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?
Within my CBT practice, I explore the following with clients to help identify their vulnerability factors for health anxiety:
CBT research has identified specific thinking patterns and behaviours that maintain 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.