Let's Talk About Health Anxiety
How Self Help and Professional Therapy Can Provide Relief
Dawn: While I waited for Dean to wrap up the spring semester and all the duties that go along with it—giving and grading finals, grading papers, entering grades, etc.—so we could get back to writing this newsletter, I spent some time thinking about what our next topic would be. And then things happened irl that signaled to me that we should cover health anxiety. First, a neighbor who recently had a heart-related procedure told me that afterward she began experiencing anxiety. Then I watched a family member exhibit signs of anxiety during a bout with food poisoning. Haven’t we all been anxious about a health issue at one time or another? Whether you have felt unwell for an extended period or have the onset of a new symptom, the feeling of impending doom is real, even when there may not truly be cause for alarm. Let’s talk about health anxiety. Dean, when someone is experiencing anxiety related to a health issue, what should they do?
Dean: It is worth highlighting, first, that most people feel anxiety following a significant medical event, whether it is something serious like heart problems or severe food poisoning. Anxiety is an emotional reaction that has developed to protect us. It’s an alarm system, and when it goes off, we then use problem-solving skills to find what might be potentially harmful. This includes internal monitoring of possible health problems. What makes this complicated is that the alarm often continues going off after the medical risk has been cleared up.
This explanation is not enough to help people feel less anxious after a health scare. Often, people experiencing anxiety like this have a lot of physical arousal - higher than usual heart rate, shallower breathing, perhaps increased urge to urinate - and these are all associated with anxiety.
Dawn: Ah, ok, that’s helpful. What should their next step be?
Dean: Anytime this comes up, I always recommend to clients that they first see their general medical practitioner. Health anxiety may accompany real health issues that demand medical attention.
Dawn: Let’s say my neighbor with the heart-related issue has healed well, and the doctor doesn’t foresee any new issues coming up in the near future. Yet, they are still feeling anxiety. Should they seek professional help?
Dean: I would say yes, but with a caveat. It is possible that the anxiety they are experiencing is only due to the recent medical event. If that is the case, they may be able to rely on some evidence-based self-help resources they can find on the websites for the Anxiety and Depression Association of America (ADAA) or the Association for Behavioral and Cognitive Therapies (ABCT). While I know these authors professionally and can vouch for the high quality of their work, we do not receive any compensation for linking to these self-help books. Relying on these guides could be more time-efficient and cost-effective than engaging in the services of a therapist. If they try these approaches and do not improve or only improve a little, they may need to work directly with a professional.
Dawn: What can someone expect when they go to a therapist for help with health anxiety?
Dean: All treatment should start with testing, including assessing anxiety severity and other mood experiences. These measures provide the therapist with an understanding of the intensity of the client’s emotional experiences. The therapist may administer them again during treatment to track progress. Treatment based on established scientific methods would most likely be cognitive-behavioral therapy (CBT). This approach to treatment, when applied to anxiety, would typically include breathing exercises to reduce physiological aspects of anxiety. That is the ‘B’ in CBT. It would also include collaborative discussions with the therapist about what patterns of thinking may increase anxiety, such as catastrophic thinking or difficulty tolerating uncertainty. That is the ‘C’ in CBT. Treatment would also include exercises to perform between sessions in order to develop skills to manage anxiety when it occurs in the future.
Dawn: I know people, and I’ll include myself in this, get very nervous when waiting for medical test results. And heavens forbid, those tests show a possible abnormality that requires further testing. The wait to receive those results can be excruciating. Does that also fall under the health anxiety umbrella, and how should one deal with it?
Dean: It is not at all unusual to experience anxiety while waiting to receive test results, and it would definitely fall under the health anxiety umbrella. The central issue here is worry. Normal worry is a thought process that provokes anxiety and also stimulates problem solving. In the case of normal worry in anticipation of receiving medical test results, you could rely on thinking through the range of possible outcomes, including ones that would be uncomfortable but not dangerous. It also may include reminding yourself about coping skills you’ve used when faced with adversity in the past. When worry becomes unmanageable, the ability to use it as a problem-solving strategy starts to break down. If this is the case, then professional help may be necessary. I’ll mention here that unmanageable worry is a key symptom of Generalized Anxiety Disorder (GAD), a psychiatric condition that typically requires professional mental healthcare. We’ll discuss GAD in the future since it deserves more extensive coverage.
Dawn: Thank you, Dean. I think this will be very helpful to our readers. I know it was helpful to me. Until next time …