Sibylle Rode’s research while affiliated with UK Department of Health and other places

An application of the cognitive-behavioural model of health anxiety (hypochondriasis) to chronic pain depends on the extent to which high levels of health anxiety occur in chronic pain, which has yet to be established. The occurrence of health anxiety in consecutively recruited chronic pain patients (n=161) and nonclinical controls with (n=34) and without pain (n=70) was investigated using a questionnaire measure of health anxiety. Conservative figures estimated a frequency of 36.7% for hypochondriasis and 51.1% of severe and disabling health anxiety in the chronic pain sample. The current finding that high levels of health anxiety are indeed very common in chronic pain indicates the potential value of an application of the cognitive-behavioural health anxiety model to at least the subgroup of highly health-anxious chronic pain patients.

This study aimed to examine the effect on anxiety about health of a self-referent health questionnaire, in which people were asked to respond to questions about personal risk factors. Participants were randomly allocated into one of two experimental conditions (completing a self-referential assessment of their current health, or personality), with dependent variables measured before and after the experimental manipulation. Dependent variables included general and disease-specific (CHD, Stroke and Diabetes) anxiety and need for reassurance. Analysis of covariance suggested that participants who completed the health-focused questionnaire significantly increased in their anxiety ratings about Heart Disease, Stroke and Diabetes relative to those who completed the personality-focused assessment. There was no effect on general anxiety ratings. The results have important implications for measurement procedures commonly employed in health psychology, as they suggest that asking participants to rate factors related to health risk may lead to other psychological changes. It is important that subsequent research identify the duration of such effects.

Cognitive-behavioural approaches to treatment have become an important part of the clinical management of chronic pain. More recent developments in cognitive-behavioural theory, based on recent developments in the understanding and treatment of health anxiety, have emphasized the importance of catastrophizing appraisals, which drive both attentional processes and behavioural responses, which in turn are believed to be crucial for the maintenance of chronic pain. The experiment conducted here investigated the responses of pain patients (n=39) and controls (n=71) to a behavioural task (prolonged squeezing a dynamometer). Subsequently, the impact of a cognitive task, which fully engaged participants' attention (dichotic listening) was examined. Participants were asked, firstly, to sustain an isometric muscle contraction task (squeezing); secondly, to learn an attentional demanding task (dichotic listening); thirdly, to recall the discomfort experienced in the squeezing task and lastly, to perform both squeezing and dichotic listening at the same time. The squeezing tasks were experimentally manipulated by attaching a more or less negative label ("pain tolerance test" vs. "muscle stamina and strength test"). Patients were found to be less able to sustain prolonged muscle tension than controls, but the effect was not evident once the distracting task was introduced; similar effects were found for discomfort. All participants subsequently recalled the squeezing task as being longer and associated with less discomfort than they had actually recorded it at the time. In the dichotic listening tasks, although patients detected the same number of words overall as controls did, they were less able to focus on the target channel (i.e. they detected more of the words included as distractors on the unattended channel).