Two Tips for Health Anxiety

Hi, I’m Dr Tracey Marks, a Psychiatrist, and I make mental health education videos. Today, I’m talking about some solutions for health anxiety. I’ve previously spoken about health anxiety in this video. If you didn’t see it, watch it after this one. The clinical term for it used to be hypochondriasis,  but it’s now been split into two disorders,  somatic symptom disorder and illness anxiety disorder.


  I am still going to call it health anxiety because I think it’s a more descriptive term.  With health anxiety,  you’re overly sensitive to body sensations and fear that you have a severe illness.  The fear of having that illness overwhelms you and leads you to engage in behaviours that keep the anxiety going.  Many people realise that their fears are irrational to some degree.


  But it’s like you can’t break out of the cycle of fear about it.  The key to getting past the health anxiety is to focus on the problem as being anxiety out of control,  rather than getting proof or reassurance that you don’t have an illness.  That reassurance is always short-lived.  It’s like taking shortcuts to avoid work.


  You may feel better in the short-term when you hear that you don’t have the illness,  but your distress eventually comes back because the real problem is your anxiety,  not whether or not you have an infection.  Now, to be clear,  you shouldn’t always ignore physical symptoms.  Sometimes physical symptoms need to be evaluated to ensure that you don’t have something other than anxiety. 


 But with health anxiety,  you’ve been tested several times for certain illnesses,  and you’ve been told that you don’t have it. Still, as soon as you experience a physical symptom that you think is the illness,  you doubt what you’ve been told and continue to worry that you have the disease.  So the road to helping you focus more on your anxiety is cognitive behaviour therapy. 


 Now here’s some good news.  Some researchers out of Sweden did a clinical trial testing, CBT delivered by the Internet.  And the results were that Internet therapy was equally as effective as treatment had face-to-face with a therapist.  With Internet therapy,  the participants worked with a therapist through brief email communications.  But the bulk of the work was done by doing exercises.


  This Internet-based program isn’t available yet,  but this is promising because this could make the therapy much more accessible to people.  So I want to share some of the techniques that they use to help,  and some of these may be helpful now as a self-help approach.  One thing that they did was to practice mindfulness for 10 minutes a day.


  Mindfulness meditation helps you experience your body’s sensations and sit with the emotions,  without trying to suppress them or escape them.  The more you get comfortable with your feelings and accept them without judgment,  the less power they have over you.  The University of California, Los Angeles,  has a mindfulness podcast with six years of meditations that you can listen to. 


 I have a body scan meditation that you can download on my website.  So you have plenty of resources to get you started on guided meditations.  A second strategy was to practice response prevention.  This means you resist doing the things that reinforce your anxiety. 


 These generally fall under four categories:  Seeking information like searching the web,  avoiding things that you believe will trigger your anxiety,  getting reassurance from others like family members or doctors,  and scanning your body for symptoms.  Those are the broad categories,s.  You want to write down your behaviours that fit into these four categories. 


 And also take note of how often you do these things.  Next, you want to restrict how much you engage in these behaviours.  An example may be that you will only check your behaviours times a day instead of the usual 20,  or when you start to feel worried,  you’ll wait at least an hour before you talk to your partner about your concerns.  


You may find that you don’t have as strong of a need to talk to them by waiting.  Practice this each day.  You can set aside a particular time of the day to review your list of behaviours a which your progress.  If you spent the day holding back on your actions,  you might be tense,  and this may be a good time to do your mindfulness exercise. 


 Other parts of the therapy involved gradually exposing yourself to anxiety-provoking situations while you resist engaging in your usual behaviours.  And this is really where you make progress in reducing your stress and breaking the connection between physical sensations and pressure.  The exercises expose you to actual situations and imagined situations to trigger your stress while you suppress your response purposely. 


 Through these gradual exposures,  you become desensitised to the trigger.  We call it habituation.  The exposure exercises are best done under the supervision of a therapist.  But even with this Internet model,  the behaviour prevention is minimal compared to what would be required if you were seeing a therapist in person for a full psychotherapy session.


  So it’s good to know that cognitive behaviour therapy some therapist intervention.  I don’t know when the program will become available,  but just seeing that it’s just as effective as traditional therapy is the first step toward gaining acceptance in clinical practice.  In the meantime,  try using daily mindfulness and changing how you respond to your triggers.  That’s a perfect first step.  I hope this was helpful to you.  See you next time.

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