Department of Psychology

Extending and refining the understanding and treatment of health anxiety and distress in medical settings

It has recently become clear that severe and disabling anxiety focused on fears of ill-health represents a significant challenge within a range of healthcare contexts. The clinical health psychology group at the University of Bath has been at the forefront of understanding this issue, both in terms of the mechanisms involved and ways in which such problems can be treated.

In addition to where anxiety about health is a person’s main problem it is now also clear from our work that health-focused anxiety and related mood problems are important in the distress associated with Persistent Physical Symptoms (PPS), such as chronic pain, Chronic Fatigue Syndrome and Irritable Bowel Syndrome. Other conditions featuring acute and chronic phases such as Cancer, Chronic Obstructive Pulmonary Disease (COPD) or Multiple Sclerosis (MS) can also give rise to debilitating health focused anxiety and more general anxiety and depression, not only disabling the person but also impacting on the effectiveness and cost of medical care for these Long-Term Conditions (LTC).

There is now considerable evidence from randomized controlled trials of the effectiveness of the cognitive behavioural treatment developed by Professor Paul Salkovskis from his research on the mechanisms involved in health focused anxiety. The group at Bath have further developed this theoretical and treatment work, developing both transdiagnostic and problem-specific approaches to understanding and treatment and identifying methods of application to PPS and LTC across the lifespan. This approach, with its emphasis on integrating physical and mental health care, has been adopted nationally by the new Improving Access to Psychological Therapies integrated services.

Examples of the specific work being carried out include Jo Daniels and Maria Loades developing the application of health anxiety and other psychological components to the treatment of Chronic Fatigue Syndrome/ME in adults and children, and Elizabeth Marks working with Tinnitus and Chest Pain. Cara Davis researches the effect of post-operative scarring in children and their families. James Gregory and Paul Salkovskis are working with 2gether Mental Health Trust to implement and evaluate an integrated PPS service in Stroud and Berkley Vale. Other work on long term conditions (including studies on MS, Parkinson’s Disease and COPD) have further demonstrated the generalizability of this work. Cathy Randle-Phillips is working on the application of psychological approaches to physical health difficulties in people with intellectual disabilities, where poor physical health is a major problem. The group are working to develop application of this approach across the lifespan; in addition to Cara Davis and Maria Loades’ work with children, young people and families, Vuokko Wallace is developing work on rare congenital conditions, and Anna Strudwick is developing the application in older adults, starting with Mild Cognitive Impairment, a known risk factor for the development of Dementia. Janet Bultitude is applying psychological principles to the understanding of Complex Regional Pain Syndrome.