Explain illness anxiety, CBT and collaborative care — CASC communication station

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in the outpatient clinic. [2]

Candidate instructions. Explain illness anxiety disorder in plain language, outline specialised CBT with exposure and response prevention elements, discuss a possible SSRI (e.g. fluoxetine or sertraline) with delayed full benefit, explain why further imaging without new clinical change is not the treatment, address partner reassurance, and check understanding. The examiner plays the patient. [1][4]

Candidate scenario

Your patient meets criteria for IAD after normal imaging. You plan referral for CBT for health anxiety and discussion of an SSRI such as fluoxetine 20 mg orally daily (or sertraline) with early review. She fears CBT means “ignoring real cancer” and believes one more MRI will end the problem. Her partner currently checks her breasts each evening to “reassure” her. [1][3]

Marking domains

• Empathy, structure and agenda-setting
• Accurate plain-language model (sensations/news → catastrophic fear → checking/internet/reassurance → short relief)
• Clear CBT explanation (hierarchy, response prevention, homework)
• Medication discussion: start dose concept, delayed full benefit, side-effects, monitoring
• Explicit collaborative plan: no non-indicated MRI tonight; criteria for re-presentation
• Family accommodation advice without blame
• Safety-net for worsening mood/suicidality
• Checks understanding / teach-back [2][5]

Common station failures

Saying “nothing is wrong” without a both–and model; agreeing to unlimited imaging for peace of mind; omitting suicide safety-netting; explaining medication without linking to CBT or monitoring; blaming the partner rather than coaching accommodation reduction.[1][2][5]