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The Impact of Health Anxiety in Multiple Sclerosis: A Replication and Treatment Case Series

Published online by Cambridge University Press:  09 October 2017

Neil Carrigan*
Affiliation:
Department of Psychology, University of Bath, Claverton Down, Bath BA2 7AY
Leon Dysch
Affiliation:
Community Neuro and Stroke Service, St Martin's Hospital, Bath BA2 5RP
Paul M. Salkovskis
Affiliation:
Department of Psychology, University of Bath, Claverton Down, Bath BA2 7AY
*
*Requests for reprints to Dr Neil Carrigan, Psychological Therapies Service, Avon and Wiltshire Mental Health Partnership NHS Trust, Chatsworth House, SwindonSN1 4BP. E-mail: [email protected]

Abstract

Background: Multiple sclerosis (MS) is commonly associated with psychological complications. Previous research by Hayter and colleagues (2016) found that in patients with MS, health anxiety (HA) can account for part of the variance in quality of life (QoL) independent of physical and cognitive impairment caused by the disease. MS patients with HA perceived their intact physical and cognitive performance as impaired relative to those without HA and attributed the impairment to MS. These misperceptions might be useful targets in the treatment of HA in MS using cognitive behaviour therapy (CBT). Aims: Study 1 sought to replicate the main findings from Hayter et al. (2016). Study 2 examined the impact of HA-focused CBT in a case series. Method: In Study 1, twenty participants with MS were screened for HA and assigned to either a high or low HA group. They completed assessments of cognitive and physical functioning before rating their performance on these tasks, followed by measures of QoL, mood and physical disability. Four participants in the high HA group subsequently received six sessions of CBT using a consecutive AB case series in Study 2. Results: Study 1 replicated the main findings from the earlier study. In Study 2, three of the four patients who received treatment showed substantial improvements in HA and mood and all showed improvement in QoL. Conclusion: Given the high rates of HA in MS patients and its impact on QoL, this case series suggests that a brief CBT intervention could significantly improve patients’ wellbeing.

Type
Research Article
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2017 

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References

Amato, M. P., Ponziani, G., Siracusa, G. and Sorbi, S. (2001). Cognitive dysfunction in early-onset multiple sclerosis: a reappraisal after 10 years. Archives of Neurology, 58, 1602.Google Scholar
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th edition). Washington DC: American Psychiatric Association.Google Scholar
Amtmann, D., Kim, J., Chung, H., Bamer, A. M., Askew, R. L., Wu, S., Karon, F. and Johnson, K. L. (2014). Comparing CESD-10, PHQ-9 and PROMIS depression instruments in individuals with multiple sclerosis. Rehabilitation Psychology, 59, 220.Google Scholar
Askey-Jones, S., David, A. S., Silber, E., Shaw, P. and Chalder, T. (2013). Cognitive behaviour therapy for common mental disorders in people with multiple sclerosis: a bench marking study. Behaviour Research and Therapy, 51, 648655.Google Scholar
Bakshi, R. (2003). Fatigue associated with multiple sclerosis: diagnosis, impact and management. Multiple Sclerosis, 9, 219227.CrossRefGoogle ScholarPubMed
Barlow, D. H. and Hersen, M. (1984). Single Case Experimental Designs: Strategies for Studying Behavior Change (2nd edition). New York: Pergamon Press.Google Scholar
Benedict, R. H. B., Cox, D., Thompson, L. L., Foley, F., Weinstock-Guttman, B. and Munschauer, F. (2004). Reliable screening for neuropsychological impairment in multiple sclerosis. Multiple Sclerosis, 10, 675678.Google Scholar
Benedict, R. H. B., Wahlig, E., Bakshi, R., Fishman, I., Munschauer, F., Zivadinov, R. and Weinstock-Guttman, B. (2005). Predicting quality of life in multiple sclerosis: accounting for physical disability, fatigue, cognition, mood disorder, personality, and behavior change. Journal of the Neurological Sciences, 231, 2934.Google Scholar
Berna, C., Vincent, K., Moore, J., Tracey, I., Goodwin, G. M. and Holmes, E. A. (2011). Presence of mental imagery associated with chronic pelvic pain: a pilot study. Pain Medicine, 12, 10861093.CrossRefGoogle ScholarPubMed
Bobholz, J. A. and Rao, S. M. (2003). Cognitive dysfunction in multiple sclerosis: a review of recent developments. Current Opinion in Neurology, 16, 283288.Google Scholar
Burgess, P. W. and Shallice, T. (1997). The Hayling and Brixton Tests. Harcourt Assessment Oxford.Google Scholar
Butler, G., Fennell, M. and Hackmann, A. (2008). Cognitive Behavioral Therapy for Anxiety Disorders. New York: Guildford Press.Google Scholar
Chwastiak, L., Ehde, D. M., Gibbons, L. E., Sullivan, M., Bowen, J. D. and Kraft, G. H. (2002). Depressive symptoms and severity of illness in multiple sclerosis: epidemiologic study of a large community sample. American Journal of Psychiatry, 159, 18621868.CrossRefGoogle ScholarPubMed
Clark, D. M., Salkovskis, P. M., Hackmann, A., Wells, A., Fennell, M., Ludgate, J. et al. (1998). Two psychological treatments for hypochondriasis. A randomised controlled trial. British Journal of Psychiatry, 173, 218225.CrossRefGoogle ScholarPubMed
Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155.CrossRefGoogle ScholarPubMed
Compston, A. and Coles, A. (2008). Multiple sclerosis. Lancet, 372, 15021517.CrossRefGoogle ScholarPubMed
Dennison, L., Moss-Morris, R. and Chalder, T. (2009). A review of psychological correlates of adjustment in patients with multiple sclerosis. Clinical Psychology Review, 29, 141153.Google Scholar
Ehlers, A. and Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behavior Research and Therapy, 38, 319345.CrossRefGoogle ScholarPubMed
Erceg-Hurn, D. M. and Mirosevich, V. M. (2008). Modern robust statistical methods: an easy way to maximize the accuracy and power of your research. American Psychologist, 63, 591601.Google Scholar
Ferrans, C. E. and Powers, M. J. (2007). Psychometric assessment of the Quality of Life Index. Research in Nursing and Health, 15, 2938.CrossRefGoogle Scholar
Greeven, A., van Balkom, A., Visser, S., Merkelbach, J., van Rood, Y., van Dyck, R., van der Does, A. J. W., Zitman, F. G. and Spinhoven, P. (2007). Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a randomized controlled trial. American Journal of Psychiatry, 164, 9199.CrossRefGoogle ScholarPubMed
Handley, R. V., Salkovskis, P. M., Scragg, P. and Ehlers, A. (2009). Clinically significant avoidance of public transport following the London bombings: travel phobia or subthreshold posttraumatic stress disorder? Journal of Anxiety Disorders, 23, 11701176.Google Scholar
Hayter, A. L., Salkovskis, P. M., Silber, E. and Morris, R. G. (2016). The impact of health anxiety in patients with relapsing remitting multiple sclerosis: misperception, misattribution and quality of life. British Journal of Clinical Psychology, 55, 371386.Google Scholar
Herschbach, P., Book, K., Dinkel, A., Berg, P., Waadt, S., Duran, G., Engst-Hastreiter, U. and Henrich, G. (2010). Evaluation of two group therapies to reduce fear of progression in cancer patients. Supportive Care in Cancer, 18, 471479.Google Scholar
Holmes, E. A., Arntz, A. and Smucker, M. R. (2007). Imagery rescripting in cognitive behaviour therapy: images, treatment techniques and outcomes. Journal of Behavior Therapy and Experimental Psychiatry, 38, 297305.Google Scholar
Holmes, E. A. and Mathews, A. (2010). Mental imagery in emotion and emotional disorders. Clinical Psychology Review, 30, 349362.Google Scholar
Jacobson, N. S. and Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 1219.CrossRefGoogle ScholarPubMed
Janssens, A. C. J. W., Van Doorn, P., De Boer, J., Kalkers, N., van der Meché, F. G. A., Passchier, J. and Hintzen, R. (2003). Anxiety and depression influence the relation between disability status and quality of life in multiple sclerosis. Multiple Sclerosis, 9, 397403.CrossRefGoogle ScholarPubMed
Julian, L., Merluzzi, N. and Mohr, D. (2007). The relationship among depression, subjective cognitive impairment, and neuropsychological performance in multiple sclerosis. Multiple Sclerosis, 13, 8186.Google Scholar
Kehler, M. D. and Hadjistavropoulos, H. D. (2009). Is health anxiety a significant problem for individuals with multiple sclerosis? Journal of Behavioral Medicine, 32, 150161.Google Scholar
Keselman, H., Othman, A. R., Wilcox, R. R. and Fradette, K. (2004). The new and improved two-sample t test. Psychological Science, 15, 4751.Google Scholar
Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M. and Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048.Google Scholar
Korostil, M. and Feinstein, A. (2007). Anxiety disorders and their clinical correlates in multiple sclerosis patients. Multiple Sclerosis, 13, 6772.Google Scholar
Kroenke, K., Spitzer, R. L. and Williams, J. B. W. (2001). The PHQ-9. Journal of General Internal Medicine, 16, 606613.Google Scholar
Lane, J. D. and Gast, D. L. (2014). Visual analysis in single case experimental design studies: brief review and guidelines. Neuropsychological Rehabilitation, 24, 445463.Google Scholar
Larcombe, N. A. and Wilson, P. H. (1984). An evaluation of cognitive-behaviour therapy for depression in patients with multiple sclerosis. British Journal of Psychiatry, 145, 366371.CrossRefGoogle ScholarPubMed
Lovera, J., Bagert, B., Smoot, K. H., Wild, K., Frank, R., Bogardus, K., Oken, B. S., Whitman, R. H. and Bourdette, D. N. (2006). Correlations of perceived deficits questionnaire of multiple sclerosis quality of life inventory with beck depression inventory and neuropsychological tests. Journal of Rehabilitation Research and Development, 43, 73.Google Scholar
Maor, Y., Olmer, L. and Mozes, B. (2001). The relation between objective and subjective impairment in cognitive function among multiple sclerosis patients-the role of depression. Multiple Sclerosis, 7, 131135.Google ScholarPubMed
McManus, F., Surawy, C., Muse, K., Vazquez-Montes, M. and Williams, J. M. (2012). A randomized clinical trial of mindfulness-based cognitive therapy versus unrestricted services for health anxiety (hypochondriasis). Journal of Consulting and Clinical Psychology, 80, 817828.Google Scholar
Middleton, L. S., Denney, D. R., Lynch, S. G. and Parmenter, B. (2006). The relationship between perceived and objective cognitive functioning in multiple sclerosis. Archives of Clinical Neuropsychology, 21, 487494.Google Scholar
Mohr, D. C., Boudewyn, A. C., Goodkin, D. E., Bostrom, A. and Epstein, L. (2001). Comparative outcomes for individual cognitive-behavior therapy, supportive-expressive group psychotherapy, and sertraline for the treatment of depression in multiple sclerosis. Journal of Consulting and Clinical Psychology, 69, 942.Google Scholar
Mohr, D. C., Likosky, W., Bertagnolli, A., Goodkin, D. E., Van Der Wende, J., Dwyer, P. and Dick, L. P. (2000). Telephone-administered cognitive-behavioral therapy for the treatment of depressive symptoms in multiple sclerosis. Journal of Consulting and Clinical Psychology, 68, 356.Google Scholar
Osborne, T. L., Jensen, M. P., Ehde, D. M., Hanley, M. A. and Kraft, G. (2007). Psychosocial factors associated with pain intensity, pain-related interference, and psychological functioning in persons with multiple sclerosis and pain. Pain, 127, 5262.CrossRefGoogle ScholarPubMed
Rao, S. M., Leo, G. J., Bernardin, L. and Unverzagt, F. (1991a). Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction. Neurology, 41, 685691.Google Scholar
Rao, S. M., Leo, G. J., Ellington, L., Nauertz, T., Bernardin, L. and Unverzagt, F. (1991b). Cognitive dysfunction in multiple sclerosis II. Impact on employment and social functioning. Neurology, 41, 692696.CrossRefGoogle ScholarPubMed
Richards, R., Simpson, F., Beard, S. and Tappenden, P. (2002). A review of the natural history and epidemiology of multiple sclerosis: implications for resource allocation and health economic models. Health Technolgy Assessment, 6.Google Scholar
Rode, S., Salkovskis, P. M. and Jack, T. (2001). An experimental study of attention, labelling and memory in people suffering from chronic pain. Pain, 94, 193203.CrossRefGoogle ScholarPubMed
Salkovskis, P., Rimes, K. A., Warwick, H. and Clark, D. (2002). The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine, 32, 843853.Google Scholar
Salkovskis, P. and Warwick, H. (1986). Morbid preoccupations. health anxiety and reassurance: a cognitive-behavioural approach to hypochondriasis. Behaviour Research and Therapy, 24, 597602.Google Scholar
Salkovskis, P. M., Warwick, H. and Deale, A. C. (2003). Cognitive-behavioral treatment for severe and persistent health anxiety (hypochondriasis). Brief Treatment and Crisis Intervention, 3, 353.Google Scholar
Seivewright, H., Green, J., Salkovskis, P., Barrett, B., Nur, U. and Tyrer, P. (2008). Cognitive-behavioural therapy for health anxiety in a genitourinary medicine clinic: randomised controlled trial. British Journal of Psychiatry, 193, 332337.Google Scholar
Seivewright, H., Salkovskis, P., Green, J., Mullan, N., Behr, G., Carlin, E., Young, S., Goldmeier, D. and Tyrer, P. (2004). Prevalence and service implications of health anxiety in genitourinary medicine clinics. International Journal of STD and AIDS, 15, 519522.Google Scholar
Sharrack, B. and Hughes, R. A. C. (1999). The Guy's Neurological Disability Scale (GNDS): a new disability measure for multiple sclerosis. Multiple Sclerosis, 5, 223233.Google Scholar
Skerrett, T. N. and Moss-Morris, R. (2006). Fatigue and social impairment in multiple sclerosis: the role of patients’ cognitive and behavioral responses to their symptoms. Journal of Psychosomatic Research, 61, 587593.CrossRefGoogle ScholarPubMed
Stuifbergen, A. K. (1995). Health-promoting behaviors and quality of life among individuals with multiple sclerosis. Research and Theory for Nursing Practice, 9, 3150.Google Scholar
Summers, M. M., Fisniku, L. K., Anderson, V. M., Miller, D. H., Cipolotti, L. and Ron, M. A. (2008). Cognitive impairment in relapsing-remitting multiple sclerosis can be predicted by imaging performed several years earlier. Multiple Sclerosis, 14, 197204.Google Scholar
Tang, N. K. Y. and Harvey, A. G. (2006). Altering misperception of sleep in insomnia: behavioral experiment versus verbal feedback. Journal of Consulting and Clinical Psychology, 74, 767.Google Scholar
Thomas, P., Thomas, S., Hillier, C., Galvin, K. and Baker, R. (2006). Psychological interventions for multiple sclerosis. Cochrane Database Systematic Reviews, 1.Google Scholar
Tyrer, P., Cooper, S., Crawford, M., Dupont, S., Green, J., Murphy, D., Salkovsikis, P., Smith, G., Wang, D., Bhogal, S., Keeling, M., Loebenberg, G., Seivewright, R., Walker, G., Cooper, F., Evered, R., Kings, S., Kramo, K., McNulty, A., Nagar, J., Reid, S., Sanatinia, R., Sinclair, J., Trevor, D., Watson, C. and Tyrer, H. (2011). Prevalence of health anxiety problems in medical clinics. Journal of Psychosomatic Research, 71, 392394.CrossRefGoogle ScholarPubMed
Tyrer, P., Cooper, S., Salkovskis, P., Tyrer, H., Crawford, M., Byford, S., Dupont, S., Finnis, S., Green, J., McLaren, E., Murphy, D., Reid, S., Smith, G., Wang, D., Warwick, H., Petkova, H. and Barrett, B. (2014). Clinical and cost-effectiveness of cognitive behaviour therapy for health anxiety in medical patients: a multicentre randomised controlled trial. The Lancet, 383, 1824.CrossRefGoogle ScholarPubMed
Tyrer, P., Cooper, S., Tyrer, H., Salkovskis, P., Crawford, M., Green, J., Smith, G., Reid, S., Dupont, S., Murphy, D., Byford, S., Wang, D. and Barrett, B. (2011). CHAMP: cognitive behaviour therapy for health anxiety in medical patients, a randomised controlled trial. BMC Psychiatry, 11, 99.Google Scholar
Vercoulen, J. H. M. M., Hommes, O. R., Swanink, C., Jongen, P. J. H., Fennis, J. F. M., Galama, J., van der Meer, J. W. M. and Bleijenberg, G. (1996). The measurement of fatigue in patients with multiple sclerosis: a multidimensional comparison with patients with chronic fatigue syndrome and healthy subjects. Archives of Neurology, 53, 642.CrossRefGoogle ScholarPubMed
Warwick, H. M. and Salkovskis, P. M. (1990). Hypochondriasis. Behaviour Research and Therapy, 28, 105117.Google Scholar
Wells, A. and Hackmann, A. (1993). Imagery and core beliefs in health anxiety: content and origins. Behavioural and Cognitive Psychotherapy, 21, 265273.Google Scholar
Wilcox, R. R. (2012). Introduction to Robust Estimation and Hypothesis Testing. San Diego: Elsevier.Google Scholar
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