Version May 2024
| Explore beliefs | Ask patients what they believe is causing their symptoms. |
| Define goals | Define goals, eg, take responsibility for one's health or reduce avoidance behavior. |
| Behavioral analysis | Analyze behavior to determine antecedents and consequences (ABC: antecedent, behavior, consequence). Ask about thoughts, behaviors, emotions, and situations that precede, accompany, and follow the symptoms. |
| Diary | The patient should use a diary to record symptoms, rate their severity, describe the situation during which a symptom occurred, describe how they felt at the time, and what they were thinking at the time. These entries are reviewed during treatment sessions. |
| Family | The spouse or parents should be invited to attend one or more treatment sessions so they understand the treatment approach. Family members should be directed to stop their responses and accommodations to symptoms that are performed out of concern but which ultimately serve to reinforce the illness. |
| Behavior first | The focus of treatment is changing cognitions and behaviors. It is easier to first change behaviors, especially for those patients who are less psychiatrically minded or more resistant to psychiatric explanations of their illness. |
| Reduce maladaptive behavior | Behavioral change starts with reducing avoidance behavior and other maladaptive behavioral responses to symptoms. This can reduce the frequency and intensity of symptoms, reduce disability, and help facilitate cognitive changes. In addition, clinicians and patients need to decide which adaptive behaviors to increase. These should be clearly specified, realistically attainable, and of value to the patient. |
| Incremental change | Behavioral change is approached in a gradual way, with graded increases in desired activities. The difference between current behavior and the desired goals is assessed, and then broken down into manageable steps. |
| Practice | The clinician should warn the patient that each increase in previously avoided behavior could cause a transient increase in symptoms. The desired behavior is practiced daily until it is mastered, and then the next goal is undertaken. |
| Relaxation | Teach relaxation techniques to increase the patient's ability to bear with symptoms, reduce stress, and develop pleasant bodily sensations. |
| Social skills | Provide social skills training. |
| Regulate emotions | Teach patients how to regulate their emotions. |
| Cognitive change | Cognitive change begins with identifying the patient's thoughts and beliefs about bodily sensations, symptoms, and IEI. The clinician then asks the patient to consider alternative explanations and interpretations of symptoms. Patients record their thoughts about symptoms and practice challenging them by producing and recording more benign explanations. |
| Psychoeducation | Provide psychoeducation about IEI. |
| Realistic health concept | Help the patient develop a realistic health concept. Challenge faulty assumptions, such as the idea that one must be in perfect health in order to function, or that any bodily sensation is pathologic. |
| Restructure cognitions | Aim to restructure cognitions to accept the role of psychiatric factors in IEI. |
| Demonstrate role of psychiatric factors | Conduct exercises to demonstrate the role of psychiatric factors in health. Biofeedback experiments can help patients understand how their somatic preoccupation perpetuates their symptoms and disability. As an example, if the patient focuses on a normal bodily sensation such as the heartbeat, this will reveal an increase in its apparent intensity. The value of distraction as a method of symptom control can then be demonstrated. These experiments provide personal evidence the patient can use in reconsidering IEI as the explanation of their symptoms. |
| Well-being | Address problems affecting well-being, such as difficulties in relationships and at work, cognitive misattributions, and emotional state. |
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