain
Jose López-Santiago
Affiliation:
Mental Health Unit, University Hospital Complex of Albacete (Spain), C/Hermanos Falcó 37, 02008-Albacete, Spain
Amparo Belloch
Affiliation:
Departmento de Personalidad, Evaluación y Tratamientos Psicológicos, Research Unit for Obsessive-Compulsive and Related Disorders (I’TOC), Faculty of Psychology, University of Valencia, Avda. Blasco Ibáñez 21, Valencia-46010, Spain
*
*Corresponding author. Email: gemma.garcia@uv.es
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Cognitive behavioural models of hypochondriasis assume that dysfunctional illness-related beliefs are involved in the genesis and maintenance of the disorder. The role that other more general dysfunctional beliefs about thoughts play in this disorder has also been highlighted. Internal triggers such as illness-related intrusive thoughts could activate these beliefs.

Aim:

The present paper examines whether general dysfunctional beliefs about distressing thoughts, such as intolerance of uncertainty, over-estimation of threat, and thought-action fusion-likelihood, mediate between illness-related intrusive thoughts and health anxiety symptoms.

Method:

A group of participants composed of individuals with hypochondriasis (n = 31; 51.5% women; mean age = 32.74 years, SD = 9.96) and community individuals (n = 219; 54.3% women; mean age = 39.56 years, SD = 15.20) completed a series of questionnaires to assess illness-related intrusive thoughts (INPIE), dysfunctional beliefs about thoughts (OBSI-R), and health anxiety symptoms (SHAI).

Results:

Results from a multiple parallel mediation analysis indicate that over-estimation of threat partially mediated the relationship between illness-related intrusive thoughts and health anxiety symptoms.

Conclusions:

The results support the importance of the tendency to over-estimate the threat in the relationship between intrusive thoughts related to illness contents and health anxiety. Conceptual and clinical implications of these results are discussed.

Keywords

health anxiety symptomshypochondriasisillness-related intrusive thoughtsintolerance of uncertaintythought-action fusion-likelihoodover-estimation of threat
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 48 , Issue 3 , May 2020 , pp. 315 - 326
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abramowitz, J. S., Schwartz, S. A., & Whiteside, S. P. (2002). A contemporary conceptual model of hypochondriasis. In Mayo Clinic Proceedings (vol. 77, no. 12, pp. 1323–1330). Elsevier.Google Scholar
Abramowitz, J. S., Whiteside, S., Lynam, D., & Kalsy, S. (2003). Is thought-action fusion specific to obsessive-compulsive disorder? A mediating role of negative affect. Behaviour Research and Therapy, 41, 1069–1079.CrossRefGoogle ScholarPubMed
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th edn, text revision). Washington, DC, USA.Google Scholar
Arnáez, S., García-Soriano, G., & Belloch, A. (2017). Hipocondría y pensamientos intrusos sobre la enfermedad: desarrollo y validación de un instrumento de evaluación. Psicología Conductual, 25, 165.Google Scholar
Arnáez, S., García-Soriano, G., López-Santiago, J., & Belloch, A. (2019). The Spanish validation of the Short Health Anxiety Inventory: psychometric properties and clinical utility. International Journal of Clinical and Health Psychology, 19, 251–260. doi: 10.1016/j.ijchp.2019.05.003CrossRefGoogle Scholar
Bailey, R., & Wells, A. (2015). Development and initial validation of a measure of metacognitive beliefs in health anxiety: the MCQ-HA. Psychiatry Research, 230, 871–877. doi: 10.1016/j.psychres.2015.11.035CrossRefGoogle ScholarPubMed
Bailey, R., & Wells, A. (2016a). Is metacognition a causal moderator of the relationship between catastrophic misinterpretation and health anxiety? A prospective study. Behaviour Research and Therapy, 78, 43–50. doi: 10.1016/j.brat.2016.01.002CrossRefGoogle ScholarPubMed
Bailey, R., & Wells, A. (2016b). The contribution of metacognitive beliefs and dysfunctional illness beliefs in predicting health anxiety: an evaluation of the metacognitive versus the cognitive models. Clinical Psychologist, 20, 129–137. doi: 10.1111/cp.12078CrossRefGoogle Scholar
Barsky, A. J., Cleary, P. D., Wyshak, G., Spitzer, R. L., Williams, J. B., & Klerman, G. L. (1992). A structured diagnostic interview for hypochondriasis: a proposed criterion standard. Journal of Nervous and Mental Disease, 180, 20–27.CrossRefGoogle ScholarPubMed
Belloch, A. (2014). Spanish translation of the Hypochondriasis Yale-Brown Obsessive-Compulsive Scale-Modified version. Unpublished translation.Google Scholar
Belloch, A., Morillo, C., Luciano, J. V., García-Soriano, G., Cabedo, E., & Carrió, C. (2010). Dysfunctional belief domains related to obsessive–compulsive disorder: a further examination of their specificity in clinical and community samples. Spanish Journal of Psychology, 13, 369–381.CrossRefGoogle Scholar
Berle, D., & Starcevic, V. (2005). Thought–action fusion: review of the literature and future directions. Clinical Psychology Review, 25, 263–284. doi: 10.1016/j.cpr.2004.12.001CrossRefGoogle ScholarPubMed
Boelen, P. A., & Carleton, R. N. (2012). Intolerance of uncertainty, hypochondriacal concerns, obsessive-compulsive symptoms, and worry. Journal of Nervous and Mental Disease, 200, 208–213. doi: 10.1097/NMD.0b013e318247cb17CrossRefGoogle ScholarPubMed
Clark, D. A., & Purdon, C. (1993). New perspectives for a cognitive theory of obsessions. Australian Psychologist, 28, 161–167.CrossRefGoogle Scholar
Deacon, B. J., & Abramowitz, J. S. (2008). Is hypochondriasis related to obsessive-compulsive disorder, panic disorder, or both? An empirical evaluation. Journal of Cognitive Psychotherapy, 22, 115–127. doi: 10.1891/0889-8391.22.2.115CrossRefGoogle Scholar
Dugas, M. J., Buhr, K., & Ladouceur, R. (2004a). The role of intolerance of uncertainty in etiology and maintenance. In Heimberg, R. G., Turk, C. L. & Mennin, D. S. (eds), Generalized Anxiety Disorder: Advances in Research and Practice (pp. 143–163). New York, USA: Guilford Press.Google Scholar
Dugas, M. J., Schwartz, A., & Francis, K. (2004b). Brief report: intolerance of uncertainty, worry, and depression. Cognitive Therapy and Research, 28, 835–842.CrossRefGoogle Scholar
Fergus, T. A. (2015). I really believe I suffer from a health problem: examining an association between cognitive fusion and healthy anxiety. Journal of Clinical Psychology, 71, 920–934.CrossRefGoogle ScholarPubMed
Fergus, T. A. (2014). Health-related dysfunctional beliefs and health anxiety: further evidence of cognitive specificity. Journal of Clinical Psychology, 70, 248–259. doi: 10.1002/jclp.22012CrossRefGoogle ScholarPubMed
Fergus, T. A., & Valentiner, D. P. (2011). Intolerance of uncertainty moderates the relationship between catastrophic health appraisals and health anxiety. Cognitive Therapy and Research, 35, 560–565. doi: 10.1007/s10608-011-9392-9CrossRefGoogle Scholar
García-Soriano, G., & Belloch, A. (2013). Symptom dimensions in obsessive-compulsive disorder: differences in distress, interference, appraisals and neutralizing strategies. Journal of Behavior Therapy and Experimental Psychiatry, 44, 441–448.CrossRefGoogle ScholarPubMed
García-Soriano, G., Belloch, A., Morillo, C., & Clark, D. A. (2011). Symptom dimensions in obsessive-compulsive disorder: from normal cognitive intrusions to clinical obsessions. Journal of Anxiety Disorders, 25, 474–482.CrossRefGoogle ScholarPubMed
Gellatly, R., & Beck, A. T. (2016). Catastrophic thinking: a transdiagnostic process across psychiatric disorders. Cognitive Therapy and Research, 40, 441–452. doi: 10.1007/s10608-016-9763-3CrossRefGoogle Scholar
Hayes, A. F. (2013). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. Guilford Publications.Google Scholar
Holaway, R. M., Heimberg, R. G., & Coles, M. E. (2006). A comparison of intolerance of uncertainty in analogue obsessive-compulsive disorder and generalized anxiety disorders. Anxiety Disorders, 20, 158–174.CrossRefGoogle Scholar
Marcus, D. K., & Church, S. E. (2003). Are dysfunctional beliefs about illness unique to hypochondriasis? Journal of Psychosomatic Research, 54, 543–547. doi: 10.1016/S0022-3999(02)00526-3CrossRefGoogle ScholarPubMed
Marcus, D. K., Gurley, J. R., Marchi, M. M., & Bauer, C. (2007). Cognitive and perceptual variables in hypochondriasis and health anxiety: a systematic review. Clinical Psychology Review, 27, 127–139. doi: 10.1016/j.cpr.2006.09.003CrossRefGoogle ScholarPubMed
Melli, G., Bailey, R., Carraresi, C., & Poli, A. (2018). Metacognitive beliefs as a predictor of health anxiety in a self-reporting Italian clinical sample. Clinical Psychology and Psychotherapy, 25, 263–271. doi: 10.1002/cpp.2159CrossRefGoogle Scholar
Melli, G., Rustici, S., Micheli, E., Stopani, E., Carraresi, C., & Bulli, F. (2014). Il ruolo della responsabilità ipertrofica nel disturbo d’ansia per la salute: un’indagine esplorativa. Psicoterapia Cognitiva e Comportamentale, 20, 343–355.Google Scholar
Muse, K., McManus, F., Hackmann, A., Williams, M., & Williams, M. (2010). Intrusive imagery in severe health anxiety: prevalence, nature and links with memories and maintenance cycles. Behaviour Research and Therapy, 48, 792–798.CrossRefGoogle ScholarPubMed
Norton, P. J., Sexton, K. A., Walker, J. R., & Norton, G. R. (2005). Hierarchical model of vulnerabilities for anxiety: replication and extension with a clinical sample. Cognitive Behaviour Therapy, 34, 50–63. doi: 10.1080/16506070410005401CrossRefGoogle ScholarPubMed
OCCWG (1997). Cognitive assessment of obsessive-compulsive disorder. Behaviour Research and Therapy, 35, 667–681.CrossRefGoogle Scholar
Purdon, C., & Clark, D. A. (1999). Metacognition and obsessions. Clinical Psychology & Psychotherapy, 6, 102–110.3.0.CO;2-5>CrossRefGoogle Scholar
Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35, 793–802. doi: 10.1016/S0005-7967(97)00040-5CrossRefGoogle ScholarPubMed
Rachman, S. (1998). A cognitive theory of obsessions: elaborations. Behaviour Research and Therapy, 36, 385–401. doi: 10.1016/S0005-7967(97)10041-9CrossRefGoogle ScholarPubMed
Raines, A. M., Oglesby, M. E., Capron, D. W., & Schmidt, N. B. (2014). Obsessive compulsive disorder and anxiety sensitivity: identification of specific relations among symptom dimensions. Journal of Obsessive-Compulsive and Related Disorders, 3, 71–76.CrossRefGoogle Scholar
Rassin, E., Merckelbach, H., Muris, P., & Schmidt, H. (2001). The thought-action fusion scale: further evidence for its reliability and validity. Behaviour Research and Therapy, 39, 537–544.CrossRefGoogle ScholarPubMed
Reuman, L., Jacoby, R. J., Blakey, S. M., Riemann, B. C., Leonard, R. C., & Abramowitz, J. S. (2017). Predictors of illness anxiety symptoms in patients with obsessive compulsive disorder. Psychiatry Research, 256, 417–422. doi: 10.1016/j.psychres.2017.07.012CrossRefGoogle ScholarPubMed
Shafran, R., Teachman, B. A., Kerry, S., & Rachman, S. (1999). A cognitive distortion associated with eating disorders: thought–shape fusion. British Journal of Clinical Psychology, 38, 167–179.CrossRefGoogle ScholarPubMed
Shafran, R., Thordarson, D. S., & Rachman, S. (1996). Thought–action fusion in obsessive-compulsive disorder. Journal of Anxiety Disorders, 10, 379–391.CrossRefGoogle Scholar
Salkovskis, P. M. (1985). Obsessional-compulsive problems: a cognitive-behavioural analysis. Behaviour Research and Therapy, 23, 571–583. doi: 10.1016/0005-7967(85)90105-6CrossRefGoogle ScholarPubMed
Salkovskis, P. M. (1989). Cognitive-behavioural factors and the persistence of intrusive thoughts in obsessional problems. Behaviour Research and Therapy, 27, 677–682. doi: 10.1016/0005-7967(89)90152-6CrossRefGoogle ScholarPubMed
Salkovskis, P. M., & Warwick, H. M. (1986). Morbid preoccupations, health anxiety and reassurance: a cognitive-behavioural approach to hypochondriasis. Behaviour Research and Therapy, 24, 597–602.CrossRefGoogle ScholarPubMed
Scarella, T. M., Laferton, J. A. C., Ahern, D. K., Fallon, B. A., & Barsky, A. (2016). The relationship of hypochondriasis to anxiety, depressive, and somatoform disorders. Psychosomatics, 57, 200–207. doi: 10.1016/j.psym.2015.10.006CrossRefGoogle ScholarPubMed
Salkovskis, P. M., Rimes, K. A., Warwick, H., & Clark, D. (2002). The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine, 32, 843–853. doi: 10.1017/S0033291702005822CrossRefGoogle ScholarPubMed
Sexton, K. A., Norton, P. J., Walker, J. R., & Norton, G. R. (2003). Hierarchical model of generalized and specific vulnerabilities in anxiety. Cognitive Behaviour Therapy, 32, 82–94.CrossRefGoogle ScholarPubMed
Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., et al. (1998). The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22–33.Google ScholarPubMed
Skritskaya, N. A., Carson‐Wong, A. R., Moeller, J. R., Shen, S., Barsky, A. J., & Fallon, B. A. (2012). A clinician‐administered severity rating scale for illness anxiety: development, reliability, and validity of the H‐YBOCS‐M. Depression and Anxiety, 29, 652–664.CrossRefGoogle ScholarPubMed
Tolin, D. F., Abramowitz, J. S., Brigidi, B. D., & Foa, E. B. (2003). Intolerance of uncertainty in obsessive-compulsive disorder. Journal of Anxiety Disorders, 17, 233–242.CrossRefGoogle ScholarPubMed
Tyrer, P. (2018). Recent advances in the understanding and treatment of health anxiety. Current Psychiatry Reports, 20, 49. doi: 10.1007/s11920-018-0912-0CrossRefGoogle ScholarPubMed
Warwick, H. M., & Salkovskis, P. M. (1990). Hypochondriasis. Behaviour Research and Therapy, 28, 105–117.CrossRefGoogle ScholarPubMed
Winer, E. S., Cervone, D., Bryant, J., McKinney, C., Liu, R. T., & Nadorff, M. R. (2016). Distinguishing mediational models and analyses in clinical psychology: atemporal associations do not imply causation. Journal of Clinical Psychology, 72, 947–955.CrossRefGoogle Scholar
Wheaton, M. G., Berman, N. C., Franklin, J. C., & Abramowitz, J. S. (2010). Health anxiety: latent structure and associations with anxiety-related psychological processes in a student sample. Journal of Psychopathology and Behavioral Assessment, 32, 565–574. doi: 10.1007/s10862-010-9179-4CrossRefGoogle Scholar
Wheaton, M. G., Mahaffey, B., Timpano, K. R., Berman, N. C., & Abramowitz, J. S. (2012). The relationship between anxiety sensitivity and obsessive-compulsive symptom dimensions. Journal of Behavior Therapy and Experimental Psychiatry, 43, 891–896.CrossRefGoogle ScholarPubMed
World Health Organization (2018). International classification of diseases for mortality and morbidity statistics. Eleventh revision. https://icd.who.int/browse11Google Scholar
Submit a response

Comments

No Comments have been published for this article.