A diary-based modification of symptom attributions in pathological health anxiety : effects on symptom report and cognitive biases

Abstract

Objective: To examine whether a 2-week attribution modification training (AMT) changes symptom severity, emotional evaluation of health-threatening stimuli, and cognitive biases in pathological health anxiety. Method: We randomized 85 patients with pathological health anxiety into an electronic diary-based AMT group (AMTG; n = 42) and a control group without AMT (CG; n = 43). Self-report symptom measures, emotional evaluation, attentional bias, and memory bias toward symptom and illness words were assessed with an emotional Stroop task, a recognition task, and an emotional rating task for valence and arousal. Results: After the 2-week period, the AMTG compared with the CG reported lower symptoms of pathological health anxiety, F(1, 82) = 10.94, p< .01, η ^2_p = .12, rated symptom, F(1, 82) = 5.56, p = .02, η^2_p = .06, and illness words, F(1, 82) = 4.13, p = .045, η^2_p = .05, as less arousing, and revealed a smaller memory response bias toward symptom words in the recognition task F(1, 82) = 12.32, p< .01, η ^2_p = .13. However, no specific AMT effect was observed for the attentional bias. Conclusion: The results support the efficacy of a comparatively short cognitive intervention in pathological health anxiety as a possible add-on intervention to existing treatment approaches to reduce symptom severity, as well as abnormalities in health-related emotional evaluation and memory processes.