The clinical term for health anxiety used to be hypochondriasis, but now it’s been split into two disorders, somatic symptom disorder and illness anxiety disorder.
With health anxiety you are oversensitive to body sensations and fear you have a serious illness. The fear of having that illness overwhelms you and leads to you engaging in behaviors that keep the anxiety going. Many people realize their fears are irrational to some degree, but it’s like you can’t break out of the cycle of fear about it.
The key to getting past the health anxiety is being able to focus on the problems as being anxiety out of control rather than on getting proof or reassurance that you don’t have an illness. That reassurance is always short-lived. It’s like taking short cuts to avoid work. You may feel better in the short-term when you hear you don’t have the illness, but your distress eventually comes back because the real problem is your anxiety, not whether or not you have an illness.
Some researchers out of Sweden did a clinical trial testing CBT delivered by the internet. The results were that the internet therapy was equally effective as therapy delivered by face to face with a therapist. With the internet therapy, the participants worked with a therapist through brief email communications. But the bulk of the work was done by doing exercises.
Two strategies that are included in the CBT program are
1. Practice mindfulness for 10 minutes a day.
2. Practice response prevention
Two sources of mindfulness meditations are the UCLA Mindfulness podcast and my website were you can download a Body Scan meditation here http://markspsychiatry.com/two-tips-for-health-anxiety
With response prevention, you want to restrict how much you engage in the behavior that reinforce your anxiety. So an example may be that you will only check your pulse three times a day instead of the usual 20. Or you when you start to feel worried, you will wait at least 1 hour before you talk to your partner about your concerns. By waiting, you may find that you don’t have as strong of a need to talk to them.
Practice this each day. You can set aside a certain time of day to review your list of behaviors and track your progress. If you’ve spent the day holding back on your behaviors, you may be tense. And this may be when you do a mindfulness exercise.
Other parts of the therapy involved gradually exposing yourself to anxiety provoking situations while you resist engaging in your usual behaviors. This is really where you make the progress in reducing your anxiety and breaking the connection between physical sensations and anxiety. The exercises expose you to actual situations as well as imagined situations to purposely trigger your anxiety while you suppress your response.
Through these gradual exposure’s you become desensitized to the trigger. We call it habituation. The exposure exercises are best done under the supervision of the therapist but even with this Internet model the therapist intervention is minimal compared to what would be required if you were seeing a therapist in person for a full psychotherapy session. So it’s good to know that the cognitive behavior therapy can be modified to be a hybrid of self-help with some therapist intervention.
Reference
Axelsson E, Andersson E, Ljótsson B, Björkander D, Hedman-Lagerlöf M, Hedman-Lagerlöf E. Effect of Internet vs Face-to-Face Cognitive Behavior Therapy for Health Anxiety: A Randomized Noninferiority Clinical Trial. JAMA Psychiatry. Published online May 13, 2020.
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