1. 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