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Health Anxiety CBT Targets — MRCPsych Paper B MCQ

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ModerateAnxiety & Stress-Related DisordersHealth Anxiety CBT TargetsMRCPsych Paper B

A 35-year-old remains convinced that intermittent palpitations indicate serious cardiac disease, although an appropriate medical assessment has found no indication for further investigation. He repeatedly checks his pulse, asks his partner whether he looks unwell and closely monitors minor bodily changes. In a cognitive-behavioural formulation of health anxiety, which is the principal therapeutic focus?

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Correct answer: C — Testing catastrophic interpretations and reducing self-focused attention and safety-seeking

Explanation lettering: C = shown as A · D = shown as B · B = shown as C · E = shown as D · A = shown as E

The correct answer is B. In the cognitive-behavioural model, benign bodily sensations are selectively attended to and catastrophically interpreted as evidence of serious illness. Checking, monitoring and reassurance-seeking function as safety behaviours: although they may reduce anxiety briefly, they prevent disconfirmation of the feared belief and maintain vigilance and doubt. CBT therefore uses cognitive reappraisal and behavioural experiments to test catastrophic predictions while reducing these maintaining behaviours. Repeated reassurance (A) and investigations (E) may reinforce the cycle rather than provide durable change, although genuinely new clinical features still require appropriate assessment. Suppression or indiscriminate ignoring of symptoms (C) is neither the CBT aim nor clinically safe. Medication alone (D) does not address the specified cognitive and behavioural maintaining mechanisms.

Reference: Leonidou C, Panayiotou G. How do illness-anxious individuals process health-threatening information? A systematic review of evidence for the cognitive-behavioral model. Journal of Psychosomatic Research. 2018. https://pubmed.ncbi.nlm.nih.gov/29935741/