It is not uncommon for me to be asked to help someone who has excessive anxiety about their present or future physical health. Indeed, this can be a symptom of a number of different difficulties including health anxiety, obsessive compulsive disorder and panic disorder. This anxiety can be very distressing and often a person has had a number of tests/investigations and these have come back ‘normal’. However, what was ‘normal’ today, may not be normal in three months’ time, and this type of thought process only exacerbates and maintains the anxiety before more tests / reassurance is achieved and the cycle repeats.
Slightly less common and less researched though is when someone has excessive fear and anxiety about their future mental health. Commonly, it is put in the bracket of health anxiety but often studies on health anxiety will focus on those with physical health anxieties. However, it was interesting to read the other day an article written by Gelinas and Hadjistavropoulos that gave preliminary evidence that CBT techniques for physical health anxiety be efficiently adapted for mental health anxiety. This is perhaps not surprising though given the wealth of evidence out there that suggests CBT can be very helpful to help those with intrusive and unwanted thoughts.
An example of an excessive fear and anxiety about a future mental health problem may be someone who fears that they will ‘become a serial killer’, despite no desire to be one, and exhibiting no behaviours to indicate that they put others at risk. The individual may however be experiencing intrusive thoughts or images of hurting others in some way. Interpreting these thoughts and images as a ‘symptom’ of being a future risk then heightens the anxiety. Often these cognitions will then lead someone to perform what we call ‘safety behaviours’ – behaviours that make a person think they have ‘saved’ themselves from a disastrous event, but have actually just inadvertently perpetuated the fear. A good example here may be that the “serial killer” may avoid using knives when others are at home. There is no doubt that this action lowers the chance that they will attack their loved ones with a knife, but the simple process of avoiding the knives will just be exaggerating the risk that they would do in the person’s mind.
When a client comes to me with a fear like this, one of the first things I do after the initial assessment is show them a very helpful piece of research by Purdon and Clark in the 90s. In this study, they asked 293 people (none of who had been diagnosed with a mental health problem) to indicate whether or not they had experienced a particular thought. The results, to many clients, are often surprising. For example, did you know that 34% of men (17% of woman) have a thought of fatally pushing a stranger? Or that 48% of men (18% of woman) have thoughts of hurting a stranger? You may be thinking that men are more likely to have these aggressive thoughts, but the study also suggested that 55% of woman (52% of men) have thoughts of swerving into traffic, whilst 47% of woman (43% of men) have thoughts of causing a public scene.
However, as with many things in life, there is always a chance, however small, that a negative prediction will become reality. Given this, it is pretty much always impossible for a therapist to give a 100% guarantee that a negative prediction will not occur. Therefore, much of CBT treatment for health anxiety revolves around helping someone to build resources to tolerate uncertainty. Some of this involves helping a person reduce the behaviours that often relieve their anxiety in the short term but perpetuate it in the long term. Examples include: looking for reassurance from family/friends/doctors, checking the internet for what a symptom could mean (I’ve seen some very very inaccurate things written on some sites!), avoiding particular activities to reduce chance that a bad thing will occur (e.g., knives example above) and frequently monitoring and checking current symptoms. This is by no means an easy thing for many to do, so we work on building up your resilience to do this.
Treatment also involves exploring a person’s thoughts and testing out particular beliefs that could be maintaining the anxiety. Sometimes I also use an Acceptance and Commitment Therapy approach, exploring a person’s values and helping them to dedicate more resources towards living by these rather than focusing on unwanted thoughts or images. Throughout treatment though, I’ll aim to work with the client and together we’ll work out the best way forward for them.
Please do get in contact if you have any questions about the information I’ve written here, whether it’s just for more information, or if you feel you may be struggling with one of the difficulties discussed. I’d be happy to talk to you.