Treatment Focuses on Thinking

Dr. Ingvard Wilhelmsen uses cognitive therapy, which he says differs from traditional psychoanalysis in that it emphasizes patterns of thought, rather than the emotions. Wilhelmsen says thought processes are easier to change than emotions.

He says hypochondriacs come to his clinic thinking about “symptom” and “cause” in a “linear” way. That is, they feel a symptom and immediately connect it with a possible cause, then start to think obsessively about this “cause.”

Wilhelmsen tries to change their patterns of thought, so that instead of a line, their behavior is seen as a circle with equidistant points that consist of:

* thoughts

* feelings

* actions

* physical sensations

* “X” (which refers to anything else that may come into play)

Wilhelmsen’s goal is to get patients to focus beyond the “cause.” That is, if they feel a physical sensation, he trains them to remember that their thought about the sensation, and the feelings that thought arouses, may produce another physical sensation.

For instance, if they feel a flutter and think they are having a heart attack, then they may get scared and start having real heart palpitations. That may, in turn, produce an action: Maybe they start eating a bizarre, “healthy” diet to prevent more “heart attacks,” which in fact gives them stomach cramps, and then they think they’re having stomach cancer, which produces more fears, more sensations, more actions. . . .

Wilhelmsen tries to teach his patients to understand these chain reactions and break them.

Some of his methods include:

* Making patients keep diaries in which they describe their symptoms, then write down the thoughts they have upon feeling these symptoms. When they bring these notes to their appointments, he goes over the notebooks with them and uses the patients’ own words to convince them that they are “catastrophizing,” or obsessively thinking the worst possible thing is happening.

* Getting patients to describe their symptoms in detail, then explaining why these symptoms cannot be evidence that the patients have the diseases they so dread. (Wilhelmsen is relatively persuasive in this area because he is both an internist and a psychiatrist.)

* Assigning homework, in which people must stop short of the action they want to take to respond to their “disease.” For instance, if someone who thinks he or she is having a heart attack always drinks water to make the “heart attack” go away, Wilhelmsen requires the person to drink less water when an “attack” starts, and to keep a written record of what happens.

* Teaching patients that it’s normal and universal to feel unexplained aches and pains, and that normal life means getting used to uncertainties.

“If you are a hypochondriac, you want to be 100% sure you don’t have the disease, and of course you can’t be, because life isn’t like that,” he says. “You have to deal with a certain amount of uncertainty.”