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Cbt behavioral therapy for health anxiety

If you find yourself preoccupied and fearful about having a serious illness, you may suffer from health anxiety. Fortunately, there are concrete steps you can take to (eventually) feel less anxious.

What Is Health Anxiety?

Health anxiety is worry or concern about having a medical condition that is disproportionate to the actual risk. Sometimes health worries are the only topic someone is anxious about. For others, health is just one of several focuses of worry. At its worst, health anxiety can be quite impairing.

If worries about your health don’t stop you from enjoying your life, then it probably doesn’t need to be addressed. However, if you notice some of the following, you might consider addressing the problem:

  • Frequent doctor visits or emails to medical providers
  • Repeatedly checking your body for signs of illness
  • Skipping necessary medical visits due to anxiety
  • Significant time spent researching possible significant health conditions
  • Asking loved ones for reassurance over and over about your health (e.g., “it’s probably nothing, right?”)
  • Frequent checking or awareness of heart rate, blood pressure, etc.
  • Avoiding people with serious illness, due to fear of catching it from them or fear of seeing the illness’ effects
  • Preoccupation with one’s health or frequently discussing one’s health

RELATED: What Is Anxiety?

If health anxiety has gotten out of control for you, consider using any of the following strategies that are commonly used in cognitive-behavioral therapy (CBT) for this problem:

1) Limit Your Checking and Safety Behaviors

If you suffer from health anxiety and you spend time researching health problems online every day, the research may cause more anxiety than it alleviates. Similarly, if you visit your doctor significantly more often than your loved ones (or your doctor) think is necessary, the doctor visits may be a safety behavior.

What are safety behaviors?

A safety behavior is anything we do that serves to make us feel less anxious without significantly reducing the threat. For example, a man who checks that the door is locked five times before leaving home makes himself feel more comfortable without meaningfully reducing the likelihood of a break-in. In contrast, putting out your cigarette before filling up at the gas station does reduce the likelihood of a fire, and so would not be a safety behavior.

For people with health anxiety, getting reassurance from loved ones, from the internet, or even from doctors can become safety behaviors. Take a minute and ask yourself which things you do that help you feel less anxious about your health, but realistically do little to keep you healthy. The more you work to reduce the frequency of these behaviors, the better your health anxiety is likely to get!

woman with health anxietywoman with health anxiety

2) Assess Threats Correctly

Decades of research on anxiety and how it works show us that threat misappraisal worsens anxiety. Threat misappraisal simply means overestimating how likely it is that something bad will happen. This often happens to people with health anxiety. They may worry significantly about a health problem that is exceedingly unlikely to occur.

For example, someone with health anxiety who is concerned about pancreatic cancer may estimate their chances of getting the disease as 20% or more. However, the actual likelihood of someone in the US being diagnosed with pancreatic cancer in 2021 was approximately 12 out of 100,000, which is 0.012%.

The good news is that if you are consistently able to correct threat misappraisal in your mind, your health anxiety will improve. This doesn’t mean just correcting it once with the hope that “it sticks.” This means that every time you worry about a serious disease, you remind yourself of your actual risk of getting it. This may mean reminding yourself of the facts dozens of times each day, but be willing to try it!

3) Make a Sustained Mental Effort to Tolerate Risk

Sometimes people have anxiety about a health condition that is realistic for them. For example, someone with a family history of a certain cancer may worry excessively about getting that cancer. Similarly, someone with a history of heavy smoking may worry about getting lung disease. So how can you cope with those situations?

Working to tolerate some risk is part of the solution. Health anxiety thrives when we have no tolerance for risk. This means that the more we accept even negative possibilities, the less anxiety we will have. Accepting these risks involves making a conscious effort to give up hope of guaranteed health. None of us are guaranteed good health, so accepting negative possibilities is just accepting reality.

RELATED: Accepting Things As They Are: Why and How to Do It

In CBT therapy, when people with health anxiety are counseled to tolerate some risk of an illness, they often say, “I just want to be sure that I don’t have it.” That’s certainly a reasonable thing to want! They don’t realize that their tolerance for risk on this one concern has fallen to zero. However, these same people are often able to tolerate the possibility that a loved one could get hit by a bus, or that we could die in a nuclear war or environmental disaster, or that their dog will run away. Tolerating the possibility of getting serious illness requires this same type of coping. The secret is to acknowledge how bad the feared illness would be, and to make a mental effort to accept that the risk of contracting it is not zero.

Consider Cognitive-Behavioral Therapy (CBT)

If your own efforts to address health anxiety aren’t as successful as you’d like, consider cognitive-behavioral therapy. It is quite effective against anxiety, and this is true for health anxiety as well. If you’d like to speak to someone about whether CBT is a fit for you, please contact us!

What is health anxiety?

If you have health anxiety, you might find yourself:

You can develop health anxiety whether you are healthy, or you have a diagnosed medical condition. You can be diagnosed with health anxiety if your symptoms have persisted for at least six months and have caused you significant distress, or have negatively affected your daily life [1].

What is it like to have health anxiety?

When you have health anxiety, concern about your health seriously affects your life, getting in the way of important relationships or things that you enjoy. Samantha’s story illustrates what health anxiety can feel like.

Samantha’s fear that she would have a stroke

I was in my early twenties and had a job as a kitchen worker when I developed a condition called pulsatile tinnitus, which meant that I could hear blood ‘whooshing’ in a vein in my ear. I used to worry that this sound meant I was about to have a stroke and die. I was really frightened, so I paid a lot of attention to it and tried not to make it worse. I didn’t exercise or do anything to raise my heart rate because it made the sound louder, and I refused to travel more than a few miles from the local hospital, preferring to stay with my boyfriend or parents in case I needed medical help. I did ask doctors about it, but after a lot of tests – and lots of my own research on the Internet – I felt they didn’t understand how serious the risk was. I tried a lot of other therapies like acupuncture and homeopathy, but nothing seemed to help very much.

Understanding Generalized Anxiety And Worry CBT Psychoeducation Guide

Do you struggle with health anxiety?

Health anxiety should only be diagnosed by a mental health professional or a doctor. However, answering the screening questions below can give you an idea of whether you might find it helpful to have a professional assessment.

Are you concerned that you might have a serious illness or disease that doctors have not found? Never Occasionally Much of my time Most of my timeHow much time do you spend worrying about your health? Never Occasionally Much of my time Most of my timeHow often are you afraid that you have a serious illness? Never Occasionally Much of my time Most of my timeHow relieved do you feel when a doctor tells you there is nothing wrong? Initially relieved Initially relieved, but worries return later Initially relieved, but worries always return Not relievedI have difficulty taking my mind off things about my health. Not at all A little bit Quite a lot Very much

 

The questions above can’t provide a definitive diagnosis, but if you ticked the rightmost box to lots of these questions, you might be suffering from health anxiety.

Understanding Psychoeducation Guides

What causes health anxiety?

There is no single cause for health anxiety. When thinking about the causes of problems psychologists often separate vulnerabilities (things that make you more likely to develop a problem) from triggers (things that make a problem begin).

Vulnerabilities to health anxiety

Some people are more vulnerable than others to becoming anxious about their health. Things that can make you more likely to experience health anxiety include:

  • Personality traits.
  • Life experiences.
  • How much you pay attention to your body, and to illness.

There may be genes which make you more likely to develop emotional problems in general, but no specific genes which make you more likely to develop health anxiety.

Triggers for health anxiety

Not everyone who is vulnerable goes on to develop health anxiety. It can develop gradually, but might be triggered by:

What keeps health anxiety going?

Research studies have shown that Cognitive Behavioral Therapy (CBT) is one of the most effective psychological therapies for health anxiety. CBT therapists work a bit like firefighters: while the fire is burning they’re not so interested in what caused it, but are more focused on what is keeping it going, and what they can do to put it out. This is because by working out what keeps a problem going, they can treat the problem by ‘removing the fuel’ and interrupting this maintaining cycle. Some of the things that psychologists think are important in keeping health anxiety going are:

Treatments for health anxiety

Psychological treatments for health anxiety

Psychological treatments for health anxiety which have good research support include Cognitive Behavioral Therapy (CBT) [2] and Acceptance and Commitment Therapy (ACT) [3].

CBT is a popular form of talking therapy. CBT therapists understand that what we think and do affects the way we feel. Unlike some other therapies, it is often quite structured. After talking things through so that they can understand your problem, you can expect your therapist to set goals with you so that you both know what you are working towards. At the start of most sessions you will set an agenda together so that you have agreed what that session will concentrate on. CBT treatment for health anxiety will involve some of the following ‘ingredients’:

  • Thinking about the costs and benefits of change.
  • Understanding more about the normal range of bodily feelings that most people experience.
  • Considering different interpretations for your experiences (sometimes referred to as ‘Theory A’ and ‘Theory B’)
  • Testing your beliefs with behavioral experiments.
  • Working with your thoughts and images.
  • Experimenting with what happens when you reduce how often you check and seek reassurance.
  • Experimenting with what happens when you don’t use safety behaviors.
  • Deliberately exposing yourself to your worries.

Medical treatments for health anxiety

There is a small amount of evidence that medication can be helpful for reducing the symptoms of health anxiety. These include clomipramine, imipramine, fluoxetine, fluvoxamine, paroxetine, and nefazodone [4]. The effectiveness of medical treatments appears to be smaller than for cognitive behavioral therapy [5].

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
  2. Cooper, K., Gregory, J. D., Walker, I., Lambe, S., & Salkovskis, P. M. (2017). Cognitive behaviour therapy for health anxiety: a systematic review and meta-analysis. Behavioural and Cognitive Psychotherapy, 45(2), 110-123.
  3. Eilenberg, T., Fink, P., Jensen, J. S., Rief, W., & Frostholm, L. (2016). Acceptance and commitment group therapy (ACT-G) for health anxiety: a randomized controlled trial. Psychological Medicine, 46(1), 103-115.
  4. Taylor, S., & Asmundson, G. J. (2004). Treating health anxiety: A cognitive-behavioral approach.Guilford Press.
  5. Taylor, S., Asmundson, G. J., & Coons, M. J. (2005). Current directions in the treatment of hypochondriasis. Journal of Cognitive Psychotherapy, 19(3), 285.

About this article

This article was written by Dr Matthew Whalley and Dr Hardeep Kaur, both clinical psychologists. It was last reviewed on 2021/12/08.

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