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Health Anxiety CBT Model — MRCPsych Paper B MCQ

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ModerateAnxiety & Stress-Related DisordersHealth Anxiety CBT ModelMRCPsych Paper B

A 20-year-old woman repeatedly experiences chest discomfort and fears that she has undetected heart disease. Following appropriate medical assessment, investigations are normal and there are no new clinical red flags. She checks her pulse about 50 times each day and has attended the emergency department 12 times in 6 months, obtaining only brief relief from reassurance. Which therapeutic approach most directly targets the processes maintaining her health anxiety?

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Correct answer: B — Use formulation-based CBT to test catastrophic appraisals and reduce checking and reassurance seeking

The correct answer is B. In the cognitive-behavioural model of health anxiety, benign bodily sensations are selectively attended to and catastrophically interpreted as evidence of serious illness. Anxiety then prompts safety behaviours such as pulse checking, reassurance seeking and repeated emergency attendance. These provide short-term relief but prevent disconfirmation of the feared belief and increase attention to bodily sensations. Formulation-based CBT therefore uses cognitive reappraisal and behavioural experiments while progressively reducing these safety behaviours. Repeated reassurance or investigation may perpetuate the cycle, although genuinely new red-flag symptoms still require appropriate assessment. Relaxation alone does not test catastrophic predictions, and leaving checking unchanged preserves a key maintaining mechanism. SSRIs may sometimes reduce health-anxiety symptoms, but medication alone does not most directly target the specified cognitive-behavioural cycle.

Reference: Hedman-Lagerlöf E, Tyrer P, Hague J, Tyrer H. Health anxiety. BMJ. 2019;364:l774. https://pubmed.ncbi.nlm.nih.gov/29935741/