CBT for Health Anxiety
Paying attention to our health is normal and often helpful, however health anxious people devote excessive time and energy to health concerns, either imagining physical symptoms of illness, or misinterpreting benign symptoms as something serious. Investigative tests or words of comfort from loved ones rarely reassure for long. I have worked therapeutically with many people suffering with moderate up to severe health anxiety, and have experienced the difference that CBT can make to their lives.
Everyone has a unique relationship with their health, meaning we all sit somewhere on the spectrum of attention we pay generally to our wellbeing. Most of us are familiar with the concept of ‘hypochondria’, be it related to a colleague who reads a news story about a disease and worries they have it. Or perhaps it’s a friend who acts as if they were already ill, for example, avoiding strenuous physical activity.
The question for CBT has been what causes some people to sit at the top end of that attentional spectrum, and become overly preoccupied, and how to help?
What about the beliefs you have related to your health? Do they stand up to investigation?
What makes someone vulnerable to health anxiety?
Within my CBT practice, I explore the following with clients to help identify their vulnerability factors for health anxiety:
- Specific personality characteristics such as a tendency to worry or an intolerance of uncertainty that means they demand black and white answers to health questions.
- Life events, such as experiencing a severe illness as a child, or a member of your family being seriously ill while you were young. Psychologists think that life experiences are particularly important because they shape our beliefs, attitudes, and behaviours in relation to health, specifically:
– Your sense of how physically robust you are.
– Your ideas about how awful an illness might be, the expected prognosis, how careful you need to be, or your likelihood of contracting a disease.
– How much you pay attention to your body and to illness.
– How well you think you’d cope with a serious illness.
What keeps health anxiety going?
CBT research has identified specific thinking patterns and behaviours that maintain health anxiety:
- Bodily checking: checking means that you have bought into the idea that there is or could be something wrong with your health. However the action of checking often leads to an increase in doubt, which in turn leads to more checking.
- How you pay attention: This matters in health anxiety because the way that you focus on a symptom can easily amplify your experience of it. The more that you pay attention to a symptom the more you become aware of it, and the more intense it can seem to be. This can lead to a vicious cycle: the more intense and important a symptom seems, the more attention you will pay to it, and the more intense it will seem.
- Reassurance-seeking: This can take multiple forms, from ‘casually’ mentioning symptoms to your partner, to asking your GP for investigative tests. Testing may seem like a quick way to alleviate worry, but for people for whom health anxiety has become uncontrollable, testing rarely provides lasting relief. It may seem like a reasonable approach, but ultimately no amount of testing ends the worry and may only serve to reinforce the anxiety.
- Avoidance: While some people often consult their doctor, in other cases health anxiety causes people to avoid the doctor entirely for fear of bad news.
- Thoughts and images. People with health anxiety often interpret situations in particularly threatening ways, resulting in strong feelings of anxiety. The unhelpful thinking includes:
– Catastrophising: Jumping to the worst possible conclusion, overestimating the probability of something awful happening and underestimating your ability to cope
– Intolerance of uncertainty: not feeling comfortable unless you have a definitive explanation for what you are experiencing.
– Selective attention: only paying attention to signs of illness, or ignoring information that does not support the health anxious view.
People with health anxiety often interpret situations in particularly threatening ways, resulting in strong feelings of anxiety.
How CBT Can Help Health Anxiety
Early goals are to develop an individualised explanation of how health anxiety came to be a problem in your life, together with understanding the patterns that are keeping it going. In my practice, I will then encourage you to shift your thinking so that the next time you have an acute health concern, we allow for the possibility that the problem is worry about health. This may be simple to say, but it’s an enormous shift in thinking for those who are health-anxious.
Next, as I mentioned earlier, the CBT model of health anxiety says the anxiety can be prolonged by some of the things that you might be doing to manage it. The best way to find out if this is the case is for you is to gather evidence through behavioral experiments. This happens alongside in-session experiments to observe the impact of some of the thinking and attentional processes on your anxiety. Do these processes make the anxiety worse or better? What about the beliefs you have related to your health? Do they stand up to investigation? We would also coach your nearest and dearest to respond helpfully to health anxieties, and if appropriate, we could ask them to join us for a session to discuss.
We would reframe checking and reassurance-seeking as attempts to gain certainty – the problem is that absolute certainty is never possible, therefore within CBT treatment we would work on increasing your tolerance of uncertainty.
Before we complete the therapy, we would develop a decision blueprint for when it is reasonable to seek medical help – even those recovering from health anxiety need to see the doctor now and again!
If you are considering CBT for health anxiety, please get in touch for an initial conversation. If you’re not quite ready to take that step, read Overcoming Health Anxiety by Rob Willson and David Veale for an overview of the self-help CBT approach.
