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Book Review   |    
William W. Van Stone
Psychiatric Services 2007; doi: 10.1176/appi.ps.58.8.1129
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by Patricia Furer, Ph.D., John R. Walker, Ph.D., and Murray B. Stein, M.D., M.P.H.; New York, Springer Publishing, 2007, 272 pages, $49.95

Dr. Van Stone is associate chief for psychiatry, Office of Mental Health Services, Veterans Affairs Central Office, Department of Veterans Affairs, Washington, D.C.

This book illuminates a special corner of clinical practice that is subject to little research, is seldom addressed in medical training, and yet remains a significant challenge for practitioners in medical and primary care settings. Treating Health Anxiety and Fear of Death offers an approach to helping people who worry too much about being sick, present with "functional" somatic symptoms, or earn full diagnostic labels of hypochondriasis, somatization syndromes, or health-related phobias. Clinicians, health care administrators, and patients alike should be concerned about the excessive health care costs for unnecessary tests and procedures, emergency room visits, and hospital stays that these persons engender. Mental health professionals working in primary care settings may find this book of particular interest.

Patricia Furer and John R. Walker are engaged in clinical research on anxiety disorders at the University of Manitoba in central Canada. Murray B. Stein is a seasoned investigator and clinician at the University of California in San Diego. These authors clearly bring their collective expertise to this publication.

This book focuses primarily on cognitive behavioral-therapy as a treatment intervention. The authors are careful to say that their approach is not for everyone and always urge a neutral position with respect to the possible presence of a threatening illness. Unlike the proverbial hammer to which everything looks like a nail, the authors address specific patients with symptoms that need a uniquely effective approach. The thorough literature review, instructive case examples, sample handouts, and common-sense approach lend credence to their approach. An excellent chapter on pharmacological treatments adds value.

The research described, limited to health anxiety, is sparse and at times tangential and includes clinical trials with control groups that are not blind. So the reader is unsure whether the generally successful outcomes of cognitive-behavioral therapy result from its content or from time spent in a special relationship with a caring therapist.

Clinical examples illustrate response prevention, an intervention in which an anxious patient's repeated reassurance seeking and checking for symptoms are systematically discouraged and exposure techniques that ask patients to write down their worst fears in detail then read them repeatedly. Both techniques have been demonstrated to reduce anxiety. Learning appropriate ways to discuss and deal directly with death and with loss of health, a loved one, or a friend has proven to be helpful. A chapter on children's issues notes that "avoidance, distractions, and reassurance-seeking give fears more power; facing fears gradually and in a controlled manner will reduce them." This chapter has useful advice for parents, teachers, and clinicians.

The final chapter on aging describes situations in which excessive anxiety or somatization accompanies obvious physical illness. A well-described, systematic regimen for managing somatizing patients is demonstrated to reduce costly emergency visits. Regularly scheduled brief visits with a primary care clinician focus first on making the patient feel understood and then on gradually introducing connections between stress and physical symptoms.

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