
CBT for Health Anxiety
We have all heard of the term ‘health anxiety’ or ‘hypochondria’ and ‘hypochondriasis’ before. It is a term that we sometimes use lightly to suggest that we struggle with the idea of becoming unwell or we feel disgust and discomfort when we think about germs.
We have all felt concerned about our health at some point in our lives. It is likely that we have experienced urges to avoid medical procedures or medical professionals or to control the future by asking for reassurance and trying to predict the future. However, this is not an indication that we experience health anxiety or hypochondria.
What does ‘health anxiety disorder’ or ‘illness anxiety disorder’ mean in clinical terms? Who would meet the diagnostic criteria and what are the signs we might suffer from health anxiety?
Health anxiety symptoms:
1. Preoccupation with having or acquiring a serious illness
2. The preoccupation is excessive and disproportionate (even if a medical condition exists)
3. Excessive controlling or avoidant behaviours related to health (e.g. frequent visits to the GP, reassurance-seeking behaviours, researching symptoms on the internet but also avoiding talking about certain health conditions, avoid checking or touching parts of one’s body etc). In most cases, there is a mixture of controlling and avoidant behaviours and they can also co-exist and alternate (e.g. frequent visits to GP replaced by avoiding the GP)
4. Preoccupation for more than 6 months (even if the concerns change in content)
5. Preoccupation is not better explained by another mental disorder
I would like to clarify here that health anxiety is not just a preoccupation with our physical health. It can also be a preoccupation with our mental health – for example, the idea that one is losing their minds or developing psychosis or dementia.
Health anxiety can be diagnosed in people who already suffer from a medical condition or who have done in the past (in their childhood or early adulthood). It adds a layer of distress, anxiety and fear in their experience and it can be treated to improve their quality of life.
Health anxiety can be a debilitating condition – its severity ranges from mild to severe but when someone meets the diagnostic criteria for health anxiety, it means that their functioning is affected by the condition.
‘Health anxiety is ruining my life! Can I stop health anxiety?’
Health anxiety disorder is indeed a condition that can have a serious impact on people’s lives, routines, relationships…it can affect all life areas. Cognitive-behavioural therapy is an evidence-based treatment for health anxiety. Unfortunately, it won’t make the health anxiety stop but it will teach you important strategies for you to start managing your health anxiety symptoms better and start taking back the control from your anxiety.
‘’How can CBT help with health anxiety? How can I handle health anxiety?
What can I expect from health anxiety treatment using the CBT model?’’
First of all, let’s think what it is realistic to expect from health anxiety therapy. Many people come to therapy expecting their worry thoughts and anxiety to go away. However, although we would expect that CBT therapy will help with the reduction in anxiety and worry symptoms in the long-term, it is unrealistic to expect that such thoughts and feelings will disappear forever. As human beings it is natural and expected to experience difficult thoughts and emotions at certain points in our lives.
CBT therapy does not aim to reduce the uncertainty that the future brings or rule out the possibility of a medical condition. These would be unrealistic expectations. CBT therapy for health anxiety aims to help the person tolerate uncertainty and find better ways in managing their distress and difficult thoughts through:
– Educating the person about how anxiety and fear affect the body and lead to distressing physical sensations. Some people ask whether health anxiety can cause ‘fake symptoms’. The answer is that anxiety activates the ‘fight-or-flight’ response in our bodies leading to new symptoms that could be perceived as dangerous and an indication of a serious health condition. For example:

– Working with the catastrophic misinterpretations that the person is led to when interpreting new or ambiguous physical symptoms.
– Helping the person identify rigid and unhelpful thinking styles. Working on reinforcing flexibility in the way situations are interpreted.
– Encouraging the person in therapy to test out negative predictions through engaging with distressing thoughts, feelings and scenarios.
– Teaching the person how to focus their attention on what they find meaningful and in line with their values, rather than what their anxiety directs them to.
– Postponing unhelpful behaviours which reinforce the anxiety in the long-term, such as: checking, asking for reassurance and monitoring symptoms excessively.
– Liaising with the GP in order to develop a joint plan that would benefit the person.
– Working with the family of the individual to educate them on health anxiety and make sure they do not unintentionally reinforce health anxiety symptoms.
– Helping the person reduce avoidant behaviours as a way of building self-confidence and self-esteem and reducing fear and anxiety.
Health anxiety by proxy
When individuals are preoccupied with the health of someone else (e.g. their children) and they experience the health anxiety symptoms we referred to in the beginning of this article, they could be diagnosed with health anxiety by proxy. The treatment for this type of health anxiety would involve the same processes and the aim of therapy would be exactly the same as the above description.
Books recommended for health anxiety
Overcoming Health Anxiety: A self-help guide using cognitive behavioural techniques (2009) by David Veale and Rob Willson