Cardiophobia and its treatment in Brief Strategic Psychotherapy


What it is and how it manifests itself
Cardiophobia represents a particular form of pathophobia. For pathophobia we mean the fear of a deadly and sudden disease and it is distinguished from hypochondria where, instead, every signal of the body can be read by the person as a possible symptom of a disease. The cardiophobic patient lives in constant fear of dying from a fulminant disease that he specifically concerns the cardio-circulatory system, for example following a heart attack.

This fear is irrational and uncontrolled as it persists well beyond the medical tests carried out and which have excluded organic pathological conditions. Also in the case of cardiophobia, thanks to the strategic model, through the method of research-intervention that for more than twenty years has characterized the activity of the Strategic Therapy Center in Arezzo for more than twenty years, it was possible to identify the main attempted dysfunctional solutions. implemented by the patient.

The attempted solution construct, formulated for the first time by the research group of the Mental Research Institute (MRI) of Palo Alto in 1974, identifies everything that is implemented by the person and his context to try to manage a difficulty and which, repeated over time, maintains and feeds the difficulty itself, determining the structuring and persistence of a real disorder. From the point of view of Brief Strategic Psychotherapy, the identification of attempted failed solutions represents the starting point for being able to intervene effectively on the problem; not only do they allow us to know how the problem works, but they also represent the privileged access route for its resolution, configuring itself as a "complexity reducer" in our intervention model.

The main attempted dysfunctional solutions in cardiophobia:

  1. Listening to the heart rhythm.
    That is the attempt at control that leads to losing control. The main attempted solution of the cardiophobic is to obsessively focus one's attention on listening to the heart and its signals in an attempt to have control over the rhythm of the beat, worrying both about a too fast rhythm - tachycardia - and a slow one. - bradycardia - or for any suspicious pains in the chest, chest area and side.
    As with all forms of rigid and obsessive control that lead to loss of control, even in this case, the cardiophobic creates a real paradox: the more he tries to reassure himself by controlling the heartbeat, the more he alters its functionality, producing how effect a change in heart rhythm. This soon triggers the onset of anxiety or panic symptoms.
  2. Specialist medical consultations.
    The attempt to keep the fear of dying from a heart problem at bay pushes the person to request numerous specialist investigations, from the cardiological visit, to the measurement of blood pressure, to the electrocardiogram. However, the reassurance that should come from clinical findings does not have the effect of reducing the patient's worries and anxiety.
  3. Use of anxiolytics.
    Treatment with anxiolytics or antidepressants can reduce the intensity of the anxious reaction but does not in any way affect the phobic and obsessive structure of thought and therefore the dysfunctional perception of the person.
  4. Avoidance of some situations.
    the cardiophobic person begins to implement a whole series of avoidances with respect to situations that could physically or emotionally strain their heart. He will begin to gradually reduce physical activity, give up the gym or soccer matches, avoid taking the stairs or running, or try to deal with all these situations through precautions (breaks and rest, for example, as soon as an increase is perceived frequency) for fear of feeling ill.
  5. Talk about fear.
    typical in phobic disorders is the socialization of these fears, but talking continuously with others produces a paradoxical effect of nourishment and amplification of fear, in this case through the logical and rational reassurances of those around the person that feed the fears of who fears something - if I am continually reassured about something, I am more and more convinced that there is a danger that I must be reassured of.

Treatment of Cardiophobia through Brief Strategic Psychotherapy

In Brief Strategic Therapy, due to its recognized efficacy in the treatment of phobic and obsessive disorders in particular, we often find ourselves successfully treating this type of problem, which together with Hypochondria and Pathophobia, can represent a frequent cause of appearance symptoms of anxiety and panic attacks.

The Strategic Therapist, after having investigated the functional structure of the problem and identified the attempted bankruptcy solutions, also in this case plans his intervention using a treatment protocol as an elective maneuver which, as for all protocols developed in the Strategic Therapy Center of Arezzo, follow the same logic of functioning of the problem - similia similibus curantur - that is techniques that fit the structure of the disorder, with the aim of modifying the patient's phobic perception with respect to the feared situation.

The main maneuver in the therapy of cardiophobia consists in making the patient feel the importance of a rigorous and timely control of his "crazy" heart through the prescription of precise daily measurements of your heartbeat.

This maneuver is able to circumvent the patient's resistance to change precisely because it follows the same operating logic of the problem and surpasses his need for control (planned monitoring is prescribed, subtracting power from the control deriving from obsession) but at the same time guides the person to discover a new way, this time more functional, to listen and perceive the signals coming from their heart.
Through this therapeutic maneuver, combined with the identification and interruption of the vicious circle between attempted solutions and persistence of the problem, in a relatively short time it is possible to restore to the patient a healthy and functional perception of reality.

Dr. Daniela Ambrogio, (Official Psychotherapist of the Strategic Therapy Center)


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Nardone G., Salvini A. 2013. "International Dictionary of Psychotherapy". Garzanti
Nardone G., Salvini A. 2004. "The strategic dialogue". Ponte alle Grazie, Milan
Nardone G., 2003, "There is no night that does not see the day ". Ponte alle Grazie, Milan

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