Health anxiety is awful. Anyone who has experienced it knows how exhausting it can be. The options of potential worst-case scenarios are endless. It is an ongoing experience of impending doom… waiting for that next symptom to pop up that threatens your life. AIDS, cancer, heart disease, meningitis, the list of potential diseases that you fear will ultimately claim your life is endless. And, of course, now you can add COVID-19 to that list.
Like other types of anxiety, this type of anxiety is totally treatable. One of the first things I do when working with a client with health anxiety is to help them develop health anxiety awareness. It is critical to have a thorough understanding of your own thinking patterns around health anxiety prior to diving into treatment, such as cognitive restructuring and behavioral interventions. First, we identify the common cognitive distortions in your thinking patterns. Cognitive distortions are thinking errors. They are unhelpful and often inaccurate thoughts that creep into our minds and increase anxiety. Below are some examples of cognitive distortions related to health anxiety. Do any of these resonate with you?
- All-or-Nothing Thinking: Seeing things in black-and-white categories, ignoring shades of gray. For example, “I am either very healthy or very ill.”
- Overfocusing on the Negatives: Hyper-focusing on a single negative detail and ignoring all the positives. For example, if your doctor said your headaches are probably due to dehydration, you start dwelling on the word “probably” and begin thinking about the lethal causes of headaches, while ignoring the doctor’s overall message that there is no cause for concern.
- Disqualifying the Positives: Rejecting positive information. For example, if your doctor said, “the test found no indication of cardiovascular issues” you might reject the result by insisting that the positive result “doesn’t count” because the test might not have been able to detect your heart issues. Similarly, you might discount benign explanations of bodily complaints (e.g., rejecting the idea that your stomach ache is the result of something you ate).
- Jumping to Conclusions: Assuming you know the results. For example, anticipating that the results of a brain scan will be bad news or jumping to the conclusion that back pain is the first sign of lung cancer. Another example is “fortunate telling” in which you assume that your expected negative outcome is already an established fact (e.g., “If I got a disease I would for sure die,” or “if I got sick, I would experience severe pain and suffering”).
- Catastrophizing: Attributing horrible consequences to minor things. For example, “A new mole means certain death.” Or “My loss of appetite indicates a serious health problem.”
- Overgeneralization: Taking one example as “proof” for a general rule (e.g., “My doctor said she will order a scan to look at the lump in my breast. This must mean I have cancer.”)
- Emotional Reasoning: Regarding your feelings as facts. For example, “I must be having a medical issue because otherwise I wouldn’t feel so worried about this.”
Another important part of developing health anxiety awareness is to fill out a thought record about health anxiety thoughts and behaviors. This will allow us to get an idea of the typical thought and behavior patterns around your health anxiety. See the example below.
Date and Day: Friday, 11/13/20
Health Anxiety Trigger: Itchiness and rash on breast
Anxiety-Provoking Thought (and strength of the belief 0-100): It is some type of breast cancer. I am going to die and my daughter is going to grow up without a mother/75
Intensity of Anxiety (0-100): 85
Cognitive Distortions: Catasrophizing/Jumping to Conclusions
Safety Behaviors (behaviors that are calming in the short-term but increase anxiety in the long-term): Repeatedly checking breasts/googling possible explanations
Rational Response/Alternative Explanations: There are many other potential explanations for a rash. It could be caused by something hormonal or bacterial, etc. I will make an appointment with the doctor to have it looked at and will wait and see what the doctor says.