Using behavioral experiments in the treatment of cardiophobia: A case study Original Research Article

A 20-year-old female who met DSM-IV criteria for both hypochondriasis and panic disorder (PD) reported intense anxiety-provoking daily chest pain, several panic attacks per month, and firmly believed she was suffering from coronary artery disease. More than 100 emergency room (ER) visits, numerous negative medical tests, reassurance, psychotropic medication, and inpatient psychiatric treatment had failed to improve her condition. In the first 13 sessions, treatment focused on reducing cardiophobic disease fear, chest pain, and avoidance behavior. Behavioral experiments were used to develop alternative symptom explanations and teach the patient to reassure herself. After a patient-initiated treatment suspension, a relapse occurred, with a fear of suffocation and uncontrollable panic becoming the patientʹs new major concern. The successful treatment of her cardiac disease fear and conviction had not much improved her fear of noncardiac bodily sensations. After an additional 13 sessions focusing on reducing her noncardiac panic symptoms, all measures of panic, illness behavior, and depression were in the normal or near-normal range. Cardiophobia-related treatment gains were maintained as evidenced by the absence of heart-focused anxiety, disease conviction, ER visits, and doctor phone calls. Occasional panic attacks and chest pain no longer worried the patient. Positive changes were maintained at 8- and 14-month follow-up. We discuss the relation between cardiophobia and panic disorder and suggest several specific treatment steps to ensure changes occur in both problem areas.