Abnormal Psychology

Dissociative and Somatoform Disorders 375

Treatment may also focus on the family—educating family members about the

disorder and the ways they may have inadvertently contributed to or reinforced

the patient’s symptoms. The therapist may teach family members how to reinforce

positive change and to extinguish behavior related to the symptoms (Looper &

Disorder Cognitive Focus Behavioral Focus Comment

Somatization Disorder Psychoeducation; cognitive

restructuring to modify faulty or

irrational beliefs about bodily

sensations; teach patients not

to amplify the sensations

Identify and then decrease

avoidant behaviors, sensations,

and activities that lead to physical

or psychological discomfort or

restriction of activitiesa; relaxation

to decrease physical tension

CBT is generally the most

effective treatment for

somatization disorder.b

Conversion Disorder Psychoeducation; identify

stressors or confl icts associated

with the emergence of

symptoms; develop alternative

ways to resolve the confl ict or

cope with stressors (problem

solving)c

Assertiveness training as

appropriate; use paradoxical

intention (suggesting that the

patient continue to have the

symptom) to decrease symptoms,

as appropriated

Insight-oriented treatment is

sometimes used to help patients

with conversion disorder

understand the meaning of the

symptoms. Once the meaning is

understood, the symptoms may

improve spontaneously.e

Hypochondriasis Identify and modify faulty or

irrational beliefs about health

worries and bodily sensations

(cognitive restructuring);

teach patients not to amplify

these sensations; decrease

catastrophic attributions about

sensations and illness worries

Identify sensations and activities

that lead to discomfort; identify

avoidant behaviors and decrease

avoidance; use exposure

with response prevention for

compulsive behaviors such

as bodily checking, seeking

reassurance, or visiting doctors

frequently

CBT is the most effective

treatment for hypochondriasis.f

Pilot studies have adapted IPT

to treat hypochondriasis, and

initial results are promising.g

Body Dysmorphic Disorder Psychoeducation; identify

and modify irrational body-

related thoughts (cognitive

restructuring); teach patients to

shift attention away from body

Exposure with response

prevention for compulsive bodily

checking; exposure or systematic

desensitization for body areas that

are viewed as defective

Behavioral techniques are

similar to those used to treat

OCD. CBT is the treatment of

choice for body dysmorphic

disorder.h

aMayou & Farmer, 2002; O’Malley et al., 1999; bAllen et al., 2006; Bass, Peveler, & House, 2001; cMaldonado & Spiegel, 2001; dAtaoglu et al., 2003; eMaldonado &

Spiegel, 2001; fBarsky & Ahern, 2004; Taylor, Asmundson, & Coons, 2005; Wattar et al., 2005; gStuart & Noyes, 2005; Stuart et al., 2008; hWilliams, Hadjistavropoulos, &

Sharpe, 2006.

Table 8.19 • Cognitive-Behavior Therapy for Somatoform Disorders

Perhaps the most effective treatment for leg

paralysis due to conversion disorder may be the

simplest: Educate the patient about the nature of

the symptoms. At least for three patients in one

study, simply showing them their normal test

results and contradictions from their physical

exam did the trick. These patients walked out

of the hospital unaided immediately after these

results were given to them (Letonoff, Williams &

Didhu, 2002).

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