Jan 2024 Health Anxiety – The Guildford Psychologist

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’.Psychologist

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.

June 2016 – Health anxiety – The Guildford Psychologist

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.