健康焦虑及其网络认知行为干预的研究进展

doi:10.12114/j.issn.1007-9572.2022.0482-1

中国全科医学 ›› 2023, Vol. 26 ›› Issue (23): 2936-2942.DOI: 10.12114/j.issn.1007-9572.2022.0482-1

所属专题：心理健康最新文章合辑

健康焦虑及其网络认知行为干预的研究进展

张心怡¹^,², 许木子¹^,², 郑艳¹^,², 赵越²^,³^,^*()

1．100034　北京市，北京大学第一医院产科
2．100034　北京市，北京大学第一医院护理部
3．100034　北京市，北京大学第一医院儿科

收稿日期:2022-08-11 修回日期:2022-10-24 出版日期:2023-08-15 发布日期:2022-11-24
通讯作者: 赵越
作者贡献：张心怡、许木子负责文献查阅与撰写论文初稿；郑艳负责监督与审校；赵越负责论文修订，对论文负责。
基金资助:
中央高水平医院临床科研业务费资助（北京大学第一医院科研种子基金项目）(2022SF62，2019SF54)

Advances in Health Anxiety and Its Online Cognitive-behavioral Interventions

ZHANG Xinyi¹^,², XU Muzi¹^,², ZHENG Yan¹^,², ZHAO Yue²^,³^,^*()

1. Department of Obstetrics, Peking University First Hospital, Beijing 100034, China
2. Department of Nursing, Peking University First Hospital, Beijing 100034, China
3. Department of Pediatrics, Peking University First Hospital, Beijing 100034, China

Received:2022-08-11 Revised:2022-10-24 Published:2023-08-15 Online:2022-11-24
Contact: ZHAO Yue

摘要/Abstract

摘要： 随着信息传播手段的发展，健康焦虑（HA）患者数量显著增加，给个人和社会带来了不良后果和沉重负担。近年HA相关临床诊断的演变和范围界定存在不一致，但认知行为干预是公认的有效手段。本文总结了HA的临床诊断、筛查工具、相关因素和网络认知行为干预，并指出HA的概念和测量工具有待统一，其目前的难点是干预临界点的界定及制订适合初级或综合医疗机构开展的心理干预措施。此外，线上形式的HA认知行为干预经济便捷且与线下认知行为干预同样有效，值得进一步开发。

关键词: 焦虑, 疑病症, 认知行为疗法, 健康焦虑, 疾病焦虑障碍, 认知行为干预, 网络认知行为干预, 综述, 新进展

Abstract:

The development of information dissemination is associated with significantly increased risk of health anxiety (HA) , imposing a heavy burden on individuals and society. Although there are inconsistencies between the evolution and revisions in clinical diagnosis of HA, cognitive-behavioral interventions have been recognized as effective treatments for HA. We reviewed the clinical diagnoses, measurement tools, associated factors and online cognitive-behavioral interventions of HA, then proposed that the concepts and measurement tools of HA need to be further standardized. Main difficulties are the determination of the threshold for intervention and the development of psychological interventions suitable for general practices. Online and face-to-face cognitive-behavioral interventions for HA have similar effects, but the former is more inexpensive and convenient, which deserve to be studied further.

Key words: Anxiety, Hypochondriasis, Cognitive behavioral therapy, Health anxiety, Illness anxiety disorder, Cognitive-behavioral intervention, Online cognitive-behavioral intervention, Review, Recent developments

张心怡,许木子,郑艳,等. 健康焦虑及其网络认知行为干预的研究进展[J]. 中国全科医学, 2023, 26(23): 2936-2942. DOI: 10.12114/j.issn.1007-9572.2022.0482-1.
ZHANG Xinyi,XU Muzi,ZHENG Yan, et al. Advances in Health Anxiety and Its Online Cognitive-behavioral Interventions[J]. Chinese General Practice, 2023, 26(23): 2936-2942. DOI: 10.12114/j.issn.1007-9572.2022.0482-1.

参考文献 58

[1]	RACHMAN S. Health anxiety disorders：a cognitive construal[J]. Behav Res Ther，2012，50(7/8):502-512. DOI：10.1016/j.brat.2012.05.001.
[2]	TYRER P, EILENBERG T, FINK P, et al. Health anxiety：the silent，disabling epidemic[J]. BMJ，2016，353:i2250. DOI：10.1136/bmj.i2250.
[3]	TYRER P, COOPER S, CRAWFORD M, et al. Prevalence of health anxiety problems in medical clinics[J]. J Psychosom Res，2011，71(6):392-394. DOI：10.1016/j.jpsychores.2011.07.004.
[4]	SUNDERLAND M, NEWBY J M, ANDREWS G. Health anxiety in Australia：prevalence，comorbidity，disability and service use[J]. Br J Psychiatry，2013，202(1):56-61. DOI：10.1192/bjp.bp.111.103960.
[5]	AXELSSON E, HEDMAN-LAGERLÖF E. Cognitive behavior therapy for health anxiety：systematic review and meta-analysis of clinical efficacy and health economic outcomes[J]. Expert Rev Pharmacoeconomics Outcomes Res，2019，19(6):663-676. DOI：10.1080/14737167.2019.1703182.
[6]	COOPER K, GREGORY J D, WALKER I, et al. Cognitive behaviour therapy for health anxiety：a systematic review and meta-analysis[J]. Behav Cogn Psychother，2017，45(2):110-123. DOI：10.1017/s1352465816000527.
[7]	OLATUNJI B O, KAUFFMAN B Y, MELTZER S, et al. Cognitive-behavioral therapy for hypochondriasis/health anxiety：a meta-analysis of treatment outcome and moderators[J]. Behav Res Ther，2014，58:65-74. DOI：10.1016/j.brat.2014.05.002.
[8]	THOMSON A B, PAGE L A. Psychotherapies for hypochondriasis[J]. Cochrane Database Syst Rev，2007(4):CD006520. DOI：10.1002/14651858.cd006520.pub2.
[9]	TYRER P. Recent advances in the understanding and treatment of health anxiety[J]. Curr Psychiatry Rep，2018，20(7):49. DOI：10.1007/s11920-018-0912-0.
[10]	WHO. The ICD-10 classification of mental and behavioural disorders：clinical descriptions and diagnostic guidelines[EB/OL]. （2012-06-16） [2022-06-06].
[11]	GUZE S B. Diagnostic and statistical manual of mental disorders，4th Ed. （DSM-Ⅳ）[J]. AmJ Psychiatry，1995，152(8):1228. DOI：10.1176/ajp.152.8.1228.
[12]	FERGUSON E. A taxometric analysis of health anxiety[J]. Psychol Med，2009，39(2):277-285. DOI：10.1017/S0033291708003322.
[13]	FERGUS T A, VALENTINER D P. Disease phobia and disease conviction are separate dimensions underlying hypochondriasis[J]. J Behav Ther Exp Psychiatry，2010，41(4):438-444. DOI：10.1016/j.jbtep.2010.05.002.
[14]	STARCEVIC V. Hypochondriasis and health anxiety：conceptual challenges[J]. Br J Psychiatry，2013，202(1):7-8. DOI：10.1192/bjp.bp.112.115402.
[15]	TYRER P, TYRER H. Health anxiety：detection and treatment[J]. B J Psych Advances，2018，24(1):66-72. DOI：10.1192/bja.2017.5.
[16]	袁勇贵，张钰群. 健康焦虑障碍是否是一种新型焦虑障碍[J]. 中华脑科疾病与康复杂志（电子版），2015，5(2):70-73. DOI：10.3877/cma.j.issn.2095-123X.2015.02.001.
[17]	CARTER M. Diagnostic and statistical manual of mental disorders，5th ed[M]. Frisco：American Psychiatric Association Publishing，2014.
[18]	GUREJE O, USTÜN T B, SIMON G E. The syndrome of hypochondriasis：a cross-national study in primary care[J]. Psychol Med，1997，27(5):1001-1010. DOI：10.1017/s0033291797005345.
[19]	GUIDI J, PIOLANTI A, BERROCAL C, et al. Incremental validity of the diagnostic criteria for psychosomatic research -revised （DCPR-R） to clinical assessment in primary care[J]. Psychiatry Res，2020，291:113233. DOI：10.1016/j.psychres.2020.113233.
[20]	FAVA G A, FREYBERGER H J, BECH P, et al. Diagnostic criteria for use in psychosomatic research[J]. Psychother Psychosom，1995，63(1):1-8. DOI：10.1159/000288931.
[21]	FINK P, ØRNBØL E, TOFT T, et al. A new，empirically established hypochondriasis diagnosis[J]. Am J Psychiatry，2004，161(9):1680-1691. DOI：10.1176/appi.ajp.161.9.1680.
[22]	HOFFMANN D, RASK C U, HEDMAN-LAGERLÖF E, et al. Efficacy of Internet-delivered acceptance and commitment therapy for severe health anxiety：results from a randomized，controlled trial[J]. Psychol Med，2021，51(15):2685-2695. DOI：10.1017/s0033291720001312.
[23]	WECK F, RICHTBERG S, NENGJ L. Epidemiology of hypochondriasis and health anxiety：comparison of different diagnostic criteria[J]. Curr Psychiatry Rev，2014，10(1):14-23. DOI：10.2174/1573400509666131119004444.
[24]	PILOWSKY I. Dimensions of hypochondriasis[J]. Br J Psychiatry，1967，113(494):89-93. DOI：10.1192/bjp.113.494.89.
[25]	WELCH P G, CARLETON R N, ASMUNDSON G J G. Measuring health anxiety：moving past the dichotomous response option of the original Whiteley Index[J]. J Anxiety Disord，2009，23(7):1002-1007. DOI：10.1016/j.janxdis.2009.05.006.
[26]	ASMUNDSON G J G, CARLETON N R, BOVELL C V, et al. Comparison of unitary and multidimensional models of the whiteley index in a nonclinical sample：implications for understanding and assessing health anxiety[J]. J Cogn Psychother，2008，22(2):87-96. DOI：10.1891/0889-8391.22.2.87.
[27]	KELLNER R, ABBOTT P, WINSLOW W W, et al. Fears，beliefs，and attitudes in DSM-Ⅲ hypochondriasis[J]. J Nerv Ment Dis，1987，175(1):20-25. DOI：10.1097/00005053-198701000-00004.
[28]	SIRRI L, GRANDI S, FAVA G A. The Illness Attitude Scales. A clinimetric index for assessing hypochondriacal fears and beliefs[J]. Psychother Psychosom，2008，77(6):337-350. DOI：10.1159/000151387.
[29]	SALKOVSKIS P M, RIMES K A, WARWICK H M, et al. The Health Anxiety Inventory：development and validation of scales for the measurement of health anxiety and hypochondriasis[J]. Psychol Med，2002，32(5):843-853. DOI：10.1017/s0033291702005822.
[30]	LUCOCK M P, MORLEY S. The health anxiety questionnaire[J]. Br J Heal Psychol，1996，1(2):137-150. DOI：10.1111/j.2044-8287.1996.tb00498.x.
[31]	苏雪，李占江，龙鲸，等. 怀特利指数中文版的信效度分析[J]. 首都医科大学学报，2019，40(5):671-676. DOI：10.3969/j.issn.1006-7795.2019.05.002.
[32]	CHEN Y X, FINK P, WEI J, et al. Psychometric evaluation of the whiteley index-8 in Chinese outpatients in general hospitals[J]. Front Psychol，2021，12:557662. DOI：10.3389/fpsyg.2021.557662.
[33]	苏雪，李占江，马云，等. 疾病态度量表中文版的效度和信度[J]. 中国心理卫生杂志，2017，31(8):619-624. DOI：10.3969/j.issn.1000-6729.2017.08.007.
[34]	HEDMAN E, LEKANDER M, LJÓTSSON B, et al. Optimal cut-off points on the health anxiety inventory，illness attitude scales and whiteley index to identify severe health anxiety[J]. PLoS One，2015，10(4):e0123412. DOI：10.1371/journal.pone.0123412.
[35]	LEBEL S, MUTSAERS B, TOMEI C, et al. Health anxiety and illness-related fears across diverse chronic illnesses：a systematic review on conceptualization，measurement，prevalence，course，and correlates[J]. PLoS One，2020，15(7):e0234124. DOI：10.1371/journal.pone.0234124.
[36]	余来洪，张钰群，毛圣芹，等. 高述情障碍女学生的健康焦虑与人格特征研究[J]. 中国妇幼健康研究，2016，27(2):198-199,209. DOI：10.3969/j.issn.1673-5293.2016.02.017.
[37]	戴利莎，周怡，胡靖，等. 述情障碍对健康焦虑的影响：认知与元认知的中介作用[J]. 中南大学学报（医学版），2018，43(9):1026-1031. DOI：10.11817/j.issn.1672-7347.2018.09.015.
[38]	罗爱静，陈阳，谢文照，等. 健康焦虑人群的网络健康信息搜索行为影响因素研究[J]. 情报资料工作，2022，43(2):66-75. DOI：10.12154/j.qbzlgz.2022.02.008.
[39]	EILENBERG T, HOFFMANN D, JENSEN J S, et al. Intervening variables in group-based acceptance & commitment therapy for severe health anxiety[J]. Behav Res Ther，2017，92:24-31. DOI：10.1016/j.brat.2017.01.009.
[40]	LANDI G, PAKENHAM K I, BOCCOLINI G, et al. Health anxiety and mental health outcome during COVID-19 lockdown in Italy：the mediating and moderating roles of psychological flexibility[J]. Front Psychol，2020，11:2195. DOI：10.3389/fpsyg.2020.02195.
[41]	MCMULLAN R D, BERLE D, ARNÁEZ S, et al. The relationships between health anxiety，online health information seeking，and cyberchondria：systematic review and meta-analysis[J]. J Affect Disord，2019，245:270-278. DOI：10.1016/j.jad.2018.11.037.
[42]	董丽云，邓玮. 健康焦虑的社会话语建构——基于医学广告的文本情感极性分析[J]. 安徽师范大学学报（人文社会科学版），2017，45(4):464-473. DOI：10.14182/j.cnki.j.anu.2017.04.010.
[43]	THORGAARD M V, FROSTHOLM L, WALKER L S, et al. Effects of maternal health anxiety on children's health complaints，emotional symptoms，and quality of life[J]. Eur Child Adolesc Psychiatry，2017，26(5):591-601. DOI：10.1007/s00787-016-0927-1.
[44]	CHEN Q S, ZHANG Y Q, ZHUANG D Y, et al. Health anxiety in medical employees：a multicentre study[J]. J Int Med Res，2019，47(10):4854-4861. DOI：10.1177/0300060519872310.
[45]	LEONIDOU C, PANAYIOTOU G. How do illness-anxious individuals process health-threatening information? A systematic review of evidence for the cognitive-behavioral model[J]. J Psychosom Res，2018，111:100-115. DOI：10.1016/j.jpsychores.2018.06.001.
[46]	NEWBY J M, SMITH J, UPPAL S, et al. Internet-based cognitive behavioral therapy versus psychoeducation control for illness anxiety disorder and somatic symptom disorder：a randomized controlled trial[J]. J Consult Clin Psychol，2018，86(1):89-98. DOI：10.1037/ccp0000248.
[47]	KABAT-ZINN J. Mindfulness-based interventions in context：past，present，and future [J]. Clinical Psychology Science & Practice，2006，10(2):144-156. DOI：10.1093/clipsy.bpg016.
[48]	MCMANUS F, SURAWY C, MUSE K, et al. A randomized clinical trial of mindfulness-based cognitive therapy versus unrestricted services for health anxiety （hypochondriasis）[J]. J Consult Clin Psychol，2012，80(5):817-828. DOI：10.1037/a0028782.
[49]	MAHEU C, SINGH M, TOCK W L, et al. Fear of cancer recurrence，health anxiety，worry，and uncertainty：a scoping review about their conceptualization and measurement within breast cancer survivorship research[J]. Front Psychol，2021，12:644932. DOI：10.3389/fpsyg.2021.644932.
[50]	COMPEN F, BISSELING E, SCHELLEKENS M, et al. Face-to-face and Internet-based mindfulness-based cognitive therapy compared with treatment as usual in reducing psychological distress in patients with cancer：a multicenter randomized controlled trial[J]. J Clin Oncol，2018，36(23):2413-2421. DOI：10.1200/jco.2017.76.5669.
[51]	SIMARD S, SAVARD J. Fear of Cancer Recurrence Inventory：development and initial validation of a multidimensional measure of fear of cancer recurrence[J]. Support Care Cancer，2009，17(3):241-251. DOI：10.1007/s00520-008-0444-y.
[52]	LENGACHER C A, REICH R R, RAMESAR S, et al. Feasibility of the mobile mindfulness-based stress reduction for breast cancer （mMBSR（BC）） program for symptom improvement among breast cancer survivors[J]. Psychooncology，2018，27(2):524-531. DOI：10.1002/pon.4491.
[53]	HAYES S C, LUOMA J B, BOND F W, et al. Acceptance and commitment therapy：model，processes and outcomes[J]. Behav Res Ther，2006，44(1):1-25. DOI：10.1016/j.brat.2005.06.006.
[54]	HEDMAN E, AXELSSON E, ANDERSSON E, et al. Exposure-based cognitive-behavioural therapy via the Internet and as bibliotherapy for somatic symptom disorder and illness anxiety disorder：randomised controlled trial[J]. Br J Psychiatry，2016，209(5):407-413. DOI：10.1192/bjp.bp.116.181396.
[55]	HEDMAN E, AXELSSON E, GÖRLING A, et al. Internet-delivered exposure-based cognitive-behavioural therapy and behavioural stress management for severe health anxiety：randomised controlled trial[J]. Br J Psychiatry，2014，205(4):307-314. DOI：10.1192/bjp.bp.113.140913.
[56]	HEDMAN E, ANDERSSON G, ANDERSSON E, et al. Internet-based cognitive-behavioural therapy for severe health anxiety：randomised controlled trial[J]. Br J Psychiatry，2011，198(3):230-236. DOI：10.1192/bjp.bp.110.086843.
[57]	AXELSSON E, ANDERSSON E, LJÓTSSON B, et al. Effect of Internet vs face-to-face cognitive behavior therapy for health anxiety：a randomized noninferiority clinical trial[J]. JAMA Psychiatry，2020，77(9):915-924. DOI：10.1001/jamapsychiatry.2020.0940.
[58]	HEDMAN-LAGERLÖF E, TYPER P, HAGUE J, et al. Health anxiety [J]. BMJ，2019，364:l774. DOI：10.1136/bmj.l774.

健康焦虑及其网络认知行为干预的研究进展

Advances in Health Anxiety and Its Online Cognitive-behavioral Interventions

RichHTML

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献 58

相关文章 15

编辑推荐

Metrics

留言

[1]	李文萍, 陈建华, 许家培, 金雪, 潘子涵, 迟春花. 数智化健康管理平台赋能社区老年人健康服务的范围综述[J]. 中国全科医学, 2026, 29(21): 2938-2949.
[2]	冯宇茜, 王津津, 蔡一, 朱润芝, 朱勤. 乳酸化修饰在肾脏疾病中的研究进展[J]. 中国全科医学, 2026, 29(21): 3056-3063.
[3]	李凤, 胡昌好, 罗旭. 老年慢性病共病患者心理健康的影响因素及干预策略研究进展[J]. 中国全科医学, 2026, 29(20): 2816-2828.
[4]	程玉, 韩士尧, 孙平, 向娟, 杨辉, 李东泽, 郑莉, 廖晓阳. 慢性病管理中的社会经济与人口学挑战分析[J]. 中国全科医学, 2026, 29(20): 2800-2807.
[5]	陈义萍, 张剑梅, 厉彦虎, 李睿, 张瑞平, 杨萍. COVID-19后遗症心肌损伤的诊疗进展[J]. 中国全科医学, 2026, 29(18): 2585-2592.
[6]	张明悦, 侯艳. 呼出气、肺泡气一氧化氮在间质性肺疾病中的研究进展[J]. 中国全科医学, 2026, 29(18): 2571-2576.
[7]	马晓雨, 马晓梅, 武国智, 郑亚, 郭庆红. 中性粒细胞外陷阱在胃癌中的研究进展[J]. 中国全科医学, 2026, 29(17): 2425-2432.
[8]	李佳威, 葛奥淇, 高欣怡, 李娟娟, 袁蓓蓓. 医防融合的概念内涵和实现路径：一项系统综述研究[J]. 中国全科医学, 2026, 29(16): 2156-2166.
[9]	汪洋, 金花, 杨森, 杨辉, 于德华. 中国基本医疗服务功能特征及其对卫生服务结局的影响路径：一项15年的混合方法系统综述[J]. 中国全科医学, 2026, 29(16): 2140-2155.
[10]	余学芳, 朱敏, 马清林, 谭神朗, 吴子幸, 江伟. 柴胡加龙骨牡蛎汤联合失眠认知行为疗法治疗肝郁化火型急性失眠的临床疗效研究[J]. 中国全科医学, 2026, 29(13): 1666-1672.
[11]	叶鑫瑛, 殷安康, 刘定岭, 吕翔, 王逸. 按病种分值付费支付模式下综合医院全科医学科发展研究[J]. 中国全科医学, 2026, 29(11): 1378-1384.
[12]	孙宇辰, 石雅馨, 师伟. 经血源性干细胞联合补肾活血类中药治疗子宫内膜功能减退类疾病的研究进展[J]. 中国全科医学, 2026, 29(11): 1481-1487.
[13]	施雨峰, 卢晨霞, 吕安淇, 李晓东. 基于肠-肝轴理论探讨韦荣球菌属与肝脏疾病关系的研究进展[J]. 中国全科医学, 2026, 29(11): 1488-1496.
[14]	杨旭, 樊洁婷, 宋红艳, 冯盼盼, 郝婧宇, 姚弥. 基层全科医生心血管疾病风险评估与沟通策略[J]. 中国全科医学, 2026, 29(10): 1294-1299.
[15]	王昱棋, 叶睿雪, 高焱, 薛凯文, 周静, 李冬霞, 郝英姿, 李晓轩, 王玉龙. 康复分级诊疗体系的国内外发展现状及应用需求探讨[J]. 中国全科医学, 2026, 29(10): 1250-1255.