Keep Your Health Anxiety in Check With These 4 Strategies

With each new case of coronavirus in a community, it’s natural for fear to spread that the illness will affect you or your family. The atmosphere of worry and anxiety can only worsen health anxiety if you are someone who is already highly tuned into their body’s symptoms.

Not only do you ordinarily preoccupy your mind with thoughts of the many diseases that can strike you, but you’re now living in a world that feeds that anxiety with every breaking story to hit your newsfeed.

As noted by Australia’s University of New South Wales psychologists Sophie Antognelli and colleagues (2020), people with health anxiety make “catastrophic interpretations of bodily changes to be indicative of debilitating and often fatal disease”(p. 1). These individuals draw these conclusions due to cognitive biases that cause them to note every small change in their bodies, which feeds their vivid images of illness that, in turn, “elicit the maladaptive safety behaviours that are known to maintain health anxiety” (p. 1).

This analysis begs the question of which safety behaviors, when there is an actual health epidemic, are considered maladaptive and which reflect appropriate coping behaviors. There is a reality to the fact that people need to protect themselves and those around them, making it even more difficult for those high in health anxiety to take these precautions without becoming panicky.

Here’s where treatment of health anxiety can provide a basis for managing the anxiety you may feel while still taking appropriate protective actions. The method best suited for such management, according to the Australian authors, involves what’s known as “cognitive bias modification for interpretations (CBM-I)” (p. 2). In previous tests of CBM-I in areas other than health anxiety, participants responded to an ambiguous stimulus that they were taught to resolve with an anxiety-reducing interpretation. For example, you might see the phrase “You tell a friend a story and she appears to be…” If you tend to hold negative cognitive biases, you would provide the word “bored,” but if you don’t, you’d be more likely to say “interested.” By training participants to complete such sentences with positive endings, previous researchers have found support for CBM-1 in reducing symptoms in individuals with anxiety disorders.

CBM-I would seem, according to Antognelli et al., to be appropriate for health anxiety disorders, which do not appear to respond to ordinary cognitive-behavioral therapy (CBT). For CBT to work, individuals need to have a certain degree of introspection, in which they learn to change the way they think about anxiety-producing situations. As the authors note, health anxious individuals not only fear the sensations of anxiety, but also tend to “think the worst” about a range of ordinary bodily cues, from tingling, sneezing, and even bumps on the skin. Perhaps because these are actual physical conditions (i.e. a sneeze is definitely something real), then it may be particularly difficult to encourage the kind of irrational thought-challenging that takes place in CBT.

To test the effectiveness of CBM-I, the Australian research team developed an internet-based method, in which participants were led through a set of instructions to change the words they used to describe ordinary physical signs. The sample members were recruited from flyers distributed on the university campus and from the pool of undergraduates registered to receive credit for experimental participation. All met the screening criteria of having elevated scores on a measure of health anxiety but had no evidence of substance use or suicidality risk. Of the original 206 eligible for participation, 89 were assigned through randomization into a CBM-I intervention group or a control group, and of these, 79 remained available for post-intervention testing two weeks later.

The CBM-I treatment consisted of two 30-minute online training sessions over the course of one week. The program instructed participants in how to complete a word completion task in which they were to fill in the end of an ambiguously worded sentence that ends in a word fragment. As an example, consider the following scenario: “You are at the clinic for a routine check-up. When you see your doctor, she asks you about your health and takes your blood pressure. She looks at the pressure reading, and you can see her write down …. “ The word fragment consists of “a_nor_al” or “n_rm_l.” Your task would be to type the first letter that would fill in the word—either “b” (for abnormal) or “o” (for normal). In the treatment group, participants were actually required to fill in the word with the healthy alternative. Researchers required the control group participants to use the healthy alternative half of the time and the unhealthy alternative on half of the other trials.

To determine whether the intervention worked, participants then completed a question asking if they regarded their blood pressure as healthy (which, presumably, it was) as well as recognition items based on similar ambiguous scenarios as those used in training. Participants also rated the intervention in terms of whether they felt it was satisfactory, logical, successful, and even enjoyable.

The main findings on CBM-I’s effectiveness showed that the effects of the intervention continued to be maintained in reducing health anxiety symptoms for at least two weeks after the treatment ended. Both the intervention and control groups showed improvements in their health anxiety scores, but two times as many (33%) in the intervention group reported improved health anxiety compared to the control group.

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Furthermore, the intervention group’s improvement seemed tied to changes in their catastrophic symptom attribution as they learned to regard their bodily symptoms as having benign origins rather than indicating the presence of a serious illness. Within both groups, improvements in health anxiety scores were correlated with increases in these benign attributions. In terms of their ratings of the method, many in the intervention group stated that they would feel comfortable recommending this intervention to a friend.

The Australian study is the first to test this novel approach on people high in health anxiety and because the sample size was small and limited primarily to younger adults, there clearly is a need for further testing. However, the idea remains intriguing that those with health anxiety can essentially rewire their typical associations between bodily sensations and the belief that they have a serious disease. Putting this into practice, along with other advice regarding the coronavirus specifically, here are the steps that you can take to keep your health, and health anxiety, in control:

1. Practice the CBM-I method of stopping yourself from concluding that a mild symptom is the sign of a serious illness if, in fact, the symptom is not a known cause for alarm.
2. Monitor the CDC and WHO guidelines, particularly if you are an individual considered at high risk by virtue of your age or health status.
3. Keep your immune system functioning at its best by continuing to exercise wherever it’s possible for you to do so, whether in the gym or at home.
4. Use this experience as an opportunity to revamp your healthy habits in general. As the CDC notes, hand washing is an important safeguard to follow all the time, so incorporate this simple step into your daily life.

To sum up, there are reasons to take health precautions all the time, and current guidelines clearly have great value as a means to protect yourself. However, the anxiety that can accompany these precautions may only place you under greater stress. The Australian study suggests that the best way to manage that anxiety may come from learning how to read your body’s signals in a way that can protect both your physical and mental health.