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Key points
- People with health anxiety commonly engage in thinking errors or cognitive distortions.
- The "all-or-nothing" thinking error involves thinking of health status in two categories: perfectly healthy or deathly ill.
- "All-or-nothing" thinking can be challenged using thought exercises.
People with health anxiety often see health and illness in rigid, inflexible terms.
Thinking errors, or cognitive distortions, are inaccurate thoughts, and there are many types. All of us have these distorted thoughts at times. However, people with anxiety tend to have them more frequently than those without anxiety. And they can cause significant distress because they lead us to draw inaccurate conclusions about what is happening around us.
All-or-Nothing Thinking
One type of thinking error is called "all-or-nothing thinking." This type of thought involves viewing everything in absolute, black-or-white categories instead of taking a more balanced approach and seeing things on a continuum. People with health anxiety often engage in this thought error because they assume one is either perfectly healthy or deathly ill, leaving very little room for anything in between those two extreme categories.
As an example: Sarah is at the doctor, receiving the results from a recent physical. As it turns out, the results from her bloodwork are normal and her doctor tells her she appears to be in good health.
Of course, Sarah is a happy little camper after hearing this news. On her drive home, she is in a fantastic mood: smiling, chatting, and laughing on the phone with her friends and is rocking out to her favorite band. After all, life is grand! How could it not be? She's healthy!
Not long after she arrives home though, she notices a small bump on the back of her head. Immediately in that moment, all of the relief and happiness she had been experiencing drains from her. She begins to ruminate and worry that it is something serious, like a cancerous tumor. She thinks, "See! This is why I shouldn't get comfortable with the idea that I am healthy—because it always turns out that I'm not."
Sarah is viewing her health status like a light switch. There is no middle ground. She is either "on" (i.e. perfectly healthy) or "off" (i.e. deathly ill).
How to Challenge This Thinking Error
The reality is that health status is not a light switch. Health and illness exist on a spectrum. The vast majority of us are not perfectly healthy. Many of us have minor health issues and arguably all of us have at least some ways that we can improve our health.
What's more, having a health issue is not a death sentence. Many people with chronic and/or serious health issues can live very long lives. If you find yourself spiraling when you notice a symptom or bodily sensation that indicates you are not in the "perfect health" you want to be in, pause and ask yourself a few questions.
First, ask yourself whether there is a more reasonable explanation for this symptom or bodily sensation (i.e. you have a headache because you didn't drink enough water as opposed to because you have terminal brain cancer). Next, consider this: even if the symptom or bodily sensation is indicative of a health issue, what are all of the "in-between" possibilities? In other words, try and consider the many possible minor issues that could lead to this symptom other than the worst-case scenario.
This exercise can help you get into the practice of recognizing that health status cannot be oversimplified into two basic categories of perfect health or impending death. It is important to get in the habit of recognizing that, as with most things in life, there are many other explanations besides the two most extreme possibilities.
