High health anxiety has negative repercussions at the individual, interpersonal, and societal levels. According to cognitive behavioural theory, health anxiety is maintained, in part, by behavioural factors, termed safety behaviours. Health-related Internet use (HRIU) may be an important safety behaviour for some health anxious individuals. The Internet offers an abundance of health information, and opportunities to engage in health-related behaviours. Paper 1 aims to establish what is known about the relationship between health anxiety and HRIU. A systematic search was undertaken to identify studies that fell into five broad categories. The identified studies (N = 30) were then narratively reviewed, with an emphasis on methodological quality, and consideration also given to clinical implications and directions for future research. The review indicated that research to date has focused almost entirely on the relationship between health anxiety and using the Internet to obtain health information, termed online health research (OHR). Health anxiety appears associated with amount of, and emotional response to, OHR. The majority of existing studies are cross-sectional. Many use unvalidated measures of HRIU, and/or convenience samples recruited from universities or via commercial services. The Cyberchondria Severity Scale has potential clinical utility as a measure of a specific health anxiety maintenance cycle. However, there is a need for a more general instrument that can be used to assess various dimensions of HRIU in a validated manner. Paper 2 is a cross-sectional, correlational study of relationships between HRIU, health anxiety, and health service utilisation in a clinical, help-seeking sample. Participants were recruited from primary care practices, and completed questionnaire measures. Extent and nature of HRIU, and emotional and behavioural responses to HRIU, were measured using the Online Health Beliefs and Behaviour Inventory (OHBBI). The OHBBI is a recently developed measure that has undergone preliminary psychometric validation. OHBBI subscales explained 30% of variance in health anxiety, but did not improve prediction of self-reported service utilisation. A moderated regression indicated that the relationship between the Illness-Focused Searching subscale and health service utilisation varied as a function of health anxiety, with a negative relationship at low levels of health anxiety, and a positive relationship at high levels. This study provides further evidence of a role for HRIU in the maintenance of health anxiety, and advances the literature by using a validated measure of HRIU, a clinical sample, and well-controlled models. Paper 3 is a critical, reflective appraisal of the thesis as a whole. Methodological decisions, and their ramifications, are discussed in detail. The importance of the thesis is summarised, and implications for clinical practice and future research are revisited. The OHBBI requires further psychometric refinement. Longitudinal studies, and studies that use objective measures of service utilisation, are needed. Safety behaviours, including various forms of HRIU, may interact with each other to perpetuate health anxiety; such complex maintenance cycles merit empirical investigation.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Introduction: There are few studies that examine the factors associated with the different levels of health anxiety in medical students. The objective was to determine the factors associated with the levels of health anxiety in medical students in 2018. Methods: An analytical cross-sectional study was carried out with 657 medical students from a private Peruvian university. Participants answered a questionnaire from which information was collected regarding levels of health anxiety (SHAI). For the analysis, linear regression was used to calculate crude and adjusted betas, and their 95% confidence intervals. Results: The mean health anxiety score was 14 ± 6.7. An association between health anxiety and the year of study is reported, with the second year showing the highest scores. In addition, an association between health anxiety and smoking is highlighted, as there are higher levels in occasional smokers, as well as a weak inverse correlation with age. No association was found with sex, place of birth, or having a first-degree relative that is a doctor or health worker. Conclusions: The present study showed that age, year of studies and smoking are associated with health anxiety levels. More studies are required, especially of a longitudinal nature. / Revisión por pares

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The aim of this study was to examine whether three different psychological predictors; Health anxiety (SHAI), Disgust sensitivity (DS-R) and intolerance of uncertainty (IUS-12) could predict COVID-19-related anxiety in students at Orebro University, Sweden. It was hypothesized that there would be a significant relationship between the three psychological behaviors and pandemic-related anxiety. An online survey, consisting of both standardized and non-standardized questionnaires, was constructed. The survey was completed by 199 participants, aged between 19-48 (M = 25.14 and SD = 5.35) from Orebro University, Sweden through Limesurvey. A correlation revealed that Health anxiety and Disgust sensitivity were significantly correlated with COVID-19-related anxiety. The regression analysis revealed that there was a significance between the three psychological behaviors and COVID-19-related anxiety. In conclusion, Health anxiety, Disgust sensitivity and intolerance of uncertainty, could indeed be associated with COVID-19-related anxiety in the students. / Syftet med studien är att examinera huruvida tre olika psykologiska beteenden; Health anxiety (SHAI), Disgust sensitivity (DS-R) och Intolerance of uncertainty (IUS-12) kan förutse COVID-19-relaterad ångest i studenter på Örebro Universitet. Det hypotiserades att det skulle finnas en signifikant relation baserat på tidigare studier. En online enkät, med både standardiserade och icke-standardiserade frågeformulär, konstruerades. Antal deltagare som kompletterade enkäten genom Limesurvey var 199 studenter mellan åldrarna 19–48 (M = 25.14 och SD = 5.35) från Örebro Universitet. Genom en korrelationsanalys kunde man se att både Health anxiety och Disgust sensitivity var signifikant korrelerade med COVID-19-relaterad Pandemi. Avslutningsvis, en multipel regressionsanalys visade att Health anxiety, Disgust sensitivity och Intolerance of uncertainty var signifikant relaterat med COVID-19-relaterad ångest i studenterna.

Cognitive behavioural theory suggests that excessive use of the Internet for health purposes can contribute to health anxiety but previous research examining the relationship between health anxiety and health-related Internet use is limited. This thesis aimed to explore if and how health-related Internet utilization and health anxiety are related, and whether such Internet use can exacerbate the health anxiety of health anxious individuals. Study 1 aimed to examine the possible relationship between health anxiety and the extent of, reasons for, and effects of health-related Internet use in university students, using a bespoke, theory-based questionnaire. Results suggested that health anxiety was significantly related to heightened and potentially problematic health-related Internet use, including: more frequent use, a greater proportion of health (vs. non-health) information sought, more time spent online for health purposes, more searches for illness information, and heightened tension post-search. We also found correlations between health anxiety and six-items concerning possible Internet addiction for health purposes. Study 2 sought to obtain information about health anxious individuals’ perspectives on health-related Internet use, using qualitative methodology. Themes uncovered during analysis were consistent with the results of study 1, and highlighted several other aspects of health-related Internet use that were relevant to health anxious users, including: metacognitions, Internet disadvantages, and health anxiety for others etc. Study 3 used the results of studies 1 and 2 to develop and psychometrically evaluate a new Internet use questionnaire in a large, non-clinical sample. Results suggested that the measure was both valid and reliable. Spearman correlations and simultaneous regressions substantiated previous findings from our earlier studies. Three aspects of health- related Internet use were uniquely predictive of health anxiety (illness-related Internet use: self; problematic use of the Internet for health purposes; anxiety post-search/perceived adverse consequences of searching). Study 4 aimed to determine the effects of presenting online health information in a manner designed to facilitate disconfirmatory information processing on subsequent anxiety, worry and illness beliefs. Results suggested that facilitating disconfirmatory information in this way was ineffective in reducing negative emotional outcomes post-search. Study 5 compared the frequency of ‘query escalations’ (searches for common, benign symptoms escalating to the consideration of serious causes/diseases) during online health searches between high and low health anxious students. We also examined the participants’ rationale for escalating queries and the effects of escalating on anxiety. Results found instances of query escalation in both high and low health anxious groups; though high health anxious participants were more likely to escalate their queries. Both groups reported increased anxiety post-escalation. In the final chapter I briefly summarise our studies, discuss major findings and the implications of our research, critically appraise our methodology, choices, and studies, and make recommendations for future research in this area.

Excessive Reassurance Seeking (ERS) is an under-researched and poorly understood behaviour that resembles the compulsive behaviours that are typically seen in obsessional problems. ERS can be complex, persistent, extensive, debilitating and may dominate the interactions of those involved. In addition to resembling compulsive checking in Obsessive-Compulsive Disorder (OCD) it may have the effect of transferring responsibility to another person. However, it could be seen as a type of support. Both ERS and support are defined and key questions about these concepts are considered in five studies which examine ERS from the perspectives of non-clinical samples, sufferers of anxiety problems, caregivers and therapists. Study 1 qualitatively examines interpersonal components of ERS in OCD and identified the experience of frustration in caregivers as being particularly pervasive. Study 2 examines the diagnosis specific/transdiagnostic elements of ERS in OCD and health anxiety contrasted with support using mixed methods. Results revealed some limited diagnosis specificity of ERS. Strikingly, people with health anxiety did not seek support; reassurance seeking may be their default response. Study 3 uses a larger sample to quantitatively evaluate therapists’ perception of ERS and its treatment, with results suggesting that there is considerable room for improvement. Study 4 examined therapeutic intervention for ERS in treatment refractory OCD using a single case experimental design; Cognitive Behavioural Treatment (CBT) that focuses on treating ERS had beneficial effects. Study 5 tackled the diagnosis specific/transdiagnostic issues in a questionnaire by considering ERS across different anxiety problems. ERS may represent a final common pathway of multiple processes; some processes appear transdiagnostic; others may indicate disorder specificity. Overall, findings reveal the complexity of ERS and its likely nature as a safety-seeking behaviour which requires attention in treatment. Engendering support as an alternative to reassurance in CBT may be particularly promising.

The purpose of this study was to assess fear of cancer recurrence (FCR) in breast cancer survivors returning for regularly scheduled follow-up mammograms. FCR was hypothesized to increase prior to the mammogram, decrease from immediately pre- to immediately post-mammogram, and then increase following the mammogram. Based on the cognitive-behavioral model (CBM) of health anxiety, greater perceived risk of recurrence, worse perceived consequences of a recurrence, lower coping self-efficacy, and more engagement in reassurance-seeking behaviors were hypothesized to be associated with greater FCR in each time segment. Finally, exploratory analyses evaluated the various trajectories in FCR over time using growth mixture modeling and the CBM to predict class membership. The sample comprised 161 women who completed treatment for stage 0-IIIA breast cancer between 6 and 36 months previously. Participants completed the following measures at least 31 days prior to the scheduled mammogram: perceived risk and perceived consequences of breast cancer recurrence, treatment efficacy beliefs, coping self-efficacy, and reassurance seeking behaviors. Participants reported FCR at one month, one week, and immediately prior to the mammogram as well as one month, one week, and immediately after the mammogram using visual analogue scales (VAS) to rate anxiety and worry about cancer recurrence, the Cancer Worry Scale (CWS), and the Fear of Cancer Recurrence Inventory (FCRI). State anxiety and reassurance post-mammogram were also assessed. FCR significantly changed over time with increases in CWS scores prior to the mammogram, a significant decline on the VAS observed immediately following receipt of results, and a significant increase on the VAS, and decrease in reassurance during the month following the mammogram. The CBM did not significantly predict change in FCR over time, but certain variables did predict fluctuations including coping-self efficacy and perceived risk in the expected directions. Finally, growth mixture models revealed two classes, high-FCR and low-FCR, which were predicted by the CBM. These study findings support the use of the CBM in predicting which cancer survivors experience greater FCR and indicates that CBM-driven interventions may prove beneficial for reducing distressing FCR.

Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 4 uppsatser.

The aim of the thesis in the theoretical section was to describe the mental health problems in the Czech Republic. The main goal of the research work was to draw attention to these problems and to explore the psychiatric treatment from the outpatients' perspective. Mental health is a vast topic which I elaborated using many relevant sources mentioned in analytical, statistical and other materials as well as the official Czech and international documents. The findings show that in spite of undisputable pluses of the Czech system, the accessibility of the psychiatric care is unsatisfactory and the promotion of the mental health services has been seriously neglected and delayed in the Czech Republic compared with most EU countries. A fundamental positive change has been expected with the implementation of two key agendas - the Psychiatric Care Reform Strategy and the Mental Health Action Plan. For the thesis an original, non-standardized written questionnaire was used to evaluate depressed and anxious patients' point of view of their treatment. The quantitative research was later evaluated using statistical methods. The quantitative research was evaluated with the SPSS statistical software. Hypotheses were tested using the chi-square. The results suggest that the fear of stigmatisation by psychiatric care as well as the time to a psychiatrist visit are influenced by diagnosis and specific health problems. The results also suggest that the personality type and family milieu are more important than socio-demographic factors. Gender differences do not influence the compliance either. The complex outcomes of the patients' attitude research can be later used in designing better mental health care.