Health Anxiety and CBT
Psychologists are human. We make mistakes. I feel it best to get that out there before I explain what prompted me to write this blog post on health anxiety…..
This morning I attended a Driving Awareness course. Why? Well, in a bid to get home quicker and have dinner, I decided it would be fine to ignore a Road Closed sign and the various cones which a Fiat 500 could just-about fit between. Anyhow, just round the corner from said sign was a police car attending an incident. And a not-too-happy policeman. To make matters worse, I was the second person who had done it and the road was very narrow so turning round almost impossible. So I got a ticket, had to use a breathalyser for the first time in my life and learnt what it feels like to hear the words ‘anything you do say will be given in evidence’. Needless to say my dinner went cold and at 7.45am today, a Sunday morning, I found myself on a course with a few other people who had not ‘driven with due care and attention’.
Now firstly, hands up, I should have paid attention to the Road Closed sign, as it did say ‘Police’ at the top, and was not just one of the those signs where you pass it in the hope that your turn-off will be before the roadworks….. So, a ticket was fair. I accepted it, and despite labelling myself an idiot for about 15 minutes, after a while I realised I should practice what I preach and tried to be more compassionate with myself.
The course this morning helped with this. I have to say it was interesting and reminded me of three biases that exist in the typical human mind:
Optimism Bias – This is where we overestimate the chance of experiencing a positive event and underestimate the chance of experiencing a negative event.
What’s worked bias – This is where if we’ve got away with something before, we think we’ll get away with it again
Self enhancement bias – Where we tend to enhance positive things and downplay negative things.
So, in my scenario, my ‘what’s worked bias’ meant my brain went “we’ve gone past many road closed signs before and nothing bad has occurred”. And my optimism bias meant I didn’t think anything bad would happen. Couple those two with an empty stomach and the thoughts of the meal my partner was making meant I did not process as fully as would have been ideal to the word ‘Police’ on the sign…..
So…. health anxiety. The thing is, we are mortal beings. We can get ill. Cancer exists. Indeed, half of us will have some form it in our lifetime. But, due to these three biases the majority of people do not focus on this fact and we just walk round believing on some level that it ‘won’t be me’. This is where someone with health anxiety is different. They often have a greater conscious awareness of the risk of health problems. This conscious awareness, and the rumination on it brings about something called ‘depressive realism’. It is important to recognise that many people with health anxiety are often not overestimating the chance of a health issue. No, that is not the problem. The problem is the amount of focus and engagement they spend on this information.
This morning I was told that in the UK, 70 people a day are seriously injured on the roads and 5 are killed. That’s over 25,000 seriously injured a year. I can safety say I have driven with optimism bias for many years. And this is the thing, because I have not focused on the dangers of the road, I’m not the slightest bit anxious when I drive. Should I focus on this, I’d imagine I’ll start driving very carefully, maybe even have a snack before I get into the car. Maybe be tentative at a roundabout. Maybe take public transport more. The problem is, if I do start to do all this, I’ll likely start to be more anxious about driving. This is what occurs with health anxiety. A person, often triggered by a reminder that we are mortal (someone close to them dying, a near miss, a diagnosis, an injury) will start to do more health driven behaviours (check all symptoms online, seek reassurance, check heart rate on apple watch, frequently check body in shower). This exacerbates the anxiety. Then, something called interpretation bias occurs and the person starts interpreting ambiguous symptoms negatively (Du et al, 2023).
A big part of cognitive behavioural therapy (CBT) for health anxiety is firstly helping a person understand what is happening that is keeping the problem going. Together, we then work on changing the reinforcing behaviours and the relationship we have with certain thoughts. From this we may start work on engaging more with thoughts that are meaningful and fulfilling and less with those that, whilst sometimes true, may not help us focus on the experience of our present living moment.
I just want to end this blog by explaining that everyone is different and peoples experiences of health anxiety can vary a lot. Therefore, whilst this blog explains a common pathway that can occur, I have to stress that it is not the pathway all with health anxiety will relate to. The aim of treatment, as with all psychological difficulties, is to understand you as an individual first. From there, help work with you to see what is maintaining your individual difficulties and the strategies that may work best for you to move forward.
As always, any questions, please do not hesitate to contact me.