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Key points
- Becoming aware of one's anxiety patterns is a critical first step in making changes.
- People with anxiety engage in common thinking errors that make them more anxious.
- Thought records can help systematically identify erroneous thoughts and behaviors that maintain anxiety.
Health anxiety is awful. Anyone who has experienced it knows how exhausting it can be. The options of potential worst-case scenarios are endless. It is an ongoing experience of impending doom, waiting for that next symptom to pop up that threatens your life. AIDS, cancer, heart disease, meningitis, the latest mutation of COVID-19, the list of potential diseases that you fear will ultimately claim your life is endless.
Bring on the Cognitive Behavioral Therapy
Like other types of anxiety, this type of anxiety is treatable with cognitive behavioral therapy (CBT). One of the first things I do when working with a client with health anxiety is to help them develop health anxiety awareness. It is critical to have a thorough understanding of your own thinking patterns and behaviors prior to diving into treatment.
Once we have a solid understanding of your patterns, the real fun begins. We can then collaboratively use cognitive restructuring and behavioral techniques to help you reshape the way you see health and disease (e.g. Socratic questioning, behavioral experiments, exposure exercises).
Let’s Identify Those Thinking Errors
First, we identify the thinking errors that you commonly engage in. They are unhelpful and often inaccurate thoughts that creep into our minds and increase anxiety. Below are some examples of thinking errors related to health anxiety. Do any of these resonate with you?
All-or-Nothing Thinking: Seeing things in black-and-white categories, ignoring shades of gray. For example, assuming you are either very healthy or very ill.
Overfocusing on the Negatives: Hyper-focusing on a single negative detail and ignoring all the positives. For example, if your doctor said your headaches are probably due to dehydration, you start dwelling on the word “probably” and begin thinking about the lethal causes of headaches, while ignoring the doctor’s overall message that there is no cause for concern.
Disqualifying the Positives: Rejecting positive information. For example, if your doctor said, “The test found no indication of cardiovascular issues,” you might reject the result by insisting that the positive result “doesn’t count” because the test might not have been able to detect your heart issues. Similarly, you might discount benign explanations of bodily complaints (e.g., rejecting the idea that your stomachache is the result of something you ate).
Jumping to Conclusions: Assuming you know the results. For example, anticipating that the results of a brain scan will be bad news or jumping to the conclusion that back pain is the first sign of lung cancer. Another example is “fortune-telling” in which you assume that your expected negative outcome is already an established fact (e.g., “If I got a disease I would for sure die,” or “if I got sick, I would experience severe pain and suffering”).
Catastrophizing: Attributing horrible consequences to minor things. For example, “A new mole means certain death.” Or, “My loss of appetite indicates a serious health problem.”
Overgeneralization: Taking one example as “proof” for a general rule (e.g. “My doctor said she will order a scan to look at the lump in my breast. This must mean I have cancer.”)
Emotional Reasoning: Regarding your feelings as facts. For example, “I must be having a medical issue because otherwise, I wouldn’t feel so worried about this.”
Record Your Thoughts
Another important part of developing health anxiety awareness is to fill out a thought record about health anxiety thoughts and behaviors. This will allow us to get an idea of the typical thought and behavior patterns around your health anxiety. See an example below from one of my many personal experiences with health anxiety.
Date and Day: Saturday, 10/9/21
Health Anxiety Trigger: Noticed a blemish on my skin
Anxiety-Provoking Thought: It is some type of melanoma. I am going to die and my children will grow up without a mother.
Strength of Belief in the Thought (0-100): 75
Intensity of Anxiety (0-100): 85
Thinking Errors: Catastrophizing or Jumping to Conclusions
Safety Behaviors (i.e. behaviors that are calming in the short-term but increase anxiety in the long-term):
- Excessive checking: Repeatedly pinched, pulled, and picked at my skin
- Reassurance seeking: Spent a few hours in the ol’ Google downward spiral
Rational Response/Alternative Explanations: There are many other potential explanations for a skin blemish. I could have rubbed it against something unknowingly. Or it could simply be a sunspot. I will make an appointment with the doctor to have it looked at and will wait and see what the doctor says.
Bottom Line
Building awareness of your thoughts is a critical step in addressing health anxiety. In order to make changes, you need to first understand the thoughts and behaviors that are keeping your anxiety alive and well. Initially, it will take a concerted effort to recognize the thoughts that are making you anxious. However, like with anything, once you build this new skill, you will be able to identify and challenge inaccurate thoughts with little effort.
