Multi-modal management of severe health anxiety in diabetes mellitus type 1 in a medical clinic setting: Including the use of blended care cognitive behavioural therapy and pharmacotherapy

There is limited literature outlining the practical management of severe health anxiety in patients attending specialist physical health settings (in this case, diabetes mellitus-Type 1, T1DM). This case outlines how a patient engaged in a multi-modal care plan involving a shared formulation, blended-care cognitive behavioural therapy (BCCBT) and pharmacotherapy. BCCBT is the combination of face-to-face CBT and internet-delivered CBT (iCBT) into one integrated treatment protocol. It also highlights some of the barriers to his care. The patient made gradual and significant improvements; and on completion reported better function at work, reduced health checking behaviours and decreased functional impacts of somatic pain. The patient was male, in his early 30′s, with a history of T1DM since childhood. He presented to the hospital outpatient endocrine clinic. Online mental health screening revealed clinical range levels on validated measures of both general anxiety and health-related anxiety. He was referred to our health anxiety clinic and met criteria for Somatic Symptom Disorder (SSD).