I have always found good CBT workbooks for clients to be an invaluable aid to therapy. They normalize problems (“I can't be so weird/the only one if enough people have this for a book to be published about it”), and they underline that the clients themselves can change how they feel if they follow certain practical strategies, which can generate hope and increase the credibility of homework. Whilst many self-help books have been available on other types of anxiety, oddly little has been written for health anxious patients, despite health anxiety being particularly common and also a significant drain on medical professionals’ time and resources. This book starts to fill that void.

The book is a companion to Treating Health Anxiety: a cognitive-behavioral approach (Reference Asmundson and Taylor2004) by the same authors, and incorporates methods used in a successful randomized controlled trial of CBT for hypochondriasis (Clark et al., Reference Clark, Salkovskis, Hackmann, Wells, Fennell, Ludgate, Ahmad, Richards and Gelder1998). Interestingly, in that trial a control treatment of stress management training also proved to be helpful, and the authors include stress management training in this book.

There is a snappy two-page preface to engage doubtful readers by emphasizing that physical symptoms are real, not “in the head”, and by setting out a “no lose” case for reading the book. Next come good accessible and substantive explanations of the many non-dangerous origins of physical symptoms, and of vicious circles, whereby stress/anxiety produces more symptoms. A clear case is made that if the doctor rules out physical disease, “then seeking alternative explanations is the next step”, and the reader is given step-by-step exercises to help them do this.

Further chapters instruct in challenging cognitive bias, reducing checking and reassurance-seeking, undertaking exposure and dealing with doctors. There are particularly convincing case examples of what individuals have gained by doing behavioural experiments, and I think these would be inspiring to clients.

The book gives considerable detail about various DSM-IV-TR diagnoses, and I was not sure that this was particularly useful and I thought it might put off some clients. While most of the writing is extremely clear, there is also a smattering of technical terms such as “interoceptive exposure”, which are not necessary and could intimidate less intellectual readers. Some of the exercises may not work for some clients (e.g. very tense muscles can simply become more tense and painful with the tense-release relaxation method, and deliberate interoceptive exposure may not help somebody who only worries about the spontaneous occurrence of symptoms).

The main weakness of the book, in my view, is the relative lack of help with underlying beliefs and meanings that may be driving health anxiety. It does not address common beliefs such as that becoming ill means that one is unacceptable, weak, or a burden. There is a short section on the need to accept uncertainty, but fuller personal testimonies from patients who actually managed to do this might better enlist the imagination. The section on accepting death is extremely short, and it suggests writing about one's own death and reading it back, as well as visiting cemeteries and funeral homes. Many health anxious clients have traumatic memories or images relating to death (see Wells and Hackmann, Reference Wells and Hackmann1993). One of my clients who had been a depressed teenager after her father was killed perpetually visualized her own children devastated, with ruined lives, should she die. Writing and reading this sort of content could precipitate rumination and depression if done without a helpful cognitive formulation and framework. Most of us (unless we are run over by a bus beforehand!) have at some point to adjust to our own mortality, and health anxious clients can sometimes be ahead of therapists in facing this, contemplating pain, disability, unfulfilled dreams or lost opportunities. Many clients also have negative predictions about medical care based on distressing family experiences. The book may possibly ring as rather “trivial” and unconvincing for people haunted by such meanings.

To test reaction to the book I asked a client, who wrote, “I found the book easy to read and I can certainly identify with many of the features of health anxiety described. . . The explanation of health anxiety and associated exercises seem. . . to be very relevant and the worksheets easy to follow. . . Overall, I think that the book is likely to be of assistance to me. . . although how effective it would be for me without ongoing professional help I am not sure”. My client particularly liked the section on “Living Life and Maintaining Your Gains”. I also thought one of the best lines in the book is, “You should keep practising until the strategies that work best for you become habitual”, as repeated episodes of health anxiety are typical.

I would say this book is definitely worth buying as an adjunct to CBT treatment, or as a first line treatment for mild health anxiety in primary care.