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Ask a Therapist is a series of columns offering insights and advice about common psychological concerns. It is not a substitute for seeking professional psychological or medical care.
If you have ever encountered someone who spends a lot of time worrying about their health even when they are healthy, or if you feel this way yourself, then you know how distressing it can be.
Health anxiety (formerly termed hypochondria) is intense, ongoing worry about having or developing a serious medical condition, even in the absence of illness. Signs include misinterpreting normal body sensations as indicators of an acute illness, constantly checking for signs of disease, frequently looking up medical information online, and consistently asking others, including medical providers, for reassurance.
It is also possible to have health anxiety about an existing, diagnosed medical condition. This may look like hyper-focus on bodily sensations, excessive worry about the condition, or a constant fear that it will worsen or recur.
The Canadian Psychological Association estimates that about 3 to 10 per cent of the general population experiences significant health anxiety, with up to 30 per cent experiencing milder anxiety.
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Being concerned about your health is not the same as having health anxiety. It is natural to be preoccupied with your health from time to time. Health anxiety is excessive and interferes with daily life. It is often fuelled by misinterpreting normal or minor physical symptoms as being serious. For example, instead of thinking your headache means you are stressed or have sinus congestion, you may worry you have a brain tumour. This misinterpretation leads to anxious behaviours, such as spending large amounts of time looking up medical information – a habit only made easier with the proliferation of health advice online and now, AI – or attending medical appointments.
Anxiety also causes certain physical sensations, such as dizziness, increased heart rate, and chest pain. If you have health anxiety, you may misinterpret these sensations as signs of a disease, creating a problematic and continuing cycle that goes like this:
– You notice a physical sensation in your body or read about a disease.
– You decide the sensation means something could be seriously wrong with you or that you could have the disease.
– You scan your body for signs of disease or search the internet for answers.
– You may briefly feel better if sensations stop or you read reassuring information, but the anxiety soon starts up again with the same or different focus.
For the clients I see in therapy for health anxiety, their anxiety is often dictating their lives. They feel consumed by worry and are propelled to spend more and more time engaged in anxious behaviours, such as looking up medical information, while spending less and less time socializing or engaging in activities they typically enjoy. If they do engage in meaningful activities, they are not fully present, as their minds are focused on health worries.
While health anxiety can feel overwhelming, there are ways to cope so it has less control over your life.
1. Track and limit your anxious behaviours
Over the course of a week, write down how often you engage in health anxiety behaviours such as checking your body for signs of illness or asking others for reassurance that you are healthy. Then, practice gradually reducing these actions. For example, if you typically spend two hours a day researching medical information, try reducing it to 30 minutes. Or, if you check your body multiple times a day, aim for just once a day. Eventually, this can help to stop these behaviours completely.
2. Schedule your worry
Set a specific time, once a day, to worry. The period should be short, about five to 15 minutes. During this time, write down your concerns and when you are done, tell yourself, “My worries are on the paper, and I don’t need to hold them in my mind right now.” When you start fretting outside of your scheduled time, remind yourself, “I can think about this during my next worry time.” Worrying at a set time teaches your brain you don’t have to do it constantly.
3. Remind yourself thoughts are not facts
Just because you think something does not mean it is true. You do not need to take your anxious thoughts literally. Thinking “I might have multiple sclerosis” does not mean you do. Thoughts are passing mental events, and practising viewing thoughts as thoughts, and not the truth, can lessen their impact on your behaviour. You can use the phrase, “I am having the thought that” before your thought. For example, “I am having the thought that I might have MS.”
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4. Non-judgmentally observe physical sensations
Practise observing your physical sensations without judging them as good or bad. If you notice a pain in your arm, you can tell yourself, “I feel some pain in my arm” instead of, “There is a horrible pain in my arm, and I might have bone cancer.” Notice how your sensations change over time. And remind yourself that a sensation may feel uncomfortable or unfamiliar, but that does not mean it is harmful or dangerous. Tell yourself, “My body has all sorts of sensations, and I am safe.”
5. Practise relaxation exercises
Anxiety activates your body’s stress response. Calming that response can ease emotional and physical discomfort. Relaxation exercises include breathing slowly and lengthening the exhale part of the breath (for example, inhale to a count of three and exhale to a count of six); tensing and releasing different muscle groups to reduce tension (for example, lifting your shoulders to your ears, holding them there for a few seconds, and then releasing the muscles); and gentle movement such as stretching or going for a slow walk.
6. Shift your focus to meaningful activities
When you have the urge to engage in an anxious behaviour, such as constantly checking your skin for possible signs of cancer, practise deliberately shifting your focus to a helpful behaviour, such as going for a walk. Also, make note of activities you may have stopped as a result of health anxiety, such as seeing friends or engaging in sports, and challenge yourself to resume these.
Jennifer Caspari, PhD, is a registered psychologist in British Columbia. She works at Tall Tree Integrated Health in Vancouver and is the author of You Are More Than Your Body.