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Background: Hypochondriasis is generally considered difficult to manage. This study aimed to assess the effectiveness of cognitive therapy and to compare it with an equally credible, alternative treatment., Method: Forty-eight patients with hypochondriasis were initially randomly assigned to either cognitive therapy, behavioural stress management or a no treatment waiting list control group. At the end of the waiting period, patients in the control group were randomly assigned to one of the two treatments. Assessments were at pre-, mid- and post-treatment or waiting list and at three-, six- and 12-month post-treatment follow-up., Results: Comparisons with the waiting list group showed both treatments were effective. Comparisons between the treatments showed that cognitive therapy was more effective than behavioural stress management on measures of hypochondriasis, but not general mood disturbance at mid-treatment and at post-treatment. One year after treatment patients who had received either treatment remained significantly better than before treatment, and on almost all measures the two therapies did not differ from each other., Conclusions: Cognitive therapy is a specific treatment for hypochondriasis. Behavioural stress management is also effective but its specificity remains to be demonstrated.

It has often been suggested that attempts to suppress a thought will lead to an immediate and/or delayed increase in its occurrence. In a recent experiment (Clark, Ball & Pape, Behaviour Research and Therapy, 29, 253-257, 1991) we obtained a delayed (rebound) effect but failed to demonstrate an immediate enhancement effect. Lavey and van den Hout (Behavioural Psychotherapy, 18, 251-258, 1991) have suggested immediate enhancement might be observed only if subjects are instructed not to use distraction while suppressing. The present experiment tested this hypothesis. An immediate enhancement effect was not obtained but the delayed (rebound) effect was twice replicated and an artifactual explanation of this effect was discounted.

Initial interest in the causes and treatment of panic disorder was triggered by biological theories and investigators. More recently, however, research on newly developed psychological approaches for panic has advanced our understanding of the disorder and has led to the development of specific treatment programs. Typically, these programs consist of a range of treatment components that more or less directly target panic attacks and the fears and behaviors associated with them. The paper reviews four studies evaluating these programs that have recently been completed or are close to completion in different centers in the United States (Albany, New York; Austin, Texas) and Europe (Oxford, England; Marburg, Germany). Conforming to strict methodological standards, these studies report consistently high success rates and temporal stability of the treatment gains. About 80% or more of the patients receiving combined cognitive-behavioral treatments achieved panic free status as well as strong and clinically significant improvement in general anxiety, panic-related cognitions, depression, and phobic avoidance. Furthermore, these gains were maintained at follow-ups of up to 2 years. The success of these psychological treatments compares favorably with the outcome for the established pharmacological treatments. In addition, the studies provide new insights into the active ingredients that may operate in cognitive-behavioral treatments for panic disorder and show the feasibility of group treatments. Together, these studies underscore the fact that cognitive-behavioral treatments rest on firm experimental evidence that justifies their application in everyday practice as well as continued research into their mechanisms of action.

An experiment investigating the hypothesis that trying to suppress a thought will lead to an immediate and/or delayed increase in its occurrence is reported. Normal subjects listened to a taped story and then verbalized their stream of consciousness during two consecutive time periods. During the first period, one group (suppression) were asked not to think about the tape while two other groups (controls) were asked to think about anything or think about anything including the tape. During the second period, all three groups were instructed to think about anything. Results from the first period failed to support the immediate enhancement hypothesis as the suppression group reported less thoughts about the tape than the controls. However, results from the second period supported the delayed (rebound) hypothesis as subjects who had previously suppressed reported more thoughts about the tape than subjects who had not. The theoretical, methodological, and clinical implications of these results are discussed.

Eighteen patients who experienced frequent panic attacks were given a treatment derived from the literature on hyperventilation and anxiety. The treatment consisted of (i) brief, voluntary hyperventilation. This was intended to induce a mild panic attack; (ii) explanation of the effects of overbreathing and reattribution of the cause of a patient's attacks to hyperventilation; (iii) training in a respiratory control technique. Substantial reductions in panic attack frequency and in self-reported fear during a behaviour test were obtained after 2 weeks' treatment and these reductions occurred in the absence of exposure to feared situations. Further reductions in panic attack frequency were evident at 6-month and 2-year follow-up though interpretation of these results is complicated by the addition of exposure and other psychological treatments.

Objective: To compare the effects of an intensive group cognitive treatment (IGCT) to individual cognitive therapy (ICT) and treatment as usual (TAU) in social phobia (DSM-IV). Method: Hundred patients were randomized to: IGCT involving 16 group sessions spread over three weeks; ICT involving 16 shorter weekly sessions in 4 months and; TAU involving an indicated selective serotonin reuptake inhibitor (SSRI) with therapy sessions as required for 1 year. The main outcome measure was a Social Phobia Composite that combined several standardized self-report measures. Diagnostic assessment was repeated at 1-year follow-up. Results: Significant improvements were observed with all treatments. ICT was superior to IGCT and TAU, which did not differ in overall effectiveness. Conclusion: The study confirms and extends previously reported findings that ICT is more effective than group cognitive treatment and treatment with SSRIs. IGCT lasts only 3 weeks, and is as effective as more protracted TAU. [ABSTRACT FROM AUTHOR]

Background: Hypochondriasis is a distressing disorder for which there is no adequate established treatment. This study evaluates the effect of cognitive-behavioural treatment of hypochondriasis, compared with a waiting list control.Method: Thirty-two patients were randomly assigned to either cognitive-behavioural therapy or a no treatment waiting list control. Cognitive-behavioural treatment consisted of 16 individual treatment sessions over a four-month period. The waiting list control lasted for four months and was followed by 16 sessions of cognitive-behavioural treatment. Assessments were made before allocation and after treatment or waiting list control. Patients who had cognitive-behavioural treatment were reassessed three months after completion of treatment.Results: Paired comparisons on post-treatment/wait scores indicated that the cognitive-behavioural group showed significantly greater improvements than the waiting list on all but one patient rating, all therapist ratings and all assessor ratings. After three months the benefits of therapy were maintained.Conclusions: Cognitive-behavioural treatment is an effective therapy for hypochondriasis. Implications of the study are discussed. [ABSTRACT FROM AUTHOR]