Health Anxiety is characterised by the belief that one has, or fears developing,
a serious disease based on the misinterpretations of one’s bodily symptoms.
From a Cognitive Behavioural perspective Health Anxiety is similar in concept to
that of Panic Disorder, the major difference being the immediacy of the threat to
one’s health e.g. if one judges that the heart attack is happening now then one is
more likely to panic than to worry about it happening at some point in the future.
The beliefs regarding the state of health are not borne out by a corresponding medical
diagnosis which supports these fears, and that these beliefs are not “delusional”
in nature as one can accept that the extent of the (feared) illness may be being
exaggerated. Typically the health anxious person will generally focus on symptoms
which one believes confirm beliefs about the state of one’s health, e.g. a cough,
a blemish or lump may be a sign of cancer or headaches may be a sign of impending
Reassurance seeking is extensive and may amount in certain extremes to “Doctor Shopping”,
other behaviours include self-examination, selective attention and the repeated checking
of the body for signs of malaise. These behaviours often result in tenderness or
over-awareness of benign symptoms which may be considered as further evidence of
a serious physical illness. Additional avoidances and safety behaviours further complicate
noticeable symptoms and contribute to maintaining the symptoms of anxiety.
Cognitive & Behavioural Psychotherapists collaborate with the patient to identify & assess
all maintaining factors; including thoughts, behaviours, emotions and physical symptoms
associated with the problem and develop a working formulation which will be utilised
to guide the course of therapy.
A number of techniques will be employed to test predictions and beliefs which may
include behavioural strategies such as exposure and cognitive interventions aimed
at identifying and challenging unhelpful thoughts and beliefs, possible thinking
errors and misinterpretations. These may then be challenged through a combination
of verbal reattribution, Socratic questioning and behavioural experiments.
Final stages of the therapeutic interventions are aimed at relapse prevention strategies.
A cognitive model of Health Anxiety, Salkovskis 1989