In a world that feels quite unsettled currently, it seems relevant to discuss health anxiety as an issue this week. Not surprisingly the recent virus has caught the eye of many clients and non-clients right now, but I’d like to generalise the issue, across the board for all those encountering panic and fear about their own health and the health of loved ones of more generic germs and illnesses.
How many of these are applicable to you most of the time:
- I constantly worry that I’ll get sick even when I’m healthy
- I constantly worry that those around me will get sick
- I check for abnormalities on my body frequently
- I find I seek reassurance about lots of things even when I am not ill
- I search obsessively online for symptoms and try to self-diagnose
- I avoid exercise and display symptoms of illness even when I am not ill
- I don’t trust test results from professionals and have a constant worry something has been missed
- I think I am more ill than I actually am when I am symptomatic
- I am overly cautious with hygiene in general
- I jump to the worst-case conclusion about any symptoms I may be displaying when I am ill
- Normal activities become viewed as risky behaviour due to fear of contracting an illness and I start to catastrophise despite having limited evidence:
- such as when eating chicken, I think I have contracted salmonella if I have a slightly bad stomach the next day.
- Protected sex leads to me thinking I have contracted an STI/ STD if I experience some discomfort the next day.
- I patted a dog that seemed poorly and uncoordinated-now I think I have rabies.
You make think that these examples are the extreme, and you would be right, but when you have such high and consistent concerns and fears about illness then these leaps in imagination seem very real and it can be difficult to talk yourself down from these fears. You end up on a fact-finding mission to prove you have an illness or to diagnose someone else because you want to have your fears confirmed. This sounds counter-intuitive but despite the subject matter, being proven right feels empowering and validating but it also reinforces the negative thought and behaviour patterns that you have developed. In the event of not contracting any illnesses you may develop ritual behaviours that help you ensure you stay germ-free, expect these behaviours can lead to obsessions which can severely restrict your life.
If reading the list has left you wondering about your own thoughts and behaviours then it may be that this is the first time that you have contemplated that you might have some problematic thoughts and behaviours, or you may already have some awareness that the way that you are leading your life right now is causing more problems by revolving your life around illness and predicting tragedy; this is actually doing you more harm than good.
- Are you avoiding activities that you used to enjoy for fear of catching something off someone else?
- Are you feeling isolated or lonely as a result?
- Is your social life routine frustrating and exhausting due to the lengths you feel you need to go to in order to just make it out the door, let alone engage with people?
- Is your relationship suffering because you fear being intimate may cause illness?
- Is your anxiety preventing a new relationship or friendship forming?
- Is going to work affected- meeting new people is difficult because you can’t predict their hygiene level or you have no previous knowledge of them?
- Are you wiping down all surfaces and hands after all contact to a point where this becoming obsessive?
In the current climate some of these measures are very necessary if you are symptomatic– please remember I am talking about physically healthy people in these examples; not people who are symptomatic of a specific illness.
Anxiety can be crippling for those experiencing it; as you can see it affects large aspects of life. It can be draining, tiring and can also lead to depression as well as very restricted lifestyles. It’s draining because the body and mind are stuck in fight or flight responses, you remain on hyper-alert, looking for threats; everything becomes perceived as threat. If you’ve witnessed a relative or friend in particular distress at the result of a passing disease or illness then that can become internalised as a traumatic experience, this then quite naturally can become something to fear. Problems arise when the evaluation of threats aren’t logical or rational and conclusions become majorly distorted based on little to no evidence or no trauma was experienced. An element of health anxiety can actually be about control, rather than disease or illness and this can be something to explore in therapy. One small event can lead to a build up of issues that become out of control; consider an avalanche- it takes a small movement to cause a landslide.
How can you manage health anxiety symptoms?
As in tackling anxiety in general, it is not surprising that similar methods are effective when dealing with health anxiety. At the root of anxiety are negative thoughts and potentially maladaptive behaviours, therefore most likely some form of Cognitive Behavioural Therapy (CBT) may well be prescribed to you if you seek out a professional or a referral from your GP. As a person-centred practitioner, I would generally go through the though record process (traditionally a CBT technique) together with my client if thoughts are the biggest problem to tackle for the client, sometimes using a Thought Record Sheet and other times verbally, depending on a client’s learning style. By understanding your triggers (what sets off your anxiety, which situations, what people etc) then we can look at the emotions that might bring up for you and how severe (or not) they may be alongside the negative thoughts that they conjure up for you.
The next step is to consider if there is any evidence for the thoughts that you think i.e. are these rational thoughts? We then look at what evidence is available to disprove your negative thoughts; i.e. looking at their actual validity.
This next step can prove the hardest for some clients- considering the balanced viewpoint of their thoughts, taking both sets of evidence (for and against) and finding the mid-point. It is at this stage that most clients either have a light bulb moment or start to resist the obvious, and revert back to finding more evidence for the negative thought despite knowing that they have actually gone some way to neutralising the initial concern. Not feeling anxiety can actually be anxiety-inducing if you’ve had symptoms for a long time. We would look to work on that in the session.
We then rate how their emotions about the new balanced thought feel for them now. This can again be eye opening or cause resistance. Depending on how long and how deeply-held these negative thoughts have been, can depend on how quickly (nor not) realisations can come to the fore.
Learning to challenge your thoughts and balance them out can be both tricky and liberating. It’s a first step towards understanding what really triggers you, how you feel, what you think and addressing how you behave in triggering situations. By no means is this a cure but it is a step closer to understanding your patterns a little more and also a step to freeing up some space in your mind for some neutral thoughts and maybe some positive thoughts too. Like anything worth doing it takes time and practice. In the current climate of the virus threat, check out the evidence for your thoughts, understand if the thoughts are genuinely carrying a threat to you personally and your loved ones, or if you have unwittingly engaged in trying to predict the future with no evidence on your side, if it is the latter then it is likely that you need to work on your anxiety, instead of anxiety working on you.
If you do think that you have symptoms of health anxiety and you wish to seek help, then a counsellor can help you with understanding your anxiety and with managing it.