From the Guidelines
For a 31-year-old patient with severe health anxiety, I recommend a combined approach of cognitive behavioral therapy (CBT) and potentially medication, prioritizing CBT as the first-line treatment, as supported by the most recent and highest quality study 1.
Key Components of Treatment
- CBT specifically designed for health anxiety, typically involving 12-16 weekly sessions with a therapist trained in this approach
- Selective serotonin reuptake inhibitors (SSRIs) like escitalopram (10-20mg daily) or sertraline (50-200mg daily) may be beneficial for severe anxiety symptoms, as suggested by 1 and 1
- Lifestyle modifications, including:
- Regular exercise (30 minutes of moderate activity 5 times weekly)
- Mindfulness meditation (10-15 minutes daily)
- Limiting health-related internet searches
- Establishing a regular sleep schedule
Rationale for Treatment Approach
Health anxiety involves excessive worry about having or developing serious illness despite medical reassurance, with the brain misinterpreting normal bodily sensations as dangerous. This creates a cycle where increased attention to bodily sensations leads to more anxiety and physical symptoms. CBT helps break this cycle by challenging catastrophic thoughts and reducing hypervigilance to bodily sensations, while SSRIs help regulate neurotransmitters involved in anxiety responses, as discussed in 1 and 1.
Ongoing Assessment and Adjustment
Regular follow-up and reassessment are crucial to monitor treatment adherence, side effects, and symptom reduction, as outlined in 1 and 1. If compliance is poor or symptom reduction is inadequate, alternative interventions or adjustments to the treatment plan should be considered.