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Cognitive-Behavioral Therapy Versus Other Active Therapies

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In an effort to determine which type of therapy is more effective, Visser and Bouman (2001) compared "pure" CBT therapy and "pure" behavioral therapy using 12 1-hour sessions for 78 patients with hypochondriasis. The CBT emphasized traditional cognitive strategies: 1) identification of dysfunctional automatic thoughts (e.g., catastrophic misinterpretations of bodily symptoms); 2) education of patients (e.g., that irrational thoughts precede fears and distress); and 3) homework assignments with daily diaries to teach patients how to monitor, identify, and label irrational thoughts and challenge these thoughts with more rational ones to observe the subsequent reduction in emotional and physical discomfort. The behavioral therapy used traditional exposure and response prevention (ERP) strategies focusing on typical hypochondriacal behavior patterns: 1) checking of one's body, 2) seeking of reassurance, and 3) avoidance of interoceptive and/or external stimuli or situations that remind one of illness. A hierarchy of exposures is created and systematically addressed in session (in vivo) and through homework assignments. The three behavior patterns are countered with response prevention strategies. Examples of in vivo assignments include watching disease-related videos, having conversations about feared diseases, visiting hospitals or graveyards, and engaging in physical exercise, which can induce physical symptoms considered frightening to the patient.

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