Keynote 2 - Treating Anxiety in the Context of Physical Illness: The Importance of Safety Behaviours and Fears of Disease Progression

Cognitive-behavioural treatments (CBT) for anxiety disorders are amongst the most successful applications of CBT, with a vast literature confirming efficacy with large effect sizes. However, when anxiety is treated in the context of a chronic physical illness, meta-analyses confirm that treatments are far less effective, typically with small effect sizes. This keynote will explore two potential mechanisms that are important in working with people with chronic physical illness and comorbid anxiety. First, the presentation of safety behaviours in people with chronic physical health problems will be explored. Clinicians must determine the difference between safety behaviours that exacerbate anxiety and safety precautions which keep patients safe from the impacts of their illness. A decision-making framework will be presented to differentiate safety behaviours and safety precautions. Second, the content of worries differs for people with anxiety in the context of chronic physical conditions. Specifically, an extremely common worry across populations of people with different chronic illnesses is the fear of their disease progressing. Our research shows that fears of progression are common amongst common chronic physical illnesses, including cancer, cardiovascular disease, rheumatological conditions, respiratory conditions and diabetes. This keynote will review evidence of the importance of fears of progression in anxious symptoms, theories of fear of progression and review the relevant treatment outcome literature.