Therapy for an Anxious Patient Who Believes His Symptoms Are Caused by a Medical Problem*

Mr. A, a 41-year-old music teacher, was referred for a psychological consultation after an extensive workup disclosed no medical basis for symptoms of chronic fatigue, faintness, palpitations, and pain in his head and chest. These symptoms had begun in September, at the start of a new academic year, and had progressively worsened. By the middle of November he was convinced that his life was forever ruined by an undiscovered physical illness, even though his internist assured him that he was healthy. In mid-December the internist suggested that his symptoms might be due to “stress” and convinced Mr. A to accept a psychological evaluation.