Obsessed with your health? Convinced you are ill, despite getting a clean bill of health? If you’ve arrived here, then it’s likely you (or perhaps someone you know) have health anxiety and you’re interested in finding out more about how CBT therapy and counselling can help health anxiety. I work as a CBT therapist in Bath and help clients to overcome their health anxiety using cognitive behavioural therapy. In this introduction, I hope to give you an understanding of what health anxiety is, some of the ways it is maintained and how we can begin to overcome the problem of health anxiety.
What is health anxiety?
Health anxiety is a preoccupation with becoming ill with a serious illness, or of succumbing to a serious illness, despite medical advice that this is not an issue. Many people worry from time to time about their health, but health anxiety is when this worry becomes persistent, taking up a lot of time and leading to restricted lifestyle choices. Someone with health anxiety might imagine they are ill, or overestimate the likelihood that they will become ill, even in the face of a doctor’s evidence to the contrary.
How does CBT help health anxiety?
Cognitive behavioural therapy is rooted in the theory that our thoughts, feelings, actions and physical symptoms (bodily sensations) are all connected. We assess the problem of your health anxiety by building up a detailed picture of it. Each person with health anxiety is unique, so the first requirement in therapy is to take a detailed look at your worries about your health, how you are thinking and what you are doing about these thoughts. Once a thorough assessment has been made, then with your therapist you can begin to deconstruct the problem…
Health anxiety worries
In health anxiety you might become preoccupied with having a serious illness or getting one. Typically, people tend to focus on serious and catastrophic health events, such as having a stroke, a heart attack or chronic, long term illness with uncertain outcomes, such as multiple sclerosis, or cancer, among others. Often what can happen is when one condition is ruled out, physical sensations can convince you that there is still something wrong. You may become an internet expert in digging out rarer conditions which appear to match the symptoms you are experiencing. It’s not uncommon for people with health anxiety to self-diagnose conditions their GP has rarely encountered in their practice.
The first step in health anxiety is to consider the possibility that you have a problem of worry about health rather than this being a real health problem. This is a huge first step and involves taking a leap of faith, possibly with the help of your therapist. Once this is acknowledged then we can begin to test out the theory that it is your problem of worry rather than an actual illness which is the target of therapy!
The belief that you have an illness can be complicated by the existence of compelling and very ‘real’ symptoms. In the past, people with health anxiety were labelled rather dismissively as ‘hypochondriacs’ and told that their problem was all in the mind. The truth is that sensations and symptoms in the body are real and do exist, it’s just that the symptoms (sometimes coming from the anxiety itself) are being misinterpreted in a catastrophic way. If you experience health anxiety you may jump to fast conclusions about bodily sensations. In fact, it’s highly likely you are acutely tuned in to your body and how it feels on a day-to-day basis.
When we experience anxiety, we might attribute our bodily symptoms to serious illness: a tension headache might mean a brain tumour or an imminent stroke; a racing heart may be seen as the onset of a heart attack; tingling sensations may be interpreted as a sign of MS or other neurological disorder. Anxiety itself contributes many physical sensations which are in reality harmless, but which can become a focus of attention. When we focus on the symptoms, they take up more of our attention and a vicious cycle of health anxiety can begin.
Beliefs in health anxiety
Health anxiety is often driven by a need to be sure that you don’t have a particular illness. This need for certainty can compel you to find a certainty that is forever out of reach. It leads to a preoccupation with trying to prove with absolute certainty that you don’t have anything wrong with you.
You may also have beliefs about your worry which motivate you to keep worrying. For example, you may believe that if you don’t worry enough and keep your focus on your health, then you might miss something, and that if you did then you’d sorely regret it. Perhaps you believe it would be irresponsible not to worry, or that worry prepares you for a worst case scenario.
In CBT we really think about our thinking. Your therapist will help you to challenge some of these ways of thinking and to come up with more helpful and balanced thoughts which can help to soothe your anxious mind.
Why do you have health anxiety?
Often clients ask, ‘why do I have health anxiety?’ For this, there’s not a single answer. It can be helpful to explore what has happened to you or around you in your life to understand why you may be predisposed towards anxiety around illness. Factors which come up often are: sudden deaths in the family or among close friends, difficult illnesses in the family when you were growing up, perhaps you’ve had a serious illness in the past yourself, or have experienced a missed diagnosis in the past (either yourself, or others), for example. Often becoming a parent can trigger health anxiety as it becomes especially important to you to stay well and be around for your children. Knowing that we have understandable reasons why we may have a tendency to overestimate the likelihood of illness and perceive this as an ongoing present threat can help to unravel some of the automatic assumptions you might have when you experience a worrying symptom.
Coping in health anxiety
When you are experiencing health anxiety, you likely have developed ways of dealing with this with what therapists call ‘safety seeking behaviours’. Of course, we all strive for peace of mind and contentment, and when you’re anxious about health then you will have come up with ways which help you to feel better (some will be helpful, others not!). In health anxiety, there are some typical ways in which you might try to cope.
A common ‘coping’ method is to consult Dr Google. Dr Google holds a wealth of information for those seeking out symptoms online. The internet certainly has a lot to answer for when it comes to health anxiety. It offers unfiltered, general information and tends to lead to increased doubt and uncertainty, as well as more questions and lines of enquiry to pursue. In case you haven’t realised it yet, the internet is an ‘all you can eat buffet’ as far as health anxiety is concerned.
You might also frequently check out a particular part of your body which is giving you concern by closely monitoring it. If you have health anxiety, do you measure your own blood pressure or heart rate to reassure yourself you are okay? Do you poke and prod at particular areas to check for changes or pain?
Other ways in which you might try to help yourself include frequent visits to the doctor to seek out medical opinions, requesting further tests and visiting different doctors for second opinions. Other ways you might try to cope might be by trying to push aside the thoughts, trying to think positively, or avoiding activities which could, in your mind, put you at risk of something bad happening. You may also avoid talking about illness as if just talking about the illness increases the likelihood of this being true. And lastly, though not exhaustively, you may even avoid TV programmes or newspaper articles where you might come across reference to illness.
What is important to understand in all of the above, is to question how helpful these actions are for you in the short term and in the long term. Do they perhaps have some unintended consequences?
How does CBT help?
Cognitive behavioural therapy counselling for health anxiety helps to break and reverse the cycle which keeps it going. This means addressing thoughts and beliefs about our health. It also means reducing unhelpful coping behaviours which tend to keep our focus on the anxiety. An anxious focus on health unfortunately keeps you on high alert for sensations in the body and at the same time making you more likely to experience sensations which can then be attributed to something other than the anxiety which caused them.
In CBT therapy you learn to face the anxiety and work towards feeling a healthy level of concern for your wellbeing. It’s completely natural to feel concerned about your health, as this will motivate you to look after yourself but without the downsides of pre-occupation and missing out on life because of anxious worry. As an experienced therapist specialising in CBT, I have a wealth of ways to share with you to help you learn to tolerate your uncertainty as you learn to manage your anxiety. We use cognitive methods to soothe your anxious mind, and mindfulness based approaches to increase your resilience and learn to retrain your attention, as you begin to reduce activity which keeps you locked in the grip of health anxiety. It’s hard work, but it’s worth it, so you can get back to the life you value!
Ali Binns is a CBT therapist in Bath offering counselling for health anxiety and other anxiety problems. If you’ve a problem with worry, stress or anxiety, please get in touch if you’d like support in overcoming your difficulties.