Theo Bouman

The treatment of hypochondriasis: exposure plus response prevention vs cognitive therapy

In this study (1) exposure in vivo plus response prevention, (2) cognitive therapy and (3) a waiting-list control condition were compared on their efficacy on the treatment of hypochondriasis. Seventy-eight patients with a DSM-IV diagnosis of hypochondriasis were randomly assigned to one of these conditions. Patients in both active treatment conditions improved significantly on all the measures, whereas the patients in the waiting-list control condition did not improve. The improvements were clinically significant. Exposure in vivo plus response prevention and cognitive therapy were equally effective. The improvements were maintained at the 7 months follow up.

A preliminary study of worry and metacognitions in hypochondriasis

It was investigated whether hypochondriasis is characterized by either a general or a more content-specific tendency to worry and to engage in meta-worry (i.e. beliefs about worries). In samples of hypochondriacal patients (n = 14), matched healthy controls (n = 25) and psychology students (n = 122) questionnaires were administered to assess hypochondriasis, the process and content of worrying, and both general and illness-related meta-worry. The results show that hypochondriacal patients tend to worry more about illness-related topics but not about general issues. Hypochondriasis as a dimension is best predicted by specific meta-worries about lack of control over thoughts about illness, as well as a cognitive self-consciousness. The findings suggest the existence of disorder-specific meta-worries. Copyright (C) 1999 John Wiley & Sons, Ltd.

Female Attitudes Regarding Labia Minora Appearance and Reduction With Consideration of Media Influence

BACKGROUND Labia minora (LM) appearance and reduction have gained increasing media attention in The Netherlands. OBJECTIVE To determine the prevailing female view about LM appearance and reduction and the role of the media in shaping that view. METHODS From October 2007 to January 2008, questionnaires designed to elicit prevailing female opinion were distributed to and completed by several groups of females. Survey participants included female medical students at the University of Groningen (n = 394; average age, 22 +/- 3 yrs); patients visiting the outpatient Department of Obstetrics and Gynaecology of the Medical Centre Leeuwarden (n = 51; average age, 40 +/- 13 yrs); and female patients visiting Heerenveen, a private clinic (n = 37; average age, 41 +/- 10 yrs). RESULTS Most participants (95%) frequently examined their own LM. Almost half of the participants (43%) found the appearance of their LM important and 71% thought that their appearance was normal. Almost all participants (95%) have known about the possibility of LM reduction for the past 2.2 years. Most participants (78%) heard about LM reduction through a media source. Fourteen percent of the total sample found the appearance of their LM to be abnormal, 7% had considered LM reduction, and 0.42% had undergone such a procedure. CONCLUSIONS Our survey demonstrates that the appearance of LM is important to women and that almost all women surveyed have heard about LM reduction during the past 2.2 years. Our findings probably reflect the influence of increased media attention on this issue in The Netherlands.

Cognitive and Behavioural Treatment of Hypochondriasis

Background: This study investigates the feasibility and effectiveness of time-limited treatment protocols based upon cognitive and behavioural interventions. Method: Seventeen patients with DSM-IV diagnoses of hypochondriasis were offered 12 1-hour sessions of either ‘pure’ cognitive or ‘pure’ behavioural (i.e. exposure in vivo and response prevention) treatment. Patients were used as their own controls by observing a 4-week period without interventions before and after treatment. Results: Patients in both treatment conditions improved on specific measures of hypochondriasis (Kellner’s Illness Attitude Scales) and depression. These changes took place during the active treatment period, whereas in the control periods scores remained unchanged. Furthermore, no differential treatment effectiveness could be demonstrated. Conclusions: Cognitive and behavioural interventions seem to be active ingredients in the treatment of hypochondriasis, although the contribution of nonspecific factors (e.g. patient motivation, therapist attitudes, and the therapeutic relationship) requires further study.

The concepts of depression, anxiety, and neuroticism in questionnaires

In this study, the relations among depression, anxiety, and neuroticism measured by self‐report questionnaires were investigated. Subjects were 207 psychiatric patients. High correlations were found among self‐report scales purporting to measure depression, anxiety, and neuroticism. Results of a content analysis showed considerable overlap among these scales. A division of items into six content categories did not result in lower correlations compared to the original scales.

Cognitive-behavioural approaches in the treatment of hypochondriasis : six single case cross-over studies

This study evaluates a cognitive and a behavioural treatment protocol for hypochondrical complaints. In a cross-over design, six patients with a primary diagnosis of hypochondriasis were treated. Three of them first received a block of behavioural therapy (exposure in vivo and response prevention), followed by a block of cognitive therapy. The other three patients were first treated with cognitive therapy followed by behavioural therapy. The results were promising: four patients made significant improvements. The behavioural therapy sessions appeared to account more often for improvement than did the cognitive sessions. The sequence of behavioural therapy followed by cognitive therapy tended to be more successful than the other way around. The results of these six case studies suggest that exposure in vivo with response prevention and cognitive therapy may both be useful in the treatment of hypochondriasis. A journal controlled study is recommended.

A community-based psychoeducational group approach to hypochondriasis

Background: This open trial investigates the feasibility and effectiveness of a cognitive-educational approach to hypochondriasis in a self-referred community sample. Method: Twenty-seven of 43 interested applicants fulfilled DSM-criteria for hypochondriasis and resembled a hypochondriacal reference group according to the Groningen Illness Attitude Scale. Subjects participated in small groups for six 2-hour sessions aimed at educating them about hypochondriasis. Results: The results showed that the 21 completers improved between pre- and post-test on parameters for hypochondriasis and depression, and that this improvement was maintained at 4 weeks and 6 months follow-up. Six subjects dropped out for various reasons, showing no decrease in relevant variables. Conclusion: Hypochondriacal subjects can be reached outside mental health settings, and a psychoeducational group approach may be an acceptable and effective method to reduce hypochondriacal psychopathology.

Relations Between the Pleasant Events Schedule, Depression, and Other Aspects of Psychopathology

In this article, relations between the Mood Related subscale of the Pleasant Events Schedule (PES), depression, and other psychopathology are studied. One hundred psychiatric inpatients and outpatients had diagnoses of either major, nonmajor. or no depression. All completed the PES, the Beck Depression Inventory, the State-Trait Anxiety Inventory, and the Dutch Personality Questionnaire. Results showed that the PES correlated negatively with depression as well as with anxiety and (social) neuroticism. Principal components analysis revealed two factors, negative and positive affect. The latter was dominated by PES scores. Using factor scores, the three diagnostic groups could be meaningfully discriminated. It is concluded that depression may be better described using two affect dimensions rather than one.

The effectiveness of lithium prophylaxis in bipolar and unipolar depressions and schizo-affective disorders

The effectiveness of lithium prophylaxis in bipolar affective disorders is generally supported in the literature. The effects in this group, as well as in unipolar depressions and schizo-affective disorders were studied, using an individual retrospective control method, and the Life Table method. Lithium prophylaxis resulted in a substantial decrease in the number of episodes and hospital admissions in bipolar and schizo-affective disorders. In addition, these two groups showed frequent relapses after termination of the prophylaxis. The number of episodes preceding the prophylaxis and the absence of unipolar depression are found to be predictors of effectiveness. The consequences of patient selection and of inconclusive diagnostic criteria are pointed out.

Clinical Features, Prevalence and Psychiatric Complaints in Subjects with Fear of Vomiting

UNLABELLED Specific phobia of vomiting (also known as emetophobia) is a relatively understudied phobia with respect to its aetiology, clinical features and treatment. In this stage, research is mostly based on people with self-reported fear of vomiting. This paper presents a survey on the clinical features of fear of vomiting of individuals. Self-reported vomit-fearful subjects from the Dutch community and from an Internet support group are included. Both vomit-fearful groups were characterized by high reports of fear, the presence of panic symptoms, and by extensive avoidance and safety behaviours. They also reported other psychiatric complaints, which were measured with a structured screening instrument. Vomiting complaints started mostly in late puberty. A significant proportion of the vomit-fearful participants had a treatment history. The prevalence rate of fear of vomiting in the community sample was established at 8.8% (female : male ratio = 4:1). Overall, results show that fear of vomiting is a common phenomenon, which can seriously impair daily functioning. Finally, clinical questions to be addressed in future research are formulated. KEY PRACTITIONER MESSAGE Specific phobia of vomiting (also known as emetophobia) is among the least studied phobias. Most clinical data come from research with self-described fear of vomiting. This paper presents data on the clinical features, prevalence and additional psychiatric complaints of fear of vomiting in two vomit-fearful samples and one control sample with no fear of vomiting. Estimates of prevalence of fear of vomiting in a Dutch community sample were established at 1.8% for men and 7% for women. Evidence suggests that fear of vomiting is a chronic and disabling condition that may cause significant impairment in daily functioning.