CBT for health anxiety: Facing your fear with vulnerability


Health anxiety is the overwhelming worry of being seriously ill. One of the most effective ways to improve health anxiety is to practice exposure to help each other:

  1. Reduce Fear Physiological sensations or symptoms; And
  2. Minimize the use of “safety features” or things that a person does when they do it worry About their health.

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Exposure activities are one of my favorite activities to do with my clients because they are such a powerful learning tool. allows them to learn, In experience, their physiological symptoms are not dangerous and they do not need to engage in safety behaviors to protect themselves. I’ll explain this in a bit, but first let’s talk a little about the fear of bodily sensations and the use of safety features.

Being afraid of body sensations makes you worry more about your health

With health anxiety, we assume that bodily sensations or symptoms are immediately dangerous. However, body sensations and symptoms do not immediately indicate an illness or medical crisis. Our body is “noise”. We may experience many symptoms and emotions as a result of normal health self-regulation processes, stress (a fight or flight event) or serious medical conditions. If you think that every feeling or symptom is a sign of an illness or medical emergency, this should make you more alert and watch for symptoms. This process further increases health concerns.

How safety features and avoidance make you more concerned about your health

Fear of body sensations and symptoms can cause you to do things to reduce the stress when symptoms appear. These are called safety features. These behaviors reduce stress in the short term but definitely increase stress in the long run. why? We become dependent on them and believe that they save us from disease and death. We never give ourselves the opportunity to test our belief that these qualities are necessary for safety. Below are examples of safety features related to health concerns.

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  • Validation criteria:
    • Asking friends and family members what they think (eg, do you think this tremor is a nervous thing? Will I marry you?).
    • Frequent primary care offices, urgent cares, hospitals, or other medical facilities and consultations with doctors and other medical professionals.
    • Signs of excitement.
  • Over-examination features:
    • Repeated pushing, pulling, pulling, or pinching of a body part or new mark; Comparing two sides of a person’s body to identify any differences; or examining a person’s stool or urine.
    • Checking a person’s heart rate, blood pressure, breathing, weight or lung capacity.
    • Administering self-examinations, such as vision tests, neurological or cognitive tests, or physical fitness tests.
    • Providing self-recommended physical exams beyond clinical recommendations (eg, daily breast exams for lumps or daily body scans for moles).
  • Protective properties:
    • Reading on health websites for advice on how to prevent disease or improve health.
    • Carry personal medical equipment (eg, stethoscope, heart rate monitor, blood pressure monitor) to routinely check a person’s vitals.
    • Turning over personal information “just in case” someone has a medical emergency.
    • Carrying personal information or protecting “safe persons” in the event of a medical emergency.
    • When traveling, in the event of a medical emergency, check where the nearest urgent care or hospital is.

Avoidance, as one would expect, when one avoids anything that makes one worry about one’s health. For example, some people with health anxiety avoid getting a physical or routine checkup by a doctor for fear of being told there is something wrong with their health. Or if they have symptoms of concern, they may be afraid of being told something is wrong, so they may avoid getting checked out again by a doctor. In another example, a person may avoid something that reminds them of a disease, such as watching a movie about cancer.

Understanding the rationale behind exposure therapy and why it works

It is natural to shy away from things that seem threatening. In fact, it makes a lot of sense. If a man with a knife starts following you down the street, you should definitely run away. However, sometimes we inadvertently label something as dangerous when it isn’t.

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With health anxiety, the fear of bodily sensations and symptoms can lead to two things: (1) avoiding any activity that leads to fearful symptoms (eg exercise); and/or (2) engage in “safety behaviors” when symptoms or feelings arise. All of this exacerbates the fear of bodily sensations.

with exposure TreatmentWe intervene to help someone stop fearing things that are not dangerous. Exposure therapy involves the systematic confrontation of one’s fears, in which a person learns to face physical cues without relying on safety behaviors or avoiding feeling unsafe. Over time, this intervention will both (1) reduce fear symptoms; It also (2) reduces the tendency to rely on safety features.

Types of Exposure Activities:

  • Virtual exposureThinking about feared situations over and over until they lose their power and seem scary. This can be done by the therapist during sessions or by the client, using audio recordings or written narrations.
  • Interactive exposure: Deliberately engaging in physical activities that elicit fearful bodily sensations (eg, rolling in a chair, running, breathing through a straw).
  • In-vivo or situational exposuresEngaging in feared activities or facing feared situations without using safety features.

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Prepare and participate in health stress exposure activities

I’ll walk you through a simple overview of what I do with my clients to (1) prepare for exposure exercises and (2) complete exposure exercises.

  • I present. Education On the role of hypervigilance about body sensations in maintaining health anxiety.
  • I offer a lesson on the role of safety behaviors and avoidance of health anxiety.
  • I engage in cognitive restructuring to help my clients see their fears rationally. This is important to do before exposure because you will be using these cognitive skills when dealing with difficult exposure tasks.
  • I help my client identify and list their feared body sensations and symptoms. This is important because health anxiety involves being hypersensitive to physiological symptoms for fear that they may indicate a medical emergency or illness.
  • I help my clients identify their “go to” habits when they are concerned about their health. We collaboratively “brainstorm” all their features into detail. This is an important step in the process because we want the vulnerability hierarchy to match a person’s unique problem behavior and feared emotions. This makes exposure functions more effective.

Below are two “brain dump” lists I created with Kendra, a former client of mine.

Kendra’s List of Fearful Physiological Emotions

  • Heart beats.
  • High body temperature.
  • Sweat.
  • Dizziness.
  • Chest pain.
  • Numbness.

List of Kendra Common Safety Features:

  • She checks her pulse twice a day. She usually does this when she is exercising or when she feels “off” or something is wrong.
  • She avoids working out to keep her heart rate from increasing.
  • Especially if you think you have some kind of cardiovascular symptoms, you would go to the doctor or urgent care more often.
  • She spent a lot of time on the Internet looking for causes of symptoms or reading about diseases.
  • She regularly asks her husband if he thinks she is okay or if she is concerned about a symptom.
  • The times she allows her to exercise, she’s close to home in case of an emergency.
  • On long drives, she makes sure there are urgent cares and/or hospitals along the way.

After my client and I created our two lists (ie, feared bodily sensations and safety or avoidance behaviors), we drew from these lists to create different exposure items. Below are examples of various exposure tasks that Kendra completed.

Examples of Kendra’s interactive exposure activities include:

  • Run on the spot for five minutes.
  • Spin in her chair.
  • Run up and down the stairs 10 times.

Examples of Kendra’s Virtual Exposure Activities:

  • Severe heart attack.
  • Dizziness and passing out.

Examples of Kendra’s in-vivo or situational exposure functions are:

  • Go to the park (a one-mile walk) without taking her phone.
  • Drive herself for an hour without needing urgent care or hospital facilities.
  • Avoid going to the doctor for three days with a new symptom.
  • If you feel “off” or notice that your heart rate is elevated, avoid checking your heart rate.
  • Run a 45-minute run by myself, away from home and without a phone.

Hierarchy of vulnerability

We finally put these into what is called a “vulnerability hierarchy”. In this vulnerability hierarchy, we order different vulnerability tasks based on severity level (or stress component 0-100, 100 being the most stressful or difficult). We start with the least difficult task and work up to 100. The key is to face the feelings and symptoms you fear when you are afraid. is not Using security features. You want to learn through these experiences that your feared symptoms and situations are not dangerous. You are safe and do not need to rely on your safety features.

The results

Exposure therapy can be scary and challenging at times, but it can produce amazing results. After several months of working together, Kendra’s health concerns have greatly improved. She began to see health and illness more logically and stopped using her safety features because she no longer believed they were necessary. We were able to move on from treatment.

Want to try? If you decide to try this and work with an exposure therapist, know that your therapist will be with you to guide you through this entire process. You also develop new cognitive skills to help you when these tasks are particularly challenging. It’s worth the hard work.

To find a therapist, please visit Psychology Today Medical Directory.


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