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Brief Clinical Reports
An extended version is also available online in the table of contents for this issue: http://journals.cambridge.org/jid_BCP
Introduction
Health anxiety refers to excessive anxiety related to one's present or future health and can be a feature of a number of different disorders, such as hypochondriasis/illness anxiety/somatic symptoms disorder, obsessive compulsive disorder, and panic disorder (Rachman, 2012). While physical illness is typically the focus of concern, it is possible that mental illness can be the focus of dread and fear. In this case, patients fear losing control of their mind, acting in violent and unpredictable ways, or being locked away in psychiatric facilities (Rachman, 2012).
While mental illness anxiety is recognized as a form of health anxiety (Rachman, 2012), extant literature has focused on individuals who fear physical rather than mental illness. Cognitive behavioral therapy (CBT) has been demonstrated to be efficacious for health anxiety (see Rachman, 2012 for a review) but there is a paucity of research on adapting CBT for mental illness anxiety. The current case study aims to advance the understanding of the clinical picture of mental illness anxiety, and facilitate the understanding of how CBT techniques for health anxiety can be effectively adapted and implemented for such a case.
Method
Overview and design
Tamara, a 24 year old woman who resided with her parents in a small town in Canada, self-referred for services at a University Psychology Training Clinic. Tamara participated in an intake assessment, feedback session, and eight treatment sessions. A telephone follow-up session was conducted 2 months after treatment. With her consent, a single case study design was used to describe Tamara's treatment.
Assessment
Presenting problem
Tamara presented with elevated anxiety characterized by fears that she was "going crazy" or may "end up in a mental institution". She further described experiencing intrusive thoughts and images of hurting people close to her, which would often trigger cued panic attacks. Tamara's interpretation of her intrusive thoughts was that she must be becoming a "serial killer" or developing a serious mental illness. Similarly, when having a panic attack, Tamara would think "this also proves I'm losing my mind". In response to her anxiety, Tamara reported avoiding places or activities that she suspected would trigger her anxiety (e.g. television depicting serial killers,...