Table : TABLE 8.13 • Cognitive-Behavior Therapy for Somatic Symptom Disorders

Disorder	Cognitive focus	Behavioral focus	Comment
Somatic symptom disorder (SSD)	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 activities^a; assertiveness training; relaxation to decrease physical tension	CBT is generally the most effective treatment for somatic symptom disorder.^b
Conversion disorder	Psychoeducation; identify stressors or conflicts associated with the emergence of symptoms; develop alternative ways to resolve the conflict or cope with stressors (problem solving)^c	Assertiveness training; to decrease symptoms, use paradoxical intention (suggest that the patient continue to have the symptom), as appropriate^d	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
Illness anxiety disorder	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 checking the body, seeking reassurance, or visiting doctors frequently	CBT is the most effective treatment for illness anxiety disorder.^f Pilot studies have adapted interpersonal therapy to treat illness anxiety disorder, and initial results are promising.^g
^aMayou & Farmer, 2002; O’Malley et al., 1999; ^bAllen et al., 2006; Bass et al., 2001; ^cMaldonado & Spiegel, 2001; ^dAtaoglu et al., 2003; ^eMaldonado & Spiegel, 2001; ^fBarsky & Ahern, 2004; Taylor et al., 2005; Wattar et al., 2005; ^gStuart & Noyes, 2005; Stuart et al., 2008.