If you live with chronic illness, it’s likely that you’ve experienced health anxiety. It’s a normal response to illness to fear disease progression or recurrence. Will our medications continue working? If not, will new treatments come along that will help us live well? What will it look like if our illness recurs or worsens? Will we suffer greatly? Will our lives be upended? Will we die?
Fear is a natural response to a real threat (Lebel et al., 2016). For a significant number of people, though, health anxiety becomes problematic. At what point does fear of illness progression become disabling? How do we manage our health anxiety so that we can enjoy a good quality of life?
Problematic health anxiety
Fear is a signal emotion, as it alerts us to the possibility of danger. When we use fear productively, we respond to it by using our cognition (including our memories, experiences, and knowledge) to ascertain whether we actually are in danger.
Living with chronic illness can cause our fear alarm to be very sensitive—and with good reason. When we’ve experienced suffering due to illness, our bodies remember this. Anything that reminds us of this suffering—an ache or pain, a medical test, even driving past the hospital—can cause our fear alarm to go off.
Evaluating the fear and, if warranted, turning off the alarm (more on this below) is a positive way to manage health anxiety. For many people, though, it is difficult or even impossible to turn off the fear alarm. For these people, health anxiety becomes its own torture.
While normal health anxiety may cause unpleasant moments, problematic health anxiety causes long-lasting, intense distress that is linked to depression, anxiety, and diminishment of quality of life (Loughan et al., 2021). Problematic health anxiety often includes death-related thoughts, intrusive thoughts and feelings, and isolation (Mutsaers et al., 2016). Many people experiencing problematic health anxiety ruminate over disease progression and recurrence so strongly that it is as if they are actually experiencing the events that they fear.
People experiencing problematic health anxiety sometimes use maladaptive coping skills in an attempt to manage it (Almeida et al., 2019). Some people avoid medical treatment in an attempt to “forget” about their illness. Others seek reassurance in the form of unnecessary medical appointments and scans to ease their minds that the illness is quiescent. Still others withdraw from family and friends, not revealing how much health anxiety is affecting their lives for fear of being judged and ridiculed.
Treating problematic health anxiety
Problematic health anxiety is a highly individual experience, meaning that psychotherapy to treat it must attend to each person’s unique needs (Almeida et al, 2019). Nevertheless, standard treatment protocols do exist, including cognitive behavioral skills, relaxation training, meditation skills, and psychodynamic/existential therapy (Hall et al., 2018).
Cognitive behavioral skills include learning how to identify thoughts, emotions, and behaviors feeding the anxiety. For example, recognizing which triggers increase anxiety and which stimuli soothe anxiety is very useful. Developing self-coaching strategies is an important part of this work. Using self-talk like “I can’t know the future” and “I am safe in this moment” is another valuable cognitive tool.
Relaxation training, self-compassion training, and meditation skills are strategies designed to calm an anxious nervous system. As anxiety is a mind/body experience, calming the body is a key piece in treatment. Practicing these techniques is fruitful.
Psychodynamic and existential work are additional components of treatment. In psychodynamic work, you explore how patterns of thinking and feeling were developed. In this context, you piece together what you learned about anxiety from your early relationships and how those early lessons have affected your relationships and experiences throughout life. In existential work, you think about suffering, death, and the meaning of life—issues that are activated by illness and health anxiety. Importantly, you’ll work to come to terms with what you cannot change, grieving losses and finding a way to live meaningfully.
Conclusion
Problematic health anxiety in chronic illness is underdiagnosed and undertreated (Loughan et al., 2021). If you see yourself in this post, please know that you are not alone and that help is available. Working with a therapist to understand and alleviate health anxiety can greatly improve your quality of life.
To find a therapist, please visit the Psychology Today Therapy Directory.