This is a competing renewal application to conduct a randomized, controlled, intervention trial for hypochondriacal patients in a general medical setting. The target population consists of consecutive clinic attenders who exceed a predetermined cutoff score on a hypochondriasis self-report questionnaire. The intervention consists of a six-session, cognitive-behavioral, group psychotherapy delivered by a nurse clinician, combined with a prescriptive, psychiatric consultation letter to the patients' primary care physicians. This will be compared with medical care-as-usual. Ninety patients will be assigned to each treatment condition. Patients will undergo a research battery before treatment, immediately following it, and 6 and 12 months later. Self-report questionnaires, structured interviews, and cognitive tests will be administered to assess hypochondriacal symptoms and other psychiatric disorder; disability and quality of life; cognitive and perceptual characteristics which are salient features of hypochondriasis; aggregate medical morbidity; and satisfaction with care. Utilization and costs of care will be determined with a medical record audit and patient diary. Primary care physicians will complete questionnaires about each patient's clinical status, the doctor-patient relationship, and their implementation of the consultation letter. We hypothesize that the intervention group will have fewer hypochondriacal symptoms and less somatization, less disability, enhanced quality of life, and greater satisfaction with care than the control patients receiving medical care-as-usual. We will also: 1) explore the effects of the intervention on medical care utilization and costs; 2) examine the clinical characteristics of a separate sample (n=45) of Spanish speaking hypochondriacal patients and compare them with those of English speaking patients; and 3) describe the effects on treatment response of the cognitive characteristics believed to predispose precipitate, and maintain hypochondriasis.
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