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Mindfulness-Based Cognitive Therapy (MBCT) for Health Anxiety (Hypochondriasis): Rationale, Implementation and Case Illustration
Abstract
Recent research has shown that mindfulness-based cognitive therapy (MBCT) could be a useful alternative approach to the treatment of health anxiety and deserves further investigation. In this paper, we outline the rationale for using MBCT in the treatment of this condition, namely its hypothesised impact on the underlying mechanisms which maintain health anxiety, such as rumination and avoidance, hypervigilance to body sensations and misinterpretation of such sensations. We also describe some of the adaptations which were made to the MBCT protocol for recurrent depression in this trial and discuss the rationale for these adaptations. We use a case example from the trial to illustrate how MBCT was implemented and outline the experience of one of the participants who took part in an 8-week MBCT course. Finally, we detail some of the more general experiences of participants and discuss the advantages and possible limitations of this approach for this population, as well as considering what might be useful avenues to explore in future research.
... Complementing phenomenological methods (Wertz, 2005), two-part focus groups were co-facilitated by and with Black women using psychoeducational prompts and techniques from mindfulness based cognitive therapy (Surawy et al., 2015). These methods were used to capture descriptive details of participants' experiences, helping them to make salient their thinking, emotional states, and subsequent reactions through therapeutic and liberatory processing. ...
... The healing power of supportive and therapeutic spaces centering Black women's experiences toward transcending microaggressions was a core theme throughout the present study. This therapeutic process was facilitated with phenomenological methods (Wertz, 2005) for indepth exploration that was centered on understanding participants' experiences of microaggressions and healing, including psychoeducational prompts and techniques from mindfulness based cognitive therapy (Surawy et al., 2015). Throughout the study, the facilitators attended to ethical considerations to not exacerbate the harm of microaggressions; essentially, to not open the racial wounds of microaggressions with participants without addressing helpful resources (American Psychological Association, 2017; Principle A, Beneficence and Nonmaleficence). ...
The pervasive and chronic racism of microaggressions (subtle, frequent, and negative slights that communicate messages of inferiority) has harmful psychological impacts for Black, Indigenous, and People of Color (BIPOC), which are exacerbated for Black women whose intersecting racial and gender identities expose them to a unique oppressive reality. Some studies have investigated coping responses of Black women. However, research to date is limited in understanding how they transcend the harmful weathering burden of continually navigating gendered racial microaggressions and restore their wellness through healing practices. The present phenomenological study, grounded in constructivist and indigenous paradigms, was conducted by and for Black women with 13 participants and two co-facilitators. In two-part focus groups, they explored their experiences of (a) psychoeducational consciousness raising toward validating and deconstructing shared and unique microaggressions, and (b) replenishing healing. Results revealed themes, with sample quotes, describing their collective process of discerning psychoeducational prompts of microaggression taxonomies and healing strategies, including aspects that did and did not describe their experiences. Findings yielded evolved definitions of and practices for replenishing healing from microaggressions.
... Hasil penelitian menunjukkan bahwa Mindfulness-based Cognitive Therapy mampu menurunkan tingkat kecemasan kedua partisipan penelitian. Keberhasilan penelitian ini, sejalan dengan penelitian-penelitian sebelumnya, yang juga mengangkat isu bahwa mindfulness dan kecemasan adalah 2 hal yang terkait secara berkebalikan (Hossein, Faroozan & Neda, 2011;Barog, Younesi, Sedaghati & Sedaghati, 2015;Cotton et al., 2015;Surawy, McManus, Muse, & Williams, 2015;Panahi & Faramarzi, 2016;Wong et al., 2016;Helmes & Ward, 2017;Jaiswal et al., 2019;Zemestani & Nikoo, 2019). Mindfulness-based Cognitive Therapy mampu menginisiasi penilaian ulang secara kognitif individu (cognitive reappraisal) (Zemestani & Nikoo, 2019). ...
... Mindfulness-based Cognitive Therapy terbukti mampu menurunkan kecemasan partisipan yang sedang berada pada fase quarter life crisis. Hal ini juga didukung oleh penelitianpenelitian terdahulu (Hossein, Faroozan & Neda, 2011;Barog, Younesi, Sedaghati & Sedaghati, 2015;Cotton et al., 2015;Surawy, McManus, Muse, & Williams, 2015;Panahi & Faramarzi, 2016;Wong et al., 2016;Helmes & Ward, 2017;Zemestani & Nikoo, 2019). Berdasarkan penelitian terdahulu, Mindfulness-based Cognitive Therapy teruji dapat menurunkan kecemasan pada berbagai rentang usia, dari remaja sampai dengan lansia dan populasi, baik klinis dan non klinis. ...
Quarter life crisis merupakan sebuah keadaan ketika individu berada di usia dewasa awal dan mengalami banyak ketidakstabilan dalam hidup. Banyak individu yang terdampak quarter life crisis ini, ditunjukkan dari beberapa penelitian baru yang membahas hal ini. Salah satu dampak yang ditimbulkan dari quarter life crisis adalah kecemasan. Kecemasan yang intens membuat individu semakin tidak produktif dan mengganggu pencapaian hasil. Oleh karena itu, penelitian ini bertujuan untuk mengetahui pengaruh Mindfulness-based Cognitive Therapy dalam menurunkan kecemasan individu yang sedang mengalami quarter life crisis. Penelitian ini dilakukan dengan metode kuantitatif single-case experimental design. Partisipan penelitian ini berjumlah 2 orang dengan jenis kelamin perempuan, memiliki usia dalam masa emerging adulthood dan keduanya sedang mengalami quarter life crisis, dibuktikan dengan pengukuran menggunakan Quarter Life Crisis Scale (Agustin, 2012). Pengukuran dalam penelitian ini menggunakan observasi sebagai metode asesmen utama. Data observasi akan dianalisis menggunakan analisis tren. Selain itu, data juga diambil dari skala Beck Anxiety Inventory (BAI) (Toledano-Toledano et al., 2020) untuk pengukuran kecemasan dan Five Facets Mindfulness Questionnaire (FFMQ) (Gu et al., 2016) untuk pengukuran mindfulness, guna melengkapi hasil observasi. Intervensi dilakukan 5 sesi pertemuan selama 5 minggu dan setiap sesinya memiliki durasi 60 menit. Hasil penelitian ini menunjukkan bahwa Mindfulness-based Cognitive Therapy efektif menurunkan kecemasan partisipan penelitian, ditinjau dari analisis tren yang dilakukan. Mindfulness-based Cognitive Therapy memperbaiki penilaian ulang individu terhadap situasi kecemasan dan kemampuan individu untuk menyelesaikan masalah. Penurunan kecemasan yang dialami partisipan diharapkan mampu membentuk persepsi yang baru terhadap quarter life crisis dan meningkatkan optimism.Quarter life crisis is a phase where emerging adults experience a lot of instability in life. Many individuals are affected by quarter life crisis, marked by the emergence of new studies that discuss this topic. One of the effects of a quarter life crisis is anxiety. High level of anxiety makes individual less productive and interferes with their achievement. Therefore, this study aims to determine the effect of Mindfulness-based Cognitive Therapy in reducing the anxiety of individuals who are experiencing a quarter life crisis. This research was conducted using a quantitative single-case experimental design method. There were two female emerging adulthood participants in this study and both were experiencing a quarter life crisis, as proven by assesment using the Quarter Life Crisis Scale (Agustin, 2012). Measurement in this study uses observation as the main assessment method. Observational data will be analyzed using trend analysis. In addition, data was also taken using Beck Anxiety Inventory (BAI) scale (Toledano-Toledano et al., 2020) for measuring anxiety and Five Facets Mindfulness Questionnaire (FFMQ) (Gu et al., 2016) for measuring mindfulness, to complement the results observation. The intervention was carried out in 5 meeting sessions for 5 weeks and each session had a duration of 60 minutes. The results of this study indicate that Mindfulness-based Cognitive Therapy is effective in reducing the anxiety of research’s participants, based on the trend analysis. Mindfulness-based Cognitive Therapy improves the individual's reappraisal of situations that evoke anxiety and the individual's ability to solve problems. Hopefully, the degression in anxiety experienced by participants will be able to form new perceptions of quarter life crisis and increase optimism.
... Mindfulness Stress Reduction (MSR) and Acceptance and Commitment Therapy (ACT) are the most effective and usable therapies in MBT area. Many studies showed the effect of MSR and ACT on anxiety, 14,15 HA, 16,17 and symptoms and QOL various diseases and their caregivers. 18,19 Although in COVID-19 pandemic using Internet-based therapies increased, before this period, there was evidence of the effectiveness of psychological treatments such as cognitive behavior therapy (CBT), Internet-delivered CBT (ICBT), ACT and Internet-delivered ACT (IACT) for HA. ...
... Thus, the intervention could reduce HA in caregivers of patients with COVID-19. Several studies have highlighted this finding, 16,17,21 using CBT or mindfulness approaches for HA; two of them used IACT or ICBT for HA similar to the present study. 17,21 On the other hand, this finding is not consistent to one study which showed acceptance or mindful-based treatments could not reduce worries. ...
Background:
Coronavirus disease-19 (COVID-19) is a widespread disease all over the world that has caused many psychological complications such as health anxiety (HA) and low quality of life (QOL). Mindfulness-based approaches could improve these complications. Therefore, this study aimed to investigate the effect of Internet-delivered mindfulness stress reduction combined with acceptance and commitment therapy (IMSR-ACT) on QOL and HA of caregivers of patients infected by COVID-19.
Methods:
In this randomized clinical trial, 72 people from Golpayegan city, Iran, who had a patient with COVID-19 in their family were selected from March to June 2020. A caregiver with a score above 27 on the Health Anxiety inventory (HAI-18) was selected using simple random sampling. Participants were assigned in the intervention or control group by permuted block random allocation. The intervention group was trained by MSR and ACT techniques for 9 weeks accomplished via WhatsApp. All participants completed the QOLQuestionnaire-12 (SF-12) items and HAI-18 before and after completing IMSR-ACT sessions. The data were analyzed through SPSS-23 software, using Chi square, independent and paired t-test, and analysis of covariance, and P-value<0.05 was considered as significant.
Results:
The results showed that the intervention group compared to the control group had a significant decrease in all subscales of HAI after the intervention including worry about consequences (5.78±2.66 vs. 7.37±1.34, P=0.004) and awareness of bodily sensation or changes (8.90±2.77 vs. 11.75±2.30, P=0.001), worry about health (10.94±2.38 vs. 13.09±1.92, P=0.001), and total score of HAI (25.62±4.93 vs. 32.25±3.93, P=0.001). Also, the intervention group compared to the control group had better QOL after the intervention in general health perceptions (3.03±0.96 vs. 2.43±0.95, P=0.01), mental health (7.12±2.25 vs. 6.34±1.85 and P=0.01) and mental component summary) 16.78±3.75 vs. 15.43±3.05, P=0.01), physical component summary (16.06±2.66 vs. 15.19±2.25, P=0.01), and total score of SF-12 (32.84±5.39 vs. 30.62±4.34, P=0.004).
Conclusion:
Internet-delivered MSR combined with ACT could improve the HA and QOL of caregivers with patients infected by COVID-19. Thus, it can used in other similar situations for now and future. Also, it seems to be a useful approach for caregivers of the other illnesses. Trial Registration Number: IRCT20180909040974N.
... Since the development and maintenance of anxiety has been shown to be highly correlated with IU (Buhr & Dugas, 2006;Ladouceur et al., 2000), awareness and IU show extremely similar relationships (Kraemer et al., 2016). For example, awareness of health anxiety can contribute to individuals' ability to move away from their fears and bodily sensations about their health, to regulate and develop their ability to accept and be unresponsive to them (Surawy et al., 2015). Thus, Kraemer et al. (2016) examined the mechanisms between mindfulness and health anxiety in which IU was a mediator. ...
The COVID-19 pandemic has increased uncertainty worldwide, which has various negative impacts on psychological well-being. In times like these, it is important to explore how individual resources such as trait mindfulness would help people deal with uncertainty. The aim of the current study was to examine the role of intolerance to uncertainty (IU) as a mediator between trait mindfulness and psychological well-being, including stress, anxiety, depression, and emotional burnout, among employees. Two hundred ninety-three employees completed an online self-report questionnaire during the first COVID-19 pandemic lockdowns in Turkey. The nonparametric bootstrap procedure in AMOS 26.0 was used to test the proposed model. The findings indicated full mediation between trait mindfulness and psychological well-being measures among employees. In other words, employees who reported higher levels of mindfulness perceived their current situation as less threatening, and they were able to tolerate uncertainty, which decreased participants’ stress, anxiety, depression, and emotional burnout. The findings are important for understanding the impact of mindfulness on the psychological well-being of people and the role of intolerance uncertainty in this relationship. The results will be useful for the development of new interventions to promote resources that will increase individual awareness and control during difficult circumstances.
... By engaging in consistent mindfulness exercises, participants can start identifying recurring patterns in their thinking and behavior that may exacerbate depression and gradually learn to modify them. [20] In a study by J. D. Teasdale et al., researchers investigated the effectiveness of Mindfulness-Based Cognitive Therapy as a group intervention aimed at training individuals who had recovered from recurrent depression to disengage from negative thinking patterns that could lead to relapse. The study involved 145 recovered recurrently depressed patients who were randomly assigned to either continue with their usual treatment or to receive MBCT in addition to their usual treatment. ...
Introduction: Depression stands as a primary contributor to disability, prompting extensive exploration of treatment and prevention strategies. Recognizing the limitations of conventional approaches, the significance of effective non-pharmacological therapies, like psychotherapy, in managing mental health disorders is increasingly acknowledged. There's a growing interest in mindfulness-based interventions such as Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based Stress Reduction (MBSR). These interventions, which prioritize present-moment awareness and acceptance, target depression's mechanisms, such as rumination, while cultivating coping strategies and resilience. Mindfulness, with its comprehensive approach and capacity for self-regulation, emerges as pivotal in addressing psychiatric conditions. This paper aims to provide a comprehensive evaluation of MBCT and MBSR's effectiveness in treating depression and preventing relapses. Description of the state of knowledge: MBCT and MBSR exhibit promising potential in effectively managing and preventing depression. Moreover, they alleviate anxiety, emotional exhaustion, stress and psychological distress, while fostering improved coping with rumination, memory disturbances and emotional regulation. Summary: Research indicates that incorporating MBCT and MBSR could offer a hopeful avenue for managing and alleviating the symptoms of depression and mental disorders, by addressing underlying factors which play a pivotal role in their development. To corroborate these encouraging results, additional randomized, large-scale, placebo-controlled trials are essential.
... It also causes impairment in the personal, social, and occupational life of the individual resulting in severe distress. Psychotherapies including cognitive behavior therapy, mindfulness, and interpersonal therapy have been useful in alleviating anxiety symptoms [6][7][8]. However, the role of pharmacotherapy in treating hypochondriasis is not well studied. ...
Hypochondriasis is a condition characterized by an unrealistic fear of having a serious medical illness resulting in health anxiety. Currently, no evidence-based pharmacological treatment options are available for the treatment of hypochondriasis. Since selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment option for anxiety disorders, they may be useful for relieving hypochondriasis symptoms. Moreover, off-label use of SSRIs in these cases is highly prevalent in clinical practice. Thus, in this study, we aimed to review the available literature to assess the role of SSRIs in the treatment of hypochondriacal symptoms. A systematic search was conducted in PubMed, Scopus, ScienceDirect, Embase, and Cochrane Database of Systematic Reviews from the date of inception to December 2022. We included only randomized clinical trials (RCTs) investigating the effect of SSRIs in the treatment of hypochondriacal symptoms. Non-RCTs, observation studies, and animal studies were excluded. The Risk of Bias 2 tool was used to assess the quality of included studies. Out of 2264 articles, six RCTs met our inclusion criteria. Studies have been conducted using different SSRIs in the treatment of primary hypochondriasis and hypochondriacal symptoms associated with other psychiatric disorders. All the studies have found that the use of SSRIs has some beneficial role in improving hypochondriacal symptoms. This suggests that SSRIs may be one of the promising pharmacological interventions in the treatment of hypochondriasis.
Attention-Deficit/Hyperactivity Disorder (ADHD) is a mental disorder characterized by difficulties in behaviour control. This study aimed to explore the socio-demographic characteristics of incarcerated male adults with ADHD in selected prisons in Kenya. A mixed methods approach was employed, combining quantitative and qualitative data collection and analysis. The target population consisted of incarcerated male adults aged 18 to 65 years. The study revealed important insights into the profile of these individuals. The majority of respondents fell within the age range of 20 to 50 years, indicating a prevalence of ADHD among individuals in their prime adulthood. Common previous occupations included agriculture, transport-related, and casual jobs. Marital status analysis showed a significant number of married respondents, highlighting family responsibilities among incarcerated male adults with ADHD. In terms of education, the majority had levels below college, with primary and secondary education being the most common backgrounds. First-borns had the highest representation, and many respondents came from large families with four or more children. Mothers were reported as the most common parent during the respondents' childhood. Regarding income levels, the majority had low-income levels, reflecting socioeconomic challenges faced by incarcerated male adults with ADHD and their limited financial resources. These findings provide a comprehensive understanding of the socio-demographic characteristics of incarcerated male adults with ADHD in Kenya. The insights gained from this study may inform targeted interventions and support services within the prison system to address the specific needs of this population.
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A look at National Institute for Health and Clinical Excellence (NICE) guidance for treatment of anxiety disorders reveals a revolution: first-line treatment for anxiety disorders is cognitive-behavioural therapy (CBT) and some other psychological interventions. Cognitive-behavioural therapy of
Understanding generalized anxiety disorder (GAD) and developing interventions for its amelioration could contribute significantly to the understanding and treatment of all adult emotional disorders. GAD has a fairly high prevalence rate, is often associated with multiple additional Axis I diagnoses, and is a frequent comorbid condition for other anxiety and mood disorders. Moreover, worry is pervasive across all anxiety and depression problems. Learning about worry could teach us a considerable amount about human ways of being. We have been attempting to acquire basic knowledge about GAD and worry, and to develop effective forms of psychological intervention for over two decades. We have added several key components to traditional cognitive-behavioral therapy (CBT) approaches over the years, including teaching clients to focus on the present moment, to value tasks based on their intrinsic value rather than solely their eventual outcomes, and to deepen interpersonal and emotional contact with events. This chapter describes some of our specific interventions. We begin with general comments about the nature of human anxiety, which provide a context relevant to our development of GAD interventions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
It has now been established in several randomized controlled trials that specialist cognitive-behavioural therapy (CBT) is an effective treatment for severe and persistent health anxiety (diagnostically, “Hypochondriasis”). It has not yet been established whether or not such results will generalize from academic research centres to routine clinical settings. The present study was designed to address the issue of generalization by evaluating the outcome of a consecutive series of patients meeting diagnostic criteria for hypochondriasis, treated using CBT in a non-academic clinic in Copenhagen, Denmark. The delivery of the treatment was adapted to fit with the practice of the clinic, so that the later components of therapy were delivered in a group therapy setting. Therapists participated in a brief training course, which was subsequently supplemented by expert clinical and peer supervision. Patients received the same amount of treatment used in previous clinical trials. Results indicate that the degree of improvement obtained in this study was significant and compared well with those obtained in the previous trials. These results support the use of dissemination of new treatments using a specialist training model.
Traces the development of the cognitive approach to psychopathology and psy hotherapy from common-sense observations and folk wisdom, to a more sophisticated understanding of the emotional disorders, and finally to the application of rational techniques to correct the misconceptions and conceptual distortions that form the matrix of the neuroses. The importance of engaging the patient in exploration of his inner world and of obtaining a sharp delineation of specific thoughts and underlying assumptions is emphasized. (91/4 p ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In mindfulness-based cognitive therapy (MBCT), it is proposed that training in mindfulness should reduce the tendency of formerly depressed patients to enter into ruminative thinking, thus reducing their risk of depressive relapse. However, data showing that rumination is associated with depressive relapse are lacking.
In an uncontrolled study with 24 formerly depressed patients, rumination was assessed with the Ruminative Response Scale. To assess the occurrence of relapse or recurrence, the Structured Clinical Interview for DSM-IV was administered 12 months after the end of the MBCT.
Rumination significantly decreased during the MBCT course. Post-treatment levels of rumination predicted the risk of relapse of major depressive disorder in the 12-month follow-up period even after controlling for numbers of previous episodes and residual depressive symptoms.
The results provide preliminary evidence that rumination is important in the process of depressive relapse.