Anxiety, while often sharing similar characteristics in physical and psychological presentation across its various forms is something which can manifest in a variety of different ways. Social anxiety, separation anxiety, OCD, generalised anxiety, phobias and much more are common presentations we see in our office at Evolve. For the purpose of this blog, we are going to look at a type of anxiety which is often referred to as hypochondria but more commonly known within the counselling and psychotherapy world as health anxiety or illness anxiety.
Health anxiety involves regularly worrying that you may currently be unwell or that you may at some point become unwell and this worry can often interrupt daily living/normal functioning. Somebody with health anxiety may be inclined to do some or all of the following:
1. worrying about your health all the time
2. frequently checking your body for signs of illness, such as lumps, tingling or pain
3. always asking people for reassurance that you're not ill
4. worrying that your doctor or medical tests may have missed something
5. obsessively look at health information on the internet or in the media
6. avoiding anything to do with serious illness, such as medical TV programmes
7. acting as if you were ill - for example, avoiding physical activities
Having had personal experience with this manner of anxiety as a teenager, I took a special interest in working with clients presenting with health anxiety throughout my career to date as it fascinates me and is a variant of anxiety which I have seen personal success in overcoming but also have seen a multitude of clients overcome, moving from a life ridiculed by anxiety to a life very much so close to being anxiety free. If you believe you are currently experiencing health anxiety, help is available, take courage and take hope, this can be overcome.
Many of my clients will be familiar with the image below which depicts just a number of the facets/elements of health anxiety and areas which during therapy we create a plan to work upon specifically. Beneath the image below I will give a brief description of each heading and why these may keep anxiety in motion, followed by briefly explaining to you the therapeutic process and approach to combatting these areas, further resulting in overall anxiety reduction.
Worry about my health - Naturally this one is self explanatory, however - it is one which is driven and kept in motion by the headings to follow and what they consist of. The more we can decrease certain thought patterns and behaviours which are maladaptive or dysfunctional around what we are worrying about, the more our feelings of anxiety, worry and panic can decrease.
Body focus - Body focus driven by the underlying belief that you may be unwell, essentially involves a heightened awareness of physical sensations, aches and pains and being hyper vigilant to these sensations, often panicking when they arise. Usually I see with clients that the more they focus on these sensations, the more they experience them due to how tuned into their body they are. I will always initially recommend to a client that with body focus we just want to become more and more aware of how tuned in we are to our bodies and then when we are tuned in… asking ourselves: what are we thinking? Could we be misinterpreting these feelings and thinking the worst when in fact there may be nothing wrong? Which leads me to the next heading.
Misinterpretation of body sensations - Our bodies throughout the day regularly undergo external and internal changes resulting in various feelings and sensations throughout the body for a multitude of reasons. When somebody is experiencing health anxiety, these regular/normal bodily sensations usually become subject to an anxiety driven interpretation that “something must be wrong” and the more we believe the misinterpretation of these feelings, the further we are driven toward that constant focus on the body waiting for something to happen and believing we are in danger. When working with clients with health anxiety, I usually would recommend various techniques such as journalling with a Socratic method to look for evidence as to whether or not what we are thinking may be truth based or a potential misinterpretation. A good question to ask yourself is: what is the fact based evidence to suggest that the feeling or bodily sensation you are experiencing is _________. (Fill in the blank)
Checking body frequently - For everyone this behaviour may vary depending on the nature of what the health anxiety is surrounding. For someone experiencing chest pain, palpitations or a racing heart, they may believe they are in grave danger of a heart attack (misinterpretation). As a result this person may find themselves regularly checking their pulse, their heart rate, looking at their complexion and much more. When working with a client, once recognising this unhelpful behaviour we want to then put a structure in place to reduce this behaviour as the more the person checks for the potential signs they are having a heart attack, the more they feed the belief/misinterpretation that this may be true when in fact it is not true and there is usually a very logical explanation for these sensations. Also it is very important to note that anxiety can cause physical sensations such as chest pain, racing heart and much more and these sensations while uncomfortable are more often than not, nothing to become alarmed about. Maladaptive behaviour reduction is massive in combatting health anxiety so we want to reduce how much and how often we check our bodies.
Avoiding situations where you may hear about illness - In all types of anxiety, avoidance is very common, however - the more we avoid something, the greater the anxiety becomes. Naturally when we face our fears and overcome them, we grow stronger, recognising that we can and will cope. With health anxiety people often may want to avoid hearing of illness as it further perpetuates anxiety within that moment. For others it may be that they lean more into the search for information about illness which we will cover shortly and that may involve engrossing themselves in situations which feeds this desire to hear more about illness as they may find out valuable information to help them decipher what they believe may actually be wrong with them physically when in fact they are in good health and do not need to look for this information. All avoidant behaviour is often treated during therapy using methods of exposure therapy which is extremely beneficial for overcoming anxiety and phobias.
Reassurance seeking - While reassurance brings temporary relief, it usually adds fuel to the fire as the person seeking reassurance struggles to discern whether or not they are actually unwell without external input which creates a level of reliance on becoming reassured, further making the person believe they need this reassurance or else they may miss something and be in further danger of being unwell. My biggest piece of advice as a starting point here is - AVOID GOOGLE. Google is one of the biggest anxiety producing areas for those with health anxiety as you may type in “headache” and it will tell you “brain tumour”. This information is often incorrect and feeds further anxiety. When working with a client, we work towards the reduction of seeking reassurance which results in a client becoming autonomous within relying on their own discernment of what it means to actually be unwell versus the misinterpretation of bodily sensations or feelings resulting in believing they are unwell.
Search for information about illness - This in ways can be similar to reassurance seeking in that it usually involves consulting online sources, doctors, family members, friends and much more. The constant search for information keeps the person who is searching very much so focussed on the idea they they need to figure out what is wrong with their health. This desire and search for information is driven by the core belief that they are unwell and in potential danger when they are in fact not in any danger at all. Working with a therapist such as ourselves at Evolve will equip you the client with ways to change your belief systems and develop an ability to overcome these unhelpful patterns using CBT.
With all of the above, in regards to thinking - our goal is to challenge the thinking, dispute the thoughts and look for evidence for and against what we are thinking and then begin to recognise that our thinking may be faulty and looking at what may be more realistic potential reasons for why we feel how we do which 99.9% of the time results in clients recognising they are not actually physically unwell. In regards to behaviour we want to reduce avoidant behaviours and lean into areas which bring discomfort. When leaning into discomfort, this may initially be difficult and induce unwanted anxiety but the more we face our fears and work through them, the easier it becomes and the more the anxiety reduces.
Thank you for taking the time to read this blog. I hope it has been somewhat educational and potentially beneficial to you in your life. Please note, while this blog/advice may be true to your own life, it is by no means an alternative to having a physical health examination where necessary. If you have reason to believe you are unwell, please get in touch with your GP and schedule a check up.
If you would like professional help in dealing with health anxiety or any other issue, please get in touch with us on info@evolvementalhealth.ie and myself or one of our team will be happy to assist you in any way that we can.
God bless you,
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