Does your mind play tricks on you about your health? You'd be surprised how common that is! Health anxiety is a common problem that can cause extreme distress in a person’s life and be so tricky to tackle! On one hand, it’s normal and productive to desire to live a long healthy life and to be proactive about our health. But it doesn’t take much for our overprotective minds to get overzealous about it. Before long, our mind has a way of convincing us about a “safer proactive” approach, which may include all day stress, frequent doctor’s visits, and constant rumination about whether a sensation is a sign of a terminal illness or not. Our mind can convince us this is the only way to stay alive and safe, but that doesn’t seem like a fun way to live, does it?
Health anxiety is very common. Studies show that anywhere between 4%-12% of the US population experience it, and experts think cases may be under reported. It can be caused by a number of reasons such as biologically being more susceptible to anxiety, life experiences, or simply increased accessibility to health information.
Health anxiety triggers can look different for everyone, but a common trigger is misinterpreting physical sensations as threats. Experiencing a physical sensation may not mean that something is wrong; it may just simply be a neutral sensation. Actually, our bodies are full of movement and feelings, and healthy bodies experience sensations that can be unexpected and even painful. Jon Abramowitz, PhD wrote an article describing this as body noise. Sensations can be caused by a lot of different reasons, which includes our body’s constant attempt to achieve homeostasis. Varying factors such as what we eat, how we sleep, and what body position we are currently in cause our bodies to adapt and make “noise”, which is normal and healthy. It is often hyper-awareness that makes this noise seem louder than usual. An exercise I like to use with clients to demonstrate this is having them choose a part of their body to focus on for 5-10 minutes, and without fail usually they eventually feel sensations there. This proves that our behavior can play into our anxiety.
Another component of health anxiety that gets people stuck is the expectation of certainty. The desire for certainty is a core component of Obsessive Compulsive Disorder (OCD). However, attaining certainty with something as complex as your health is not possible. The human experience includes being exposed to illness and death, and we’ll all experience it one time or another. But, that does not necessarily mean we will get sick all the time, or that we can’t live a full, fulfilling life. The goal is not trying to obtain absolute certainty about our health, but to practice living while knowing enough. Living this way does not mean you’re careless about your health, it just means that you stop searching for something that is impossible to achieve. That endless search has consequences too.
Years ago I experienced some unpleasant symptoms that caused a fear of having a particular illness. This caused me to spiral and alter my life in search of certainty about this, which included frequent doctor’s visits, little sleep, asking for reassurance from anyone that would listen, and looking endlessly on the internet. Even after getting an explanation for my symptoms from my doctor, my mind still wanted more! Luckily I did not end up with a diagnosis of my feared illness, but thanks to the internet I learned that I could develop it at any point in life. With the help of my therapist, I eventually got comfortable tolerating the symptoms and risking uncertainty. To this day I still get a “what if” thought every now and again, and some days it’s hard to resist it. But most days I choose to go on living my life with what matters to me, risking uncertainty while trusting my doctors.
Treatment plans can differ for everyone, and it is a great idea to work together with your therapist and medical provider as a team to come up with one for you. Since it is possible to have anxiety and an illness (wait, don’t say that, Paul!), a good first step would be to see your primary care physician and get a physical to rule out any medical condition. Most commonly people with health anxiety see their provider too frequently, but there can also be sufferers who avoid them. If this is you, that may be a great goal to set, since most therapists are not physicians.
Effective treatment modalities for health anxiety include Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT) and Exposure and Response Prevention (ERP). Cognitive Behavioral Therapy (CBT) entails discussing how thoughts influence our perception and emotions around an event, which then influences our actions.
Here are also some tips that I usually encourage trying
- Trust your medical provider, their diagnosis and their treatment recommendations
With health information available at our fingertips, it is incredibly hard to not play doctor. But we can acknowledge that you’re not a doctor, and your anxiety is not a doctor. Karen Lynn Cassiday frames this action very well in her book Freedom From Health Anxiety as agreeing to “not practice medicine without a license”. When we challenge and do actions that go against our doctor’s recommendation, that is essentially what we are doing.
- Giving up reassurance seeking
If you have health anxiety, you’ve probably spent a lot of time looking and analyzing symptoms online and asking others of their opinions about a symptom. While this might bring some short term relief, it reinforces the idea that the sensations are dangerous and actually increases your anxiety over time. Let’s be honest, when was the last time WebMD was helpful? I tend to leave with more questions than I showed up with.
- Distinguishing physical symptoms (body noise, or symptoms of anxiety) from medical symptoms (symptoms that need to be treated by a doctor).
This might look like creating a list or a chart of feared or triggering symptoms, and then categorizing them as either physical symptoms (annoying but most likely safe) or medical symptoms (symptoms that need to be treated by a doctor). The idea is to not act on the physical symptoms and to practice moving on through life with them. This can be an exercise you can do with your provider and even run it by your physician for confirmation.
- Setting boundaries for your symptoms
This may be a helpful way to try exposures without seeming careless about your health. Pick out a symptom that seems to be troubling, and set a boundary (i.e. pain level or duration that symptoms remain present) when it seems necessary to contact a doctor. Any symptoms that don't reach that threshold may just be anxiety or body noise. You can also confirm the boundaries that you plan to set with a doctor.
Risking uncertainty about your health may seem scary but it’s very doable! Taking small steps can help get you there. Working with a therapist who is well versed in CBT, ACT and ERP is a great place to start.
