ET CBT Effective Nursing Interventions For Patients With High Health Anxiety: An Integrative Literature Review Christina Hetz, Larry Maturin DePaul University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . BACKGROUND METHODS DISCUSSION High health anxiety is a preoccupation with fears of having or the idea one has a serious disease that persists despite appropriate medical evaluation. Patients with high health anxiety over seek medical services, often resulting in unnecessary and possibly invasive tests, consultations, and medication. This causes: Iatrogenesis  injury resulting from healthcare service Increased health anxiety Hypochondriasis is often used interchangeably for high health anxiety. Hypochondriasis is a DSM-IV that was replaced in the DSM-V with: Somatic symptom disorder – physical complaints are prominent (75% of hypochondriacs) Illness anxiety disorder - physical complaints are not present or minimal and are considered misperceptions of normal body sensations (25% of hypochondriacs) The purpose of this integrative literature review was to identify interventions to lessen symptoms of high health anxiety, and the healthcare providers most successful in providing these interventions. Application of H. Peplau’s Theory of Interpersonal Relations 4 Phases of nurse-patient relationship: Orientation – establish parameters Identification – patient identifies problems; nurse helps patient recognize interdependent participation role and promotes taking responsibility for self Exploitation – goals are identified and oriented Resolution – patient has increased self-reliance This study utilized an integrative literature review to explore the research on interventions that exist for nurses to alleviate symptoms of high health anxiety. An integrative literature review summarizes past literature to provide a more comprehensive understanding of the topic at hand Databases utilized: CINAHL Complete, PubMed, PsychINFO Interventions for high health anxiety fall under two categories: cognitive behavioral therapy (CBT) and exposure therapy (ET). Nurses are well suited to provide interventions for patients and are the therapists of choice in the clinical setting. Nurses were superior therapists to assistant psychologists, dieticians, graduates in psychology, and physicians. Treatment by nurses prevents the stigma that comes with a mental health referral Patients have more confidence in nurses as they are more knowledgeable about medical disorders than psychiatrists Physicians often only focus on organic causes of illnesses The nurse-patient relationship is based on trust and collaboration Nursing is often considered the highest trusted profession Nurses can be effectively trained in CBT with two informational workshops. Nurses in the medical setting can treat repeat attenders, many of whom may have existing medical diagnoses as well as suffer from high health anxiety. Although nurses cannot diagnose, they can examine a patient’s chart and assess the patient for red flags indicating high health anxiety, including: Dissatisfaction despite receiving extensive medical care Multiple clinical consultations with consistently negative results Medical attention and interventions worsening the patient’s anxiety Timely and appropriate management of high health anxiety symptoms is ideal in preventing secondary problems and exacerbation of the health anxiety. Successful nurse-led high health anxiety interventions will: Prevent unnecessary and possibly invasive tests, consultations, and medication Prevent iatrogenesis that might result from these treatments Lessen, as opposed to increase, symptoms of high health anxiety Additional research is needed on the effectiveness of nurses integrating current identified interventions into practice. Future research on additional effective high health anxiety interventions is needed – specifically nurse-led interventions. Long-term studies are needed with a higher percentage of participation from eligible patients and lower dropout rates. A clinical trial currently underway hypothesizes mental health nurse practitioners to be the gold standard in treating high health anxiety. Results are expected in 2018. FINDINGS ET Thoughts What we think affects how we feel and act PURPOSE CBT Anxiety Emotions What we feel affects how we think and act Behaviors What we do affects how we think and feel Exposure LIMITATIONS/FUTURE RESEARCH WHY NURSES? CONCEPTUAL FRAMEWORK