Cognitive and behavioural processes in health anxiety
In this thesis a cognitive-behavioural model of health anxiety is used to investigate the psychological effects of bone densitometry, a health test which can provide an indication of future risk for osteoporosis. The cognitive-behavioural model of health anxiety proposes that people will experience relatively high levels of anxiety about their health if they have a tendency to make particularly negative interpretations of bodily variations and information which may be relevant to health. It was therefore predicted that people who have a pre-existing tendency to worry about their health would react more negatively to the results of bone density measurement. Consistent with this prediction, after a low bone density ("high risk") result, women who reported high levels of pre-existing health anxiety gave higher ratings of anxiety about osteoporosis and perceived likelihood of developing osteoporosis in the near future than women with low levels of preexisting health anxiety. (The two groups did not differ significantly in these ratings before the scan). Differences in the reactions of women with high and low levels of pre-existing health anxiety were still apparent 14 months after the scan. Women receiving a low bone density ("high risk") result showed a "minimization" of the seriousness of low bone density; when individual differences were investigated, it was found that women with very high levels of pre-existing health anxiety did not show minimization. Furthermore, after a "low risk" result, women with high levels of health anxiety were only temporarily reassured. It thus appears that the new measure of health anxiety which was used in this thesis may be useful in helping to identify people who are vulnerable to experiencing distress after health screening. More specific pre-scan measures of beliefs about osteoporosis (derived from the cognitive-behavioural model) also predicted reactions to bone density screening. For example, pre-scan beliefs about the seriousness or burden of low bone density / osteoporosis were stronger predictors of anxiety about osteoporosis three months after the scan than the actual scan result. Factors such as the type of interpretation the woman makes of her scan result, and whether the woman is having her first or second scan, were also found to influence psychological reactions.