It is quite common for me to be asked to help someone who has excessive anxiety about their present or future physical health. This anxiety can be very distressing can cause someone to regularly have multiple tests to ensure there are no major problems. Each time a test comes back negative a person will feel relieved. However, a few months later the question may return and the doubt sets in. After all, what if something has happened in the preceding months? The cycle then repeats.
Physical and Mental Health Anxiety
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. It was therefore interesting to read the other day an article written by Gelinas and Hadjistavropoulos. In the article they gave preliminary evidence that cognitive behavioural techniques for physical health anxiety be efficiently adapted for mental health anxiety.
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’. This is despite having no desire to be one, and exhibiting no behaviours to indicate that they put others at risk. They may though 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’. These behaviours make a person think they have ‘saved’ themselves from doing something bad, but have actually just perpetuated the fear. A good example here may be that the “serial killer” may avoid using knives when others are at home. This action lowers the chance that they will attack their loved ones with a knife. However, seeing oneself avoiding knives will then promote doubt in the person’s mind. Why avoid the knives if you are no danger to others?
If someone has a fear like this, I often show them a piece of research by Purdon and Clark. 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? It’s not just predominantly men either. The study showed that 55% of woman (52% of men) have thoughts of swerving into traffic. Finally, 47% of woman (43% of men) have thoughts of causing a public scene.
Tolerating Uncertainty
However, as with many things in life, there is always a chance, however small, that a negative prediction will become reality. Therefore, generally it is impossible for a therapist to give a 100% guarantee that a negative prediction will not occur. Therefore, much of CBT treatment for health anxiety involves building 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. For many, this is not easy. So we work on building up 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.
