Managing Health Anxiety in Patients

Assessment and Diagnosis

The American College of Oncology recommends using validated screening tools, such as the Hospital Anxiety and Depression Scale (HADS) with a score ≥8 indicating significant anxiety, or the Penn State Worry Questionnaire (PSWQ) to evaluate worry severity, to assess the severity of health anxiety symptoms in patients 1, 2
The American College of Oncology suggests identifying signs and symptoms of anxiety, including panic attacks, trembling, sweating, tachycardia, palpitations, and sweaty palms, to diagnose health anxiety in patients 3
Assessing the severity of symptoms, possible stressors, risk factors, and exploring underlying problems/causes is crucial in diagnosing health anxiety, according to the American College of Oncology 4
Ruling out medical causes of anxiety symptoms, such as unrelieved pain, fatigue, or endocrine disorders, is essential before confirming a diagnosis of health anxiety, as recommended by the American College of Oncology 3

The American College of Oncology recommends providing education and information to patients and families about health anxiety, including normalcy of health-related concerns and anxiety, specific stress reduction strategies, and information about signs and symptoms of anxiety and their treatment, for patients with mild health anxiety 5
For moderate health anxiety, the American College of Oncology suggests using psychological interventions derived from empirically supported treatment manuals that specify content and structure, such as cognitive behavioral therapy (CBT) 6
Combining psychological and pharmacological approaches is recommended for severe health anxiety, according to the American College of Oncology, with first-line pharmacotherapy including selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) 3
When selecting medication, considering adverse effect profiles, potential drug interactions, response to prior treatment, and patient preference is crucial, as recommended by the American College of Oncology 7

Regular follow-up is crucial, as patients with anxiety often avoid treatment, and assessing compliance with referrals and treatment monthly until symptoms subside is recommended, according to the American College of Oncology 7
Modifying the treatment approach, such as adding psychological intervention or changing medication, is necessary if symptoms persist after 8 weeks of treatment despite good compliance, as suggested by the American College of Oncology 7
Using outcome measures routinely to gauge treatment efficacy, monitor adherence, and evaluate practitioner competence is essential, according to the American College of Oncology 8

The American College of Oncology recommends caution when using benzodiazepines, as they carry increased risk of abuse and dependence and are associated with cognitive impairment, and their use should be time-limited according to psychiatric guidelines 3
Dismissing patient concerns can increase anxiety and reduce trust in healthcare providers, and addressing underlying anxiety mechanisms is essential, as recommended by the American College of Oncology 5

The American College of Oncology recommends assessing treatment response at 4 weeks and 8 weeks after initiating treatment, with monthly follow-up thereafter until symptoms stabilize, for patients with moderate to severe anxiety 9
Evaluate symptom relief using standardized validated instruments, such as GAD-7, HADS, or BAI, at week 4 and week 8 assessments 9
Assess medication side effects and adverse events if pharmacotherapy was initiated, and determine patient satisfaction with treatment at week 4 and week 8 assessments 9
Check adherence to the treatment plan at week 4 and week 8 assessments 9

If little improvement is seen despite good adherence, adjust the treatment regimen by adding psychological intervention to medication, changing medication, or switching from group to individual therapy at week 8 assessment 9
Re-evaluate the treatment plan if patient satisfaction is low or barriers to treatment exist at week 8 assessment 9
Mental health professionals should assess treatment response at pretreatment, 4 weeks, 8 weeks, and end of treatment for psychological interventions 9
Most effective psychological interventions in primary care maintain treatment gains at follow-up assessments ranging from 2-12 months, with 77.8% maintaining benefits 10, 11

At 8 weeks, modify the approach by adding a psychological intervention to pharmacotherapy, changing the medication class, or switching from group to individual therapy if symptoms are stable or worsening despite good adherence 9
Do not wait beyond 8 weeks to adjust treatment if there is minimal improvement, as this delays recovery and increases patient suffering 9
Do not assume patients are following through with referrals, and actively verify attendance at the first appointment and identify barriers 9
Do not rely on clinical impression alone, and always use standardized instruments, such as GAD-7, HADS, or BAI, to objectively track progress 10, 11