Fugen Neziroglu, Ph.D.

Neziroglu Recommends In Vivo

Treatment of Obsessions

                                                                 By Milton Spett & Lynn Mollick

On December 5, Fugen Neziroglu presented her ideas on treating obsessions and hypochondria to 50 members of NJ-ACT.  The highlight of her presentation was a new concept in the treatment of obsessions.

 In Vivo Treatment of Obsessions

             Traditional behavioral treatment of obsessions asks patients to expose themselves to the obsession through mentally focusing on their obsession, listening to loop tapes describing their obsession, or writing and repeatedly reading their account of the obsession.  Neziroglu recommended an in vivo technique: asking patients to put themselves in situations that evoke their obsessions.  For example, if a patient’s obsession is that he is gay, the patient should be asked to perform a hierarchy of behaviors that he believes make him appear gay, for example wearing a “gay rights” T shirt.

Neziroglu advised exposure sessions of 90 minutes in order for habituation to occur.  Eventually, patients’ anxiety will decrease and a therapeutic cognitive shift will occur.  If the obsession is “What if I am gay?” the cognitive shift might be a realization that the patient is not gay, or an acceptance of being gay.  Since exposure exercises cause many patients to terminate treatment, she recommended beginning therapy with cognitive interventions, and adding exposure exercises only after forming a solid therapeutic relationship.

She also reported that to effect cognitive shifts, behavioral interventions, such as in vivo exercises, are more effective than cognitive interventions.  At first glance, this seems counter-intuitive.  But it does seem reasonable that behavioral exercises, especially in vivo exercises, create a more compelling experience than logical argument.  This compelling experience may more fully evoke a dormant dysfunctional schema, and constitute a more powerful  method of disconfirming dysfunctional beliefs.

 Treatment of Hypochondria

Hypochondriacal patients experience obsessive fears of being ill and perform compulsive behaviors to reassure themselves that they are well.  Neziroglu recommended reassuring these patients once at the beginning of therapy that they don’t have the illnesses they fear.  Therapists should then tell hypochondriacal patients that no further reassurance will be provided.  Patients should also be asked to limit or end other forms of reassurance-seeking, such as repetitive visits and phone calls to doctors.  In addition, patients should be asked to stop any unrealistic behavior designed to avoid the illnesses they fear, for example, not touching doorknobs.

If medical attention is necessary, it should be scheduled at reasonable intervals rather than sought when the patients’ anxiety is very high.

Hypochondriacal patients tend to overestimate the likelihood of contracting illness, and underestimate their ability to cope with an illness should they contract it.  Cognitive interventions, such as having patients estimate the likelihood of contracting the illness they fear, should be used to treat these dysfunctional beliefs.

Neziroglu also recommended asking patients not to use the internet to research their feared illness.  Internet information is likely to misinform patients and intensify their unrealistic fears.  Ultimately, hypochondriacal patients must learn to live with uncertainty about their health and mortality.

 Differential Diagnosis

Neziroglu explained the differences among a number of similar disorders:

Somatization Disorder: Multiple complaints about physical symptoms with no organic basis.

OCD – Obsessive Type: Unrealistic fears of contracting physical illness.

Hypochondria: Misinterpreting ordinary physical symptoms as evidence of serious illness.

In Generalized Anxiety Disorder, patients worry about numerous negative events.  Obsessions are focused on one or a small number of negative events

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