email      DrSooHoo@sequoiacounselingoc.com                                                     
phone     949.337.1034                 
mailing address   340 E. 1st St. #291, Tustin, CA 92781         
Sequoia Counseling & Wellness Services OC offers virtual teletherapy services for California Residents  

What is Health Anxiety?

Health anxiety results from a desire to protect one’s health and persistent fear that one’s health is threatened. This anxiety becomes problematic when it occupies one’s mind and behaviors on a regular basis. Characteristic signs and diagnostic symptoms of someone suffering from health related anxiety include:
  • Difficulties functioning or enjoying life due to fears and preoccupations
  • Frequent thoughts and worries about bodily functions, physical oddities, and physical discomfort.
  • Worries about a specific organ they hear about on the news or at work.
  • Preoccupation of having or danger of getting, a serious illness
  • Frequent medical visits (primary care, urgent care, ER) and requests for repeated testing for reassurance

Example of Living with Health Anxiety 

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​Jim often worries, “What if I have a brain tumor?” He has been having painful headaches for the past few days. Every time the headache starts (it starts right behind the eyes) he worries about what is causing this pain. He often thinks his pain is coming from a brain tumor or an aneurysm.

He tries to tell himself that the headache is just from stress but this doesn’t help much. Jim finds himself rubbing his temples and forehead to see if he feels any lumps. When he notices that there might be a bit of swelling around his right temple, his anxiety becomes very intense. Jim wonders if he should talk to his doctor and have tests done.

He asks his wife about this and she tells him he is just fine. Her calm words do not help. He fears that she no longer takes his concerns seriously and that she automatically dismisses his health fears. Jim began finding it very difficult to read books or watch TV shows where a character had brain cancer. As time went on, he found it more and more difficult to hear stories related to all types of tumors and cancers. He would ask his wife to turn off the TV whenever health-related news stories came on or if cancer storylines unexpectedly arose on other programs.

His wife was initially understanding but began to find it annoying when Jim’s anxiety meant that she had to hide in the basement to watch her favorite show after a main character was diagnosed with breast cancer. (Furer, Walker, and Stein, 2007) 

What causes health anxiety?

The anxiety starts when the person experiences an internal trigger (sensation, emotion, memory, etc) or external trigger (such as hearing or seeing something illness related) and has an illness related thought that interprets the sensation as something dangerous. This thought then leads to feelings of anxiety and fear. As the emotions intensify, there may be bodily sensations (such as increased heart rate, feelings of weakness, etc) that are interpreted as a sign that something is seriously physically wrong. The person then has a strong urge to check, seek reassurance, or engage in avoidance behaviors, and will experience a temporary decrease in the anxiety and fear. However, similar to the anxiety/avoidance cycle, the person continues to experience worsening anxiety each time he/she is exposed to the same internal or external triggers.  ​
Experts say that health anxiety may develop in persons with a genetic predisposition, certain childhood experiences, or a history of stressful life event(s).  

Circumstances that worsen health anxiety symptoms include anxiety, depression, and preoccupation with body sensations. Behaviors that can reduce these symptoms include exercise, relaxation, reduced attention, and conservative medical management. Building on these two recommendations, I would also reccomend decreasing time spent on the internet researching symptoms (an avoidance/reassurance behavior) and establishing a routine schedule for doctors visits (such as only having scheduled monthly visits) to help manage reassurance seeking behaviors. 

As with any anxiety disorder, management of these symptoms will take time and require a commitment to engage in deliberate thoughts and behaviors intended to break this cycle of health anxiety.

What about worries related to the COVID-19 pandemic?  

If you have concerns that you are overly worried or anxious about the pandemic, ask:
  • Are your worries especially intense, long lasting, and frequent?
  • Do they influence your motivation, behaviors, and performance in different areas of your life?
  • Is life less enjoyable because of your worries?
  • Do friends/family express concern that you are worrying too much?
A certain amount of worry and emotional stress is normal during a pandemic. Other factors, such as physical and emotional health, presence of a support system, and daily activity level can also play a role in preventing or increasing health anxiety. If you are struggling in this area, talking with a therapist can provide help and prevent worsening of symptoms.

To date, there is limited research available on COVID-19 and health anxiety. Some of the data is based upon information on coping with previous pandemics, such as H1N1 in 2009. Jungmann and Witthoft (2020) suggest the following events and factors that can trigger, worsen, or perpetuate COVID19 specific health anxiety include:
  • excessive use of media as a safety-seeking behavior (such as researching if certain symptoms are a sign of virus infection)
  • repeated/excessive use of health-related internet searches to cope with emotional stress (especially anxiety)
  • tendency to dwell on COVID-19 fears or imagine “what if” or worst-case scenarios

Being well informed about the virus by reliable sources, acceptance (accept what has happened), and putting into perspective (e.g. there are worse things in life) can help with emotional coping and decreasing risks of developing COVID19 specific health anxieties (Jungmann & Witthoft, 2020).

RiseOC church invited me to prepare video(s) to share information with its community on how to cope and be healthy during the COVID-19 pandemic. To watch these videos on how to manage COVID-19 related stressors and optimize physical and emotional health, click here and select episode 1 or 2. 

Evidence Based Treatments for Health Anxiety

Recommended treatments include: CBT has shown success in:
  • reducing worries about health
  • decreasing time spent checking bodily symptoms and obtaining reassurance from others
  • reducing avoidance of health-related situations
CBT benefits were still maintained 6-12 months later by most study participants after completion of therapy. 

Sample CBT interventions include:
  • reviewing and identifying triggers and irrational thoughts
  • changing problematic behaviors
  • developing alternate coping skills to better tolerate discomfort and uncertainty
  • guidance on how to approach anxious situations differently 

CBT is best suited for individuals who want to participate in therapy, are interested to learn about psychological approaches to manage their worries, has the time and energy available, and has a positive therapy experience (if applicable). Those with severe distress or other psychological conditions that affect their ability to participate may benefit more from pharmacological treatments.
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Whether medication, therapy, or both are selected as a treatment choice, the client must participate fully in the treatment to be successful.
If you are ready and want help breaking free from this cycle of worrying, I can help! Call or send me a note. I look forward to hearing from you ! ​​
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           - Dr. Melissa Soo Hoo