Hypochondriasis, its Treatment, and Exposure to the Imaginative Illness and Death Experience

Patients concerned about their health are often unable to describe particular consequences of their imaginary disease. Since their thoughts and ideas produce severe anxiety, they try to block them. Therefore, persons with excessive worries about their health try not to think about the feared disease and to control their thinking by distracting their attention. This is referred to as cognitive avoidance. However, their effort “not to think about the disease” means that they think about it all the time. Our method of “imagining illness and death” is based on a therapeutic dialogue using inductive and Socratic questioning to help overcome cognitive avoidance. Patients are made to think about the worst variants of their imaginary disease and the future with it. Gradually, they imagine the worst consequences for both themselves and their relatives. The interview guides them through the severe course of their disease, its physical, mental and social consequences, dying and death experience with all emotions and details they can imagine. Then patients are asked about their fantasies about life after death. For next sessions, patients always bring written concepts of what was discussed during previous visits. The texts are read at the beginning of each session, with patients imagining everything. Gradual habituation observed, in our experience, after several exposures, lead to a significant decrease in anxiety symptoms, safety and avoidance behaviours.