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Overcoming Health Anxiety: A Complete CBT Guide - Talking Therapies UK
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Overcoming Health Anxiety

A Comprehensive CBT Guide to Understanding and Managing Your Fears

Introduction: You Are Not Alone

If you're reading this guide, you've likely experienced the distressing and exhausting cycle of health anxiety. Perhaps you find yourself constantly checking your body for signs of illness, spending hours researching symptoms online, or repeatedly seeking reassurance from doctors despite being told you're physically well. You might feel trapped in a pattern of worry that dominates your thoughts and significantly impacts your quality of life.

Health anxiety, also known as illness anxiety disorder or hypochondriasis, is far more common than many people realise. It affects approximately 4-6% of the population at any given time, though many more people experience periods of heightened health concern throughout their lives. The experience is genuinely distressing—the fear feels real, the anxiety is overwhelming, and the impact on daily functioning can be profound.

What You'll Learn in This Guide

This comprehensive guide will help you understand health anxiety from a cognitive behavioural therapy (CBT) perspective and provide you with practical, evidence-based strategies to overcome it. You'll learn how your thoughts, feelings, physical sensations, and behaviours all interact to maintain anxiety, and more importantly, how you can interrupt this cycle to reclaim your life from constant health worry.

The good news is that health anxiety is highly treatable. Research consistently demonstrates that Cognitive Behavioural Therapy is one of the most effective approaches for overcoming health anxiety, with many people experiencing significant improvement in their symptoms. Throughout this guide, you'll discover practical techniques, complete worksheets, and develop a personalised plan for recovery. This isn't about pretending your concerns don't matter or forcing yourself to "just relax"—it's about learning to respond to health-related thoughts and sensations in a new, more helpful way.

This guide is designed to be comprehensive and detailed, providing you with both understanding and practical tools. You can work through it at your own pace, returning to sections as needed. Many people find it helpful to work through this material with the support of a qualified therapist, and Talking Therapies UK is here to provide that professional guidance whenever you need it.

Understanding Health Anxiety: What It Is and How It Works

What Is Health Anxiety?

Health anxiety is characterised by persistent worry about having or developing a serious illness, despite medical reassurance that you are physically well. Unlike ordinary health concern—which most people experience occasionally and which serves the helpful purpose of motivating us to seek medical care when genuinely needed—health anxiety involves excessive preoccupation with health that causes significant distress and interferes with daily life.

People experiencing health anxiety often find themselves caught in a cycle where normal bodily sensations are interpreted as signs of serious disease. A slight headache becomes a brain tumour, a skin blemish becomes melanoma, or heart palpitations become evidence of an impending heart attack. These fears feel entirely rational in the moment, even though medical professionals have provided reassurance. The anxiety persists because the problem isn't actually about your physical health—it's about how you're interpreting and responding to normal bodily experiences.

Common Features of Health Anxiety
  • Excessive preoccupation with having or developing a serious illness
  • High levels of anxiety about health despite medical reassurance
  • Frequent body checking or examination of specific body parts
  • Repeatedly seeking reassurance from doctors, family, or online sources
  • Avoiding health-related information or medical appointments (in some cases)
  • Misinterpreting normal bodily sensations as signs of serious disease
  • Spending excessive time researching symptoms and diseases
  • Difficulty accepting medical reassurance or test results

The Cognitive Behavioural Model of Health Anxiety

CBT is based on the understanding that our thoughts, feelings, physical sensations, and behaviours are all interconnected. In health anxiety, these elements create a self-maintaining cycle that keeps the anxiety going. Understanding this cycle is the first crucial step towards breaking free from it.

The cycle typically begins with a trigger—this might be a physical sensation (like a headache or stomach pain), something you notice about your body (like a mole or lump), or external information (such as hearing about someone's illness). This trigger activates underlying beliefs about illness and health, leading to anxious thoughts and interpretations.

The Health Anxiety Cycle

1. TRIGGER
Physical sensation, noticing something, or health-related information
2. ANXIOUS THOUGHTS
"This could be something serious" / "What if I have cancer?"
3. ANXIETY & PHYSICAL SYMPTOMS
Increased heart rate, muscle tension, sweating, nausea
4. SAFETY BEHAVIOURS
Body checking, researching online, seeking reassurance
5. TEMPORARY RELIEF
Brief reduction in anxiety
6. MAINTAINING THE PROBLEM
Anxiety returns, often stronger; the cycle repeats

Let's explore each element of this cycle in more detail, as understanding exactly how your health anxiety works is essential for developing effective strategies to overcome it.

The Role of Thoughts in Health Anxiety

In health anxiety, certain thinking patterns become automatic and overwhelming. You might notice that your mind immediately jumps to the worst-case scenario when you experience any bodily sensation. This tendency is called "catastrophising"—interpreting situations as much more dangerous or serious than they actually are. Your mind might also engage in "selective attention," where you become hyper-focused on potential signs of illness while filtering out evidence that you're actually healthy.

These thought patterns aren't happening because you're irrational or weak—they're the result of your mind trying to protect you from perceived danger. The problem is that this protective mechanism has become overly sensitive, rather like a smoke alarm that goes off when you're merely cooking toast. The alarm itself isn't broken; it's just responding inappropriately to the situation.

Common Thought Patterns in Health Anxiety

Catastrophising: "This headache must mean I have a brain tumour" rather than "I probably didn't drink enough water today."

All-or-Nothing Thinking: "Either I'm completely healthy or I'm seriously ill" rather than recognising the spectrum of minor ailments and health fluctuations.

Probability Overestimation: "I'm certain I have this disease" when the actual probability is extremely low.

Intolerance of Uncertainty: "I need to know for absolutely certain that I'm not ill" when uncertainty is an inevitable part of life.

Emotional Reasoning: "I feel anxious, therefore there must be something wrong" rather than recognising that anxiety itself creates uncomfortable physical sensations.

The Role of Physical Sensations

A crucial aspect of health anxiety that many people don't realise is that anxiety itself creates physical symptoms. When you become anxious about your health, your body's stress response activates—this is the "fight or flight" response that evolved to help our ancestors escape from physical danger. This response involves numerous physical changes: your heart rate increases, your breathing becomes faster and shallower, your muscles tense, blood flow is redirected away from your digestive system, and you become hyper-alert to potential threats.

Here's the problem: these anxiety-induced physical sensations can then be misinterpreted as further evidence of illness, creating a vicious cycle. You notice your heart racing and think "Something's wrong with my heart," not realising that the racing heart is simply anxiety. This interpretation increases your anxiety, which makes your heart race even more, which seems to confirm your fears. You're caught in a feedback loop where anxiety creates symptoms, which create more anxiety, which creates more symptoms.

Understanding Anxiety's Physical Symptoms

Many symptoms of anxiety are remarkably similar to symptoms of serious illness, which is why health anxiety can feel so convincing. Recognising which sensations are actually caused by anxiety—rather than physical disease—is an important step in recovery.

Body System Anxiety Symptoms Why They Occur
Cardiovascular Racing heart, palpitations, chest tightness, chest pain Increased heart rate prepares body for action; muscles tense in chest area
Respiratory Shortness of breath, feeling unable to breathe deeply, hyperventilation Breathing becomes faster and shallower; over-breathing can cause dizziness and tingling
Digestive Nausea, stomach pain, diarrhoea, loss of appetite, dry mouth Digestion slows as blood redirected to muscles; increased stomach acid
Neurological Dizziness, lightheadedness, headaches, difficulty concentrating, feeling unreal Changes in breathing and blood flow; muscle tension; heightened alertness
Muscular Tension, aches, trembling, weakness, fatigue Muscles tense in preparation for action; sustained tension causes aches and fatigue

The Role of Safety Behaviours

Safety behaviours are actions you take in an attempt to prevent the feared outcome or to reduce anxiety in the short term. In health anxiety, common safety behaviours include repeatedly checking your body for signs of illness, frequently visiting doctors, extensively researching symptoms online, seeking reassurance from others, or conversely, avoiding anything health-related (such as doctor's appointments or health news).

These behaviours feel necessary and helpful in the moment—they provide temporary relief from overwhelming anxiety. However, they actually maintain the problem in several important ways. Firstly, they prevent you from learning that the feared outcome wouldn't occur anyway. If you constantly check your body and nothing bad happens, your mind concludes "I stayed safe because I checked," rather than "I was safe anyway." Secondly, safety behaviours keep your attention focused on health concerns, making you more likely to notice normal sensations and interpret them as threatening. Thirdly, some safety behaviours (like excessive body checking) can actually create or worsen the very symptoms you fear.

Real-Life Example: Sarah's Story

The Trigger: Sarah, a 34-year-old teacher, noticed a small lump under her arm while showering.

The Thoughts: Her mind immediately thought, "This could be cancer. What if I have lymphoma? I need to check if it's getting bigger."

The Feelings: Intense anxiety, panic, dread. Her heart started racing and she felt shaky.

The Physical Symptoms: The anxiety made her heart race, she felt sick, had difficulty concentrating, and experienced muscle tension in her shoulders and neck.

The Safety Behaviours: She checked the lump multiple times daily, compared it with the other side, researched "lumps under arm" for three hours that evening, and rang her GP first thing in the morning for an urgent appointment.

The Short-Term Relief: After the GP examined her and said it was just a normal lymph node that everyone has, she felt temporarily relieved.

The Maintenance: However, the next day she noticed the lump was still there. "Maybe the GP missed something," she thought. She started checking again, found herself comparing both sides constantly, and began researching "lymph nodes that don't go away." The cycle continued, with her anxiety actually increasing over time despite medical reassurance.

Identifying Your Own Health Anxiety Pattern

Now that you understand how health anxiety works in general, it's time to map out your own personal pattern. Everyone's health anxiety is slightly different—you might fear specific diseases, focus on particular body parts, or engage in unique safety behaviours. Identifying your specific pattern is crucial because it allows you to develop targeted strategies that address your particular difficulties.

The following worksheets will help you develop a detailed understanding of your health anxiety. Take your time with these exercises, and try to complete them when you're feeling relatively calm rather than in the midst of an anxiety episode. You might want to work on them over several days, returning to add more detail as you become more aware of your patterns.

Worksheet 1: Mapping Your Health Anxiety Cycle

Think about a recent episode of health anxiety and use it to complete this worksheet. Try to be as specific and detailed as possible.

Worksheet 2: Identifying Your Safety Behaviours

Safety behaviours keep health anxiety going. Identifying yours is an important step towards change. Tick all that apply and add any others specific to you.

Understanding the Cost of Health Anxiety

Health anxiety doesn't just cause distress—it has wide-ranging effects on your life. Before we move on to learning new strategies, it's important to recognise what health anxiety is costing you. This isn't about making you feel bad; rather, it's about clarifying your motivation for change. When the work of overcoming health anxiety feels difficult (and it will at times), remembering what you're working towards can help you persevere.

Worksheet 3: The Cost of Health Anxiety

Consider how health anxiety has affected different areas of your life.

Challenging and Changing Anxious Thoughts

One of the most powerful components of CBT for health anxiety involves learning to identify and challenge the anxious thoughts that fuel your worry. This isn't about "positive thinking" or pretending everything is fine—it's about developing a more balanced, realistic way of interpreting bodily sensations and health information.

When you're experiencing health anxiety, your thoughts feel like facts. "I have cancer" or "Something is seriously wrong with me" feel like truths rather than interpretations. However, these are actually predictions or beliefs rather than established facts. Learning to recognise them as thoughts—and to evaluate them objectively—is a skill that can dramatically reduce anxiety.

The Process of Cognitive Restructuring

Cognitive restructuring is the CBT technique for identifying and challenging unhelpful thoughts. It involves several steps: first, catching the anxious thought; second, examining the evidence for and against it; third, considering alternative explanations; and finally, developing a more balanced perspective. Let's explore each step in detail.

Step 1: Catching Your Anxious Thoughts

The first challenge is simply noticing your thoughts. When anxiety strikes, thoughts can be so automatic that you barely register them consciously. You might just feel overwhelming anxiety without being fully aware of the specific thoughts driving it. Learning to pause and ask yourself "What was just going through my mind?" is the essential first step.

Helpful questions to identify thoughts:

  • What was going through my mind just before I started feeling anxious?
  • What does this sensation/symptom mean to me?
  • What am I predicting will happen?
  • What's the worst thing that could happen?
  • What am I imagining?
Step 2: Examining the Evidence

Once you've identified an anxious thought, the next step is to evaluate it objectively. This means looking at both the evidence that supports the thought and—crucially—the evidence against it. People with health anxiety tend to focus exclusively on information that confirms their fears whilst dismissing or overlooking contradictory evidence.

Questions for examining evidence:

  • What actual evidence do I have that supports this thought?
  • What evidence contradicts this thought?
  • Am I confusing a feeling with a fact?
  • What would a doctor say about this evidence?
  • Am I paying more attention to evidence that confirms my fear?
  • What have I been told by medical professionals?
  • Have I had similar worries before that turned out to be unfounded?
Step 3: Generating Alternative Explanations

Health anxiety involves jumping to catastrophic conclusions about bodily sensations. An important skill is learning to generate alternative, more likely explanations for what you're experiencing. This doesn't mean pretending there's definitely nothing wrong—it means acknowledging that there are usually multiple possible explanations, and the catastrophic one is typically the least probable.

Questions for alternative explanations:

  • What else could explain this sensation or symptom?
  • What would I tell a friend who had this worry?
  • Could this be caused by anxiety itself?
  • Could this be a normal bodily variation?
  • What's the most likely explanation, based on probability?
  • Could this be related to stress, sleep, diet, or exercise?
Worked Example: Challenging Health Anxious Thoughts

Situation: James, 42, notices his heart racing whilst sitting at his desk.

Anxious Thought: "My heart is racing. This must mean I'm having a heart attack. I'm going to die."

Evidence Supporting the Thought:

  • My heart is definitely racing—I can feel it
  • Heart attacks are serious and can happen to people my age
  • My uncle had a heart attack at 45
  • Racing heart is a symptom of heart problems

Evidence Against the Thought:

  • I had a full cardiac workup six months ago and everything was completely normal
  • My blood pressure and cholesterol are both in the healthy range
  • I don't have any other symptoms of a heart attack (no chest pain, arm pain, shortness of breath)
  • My heart has raced like this before many times and nothing bad happened
  • This happened when I was anxious, and I know anxiety causes rapid heartbeat
  • The racing started after I received a stressful email from my boss
  • I've been worried about my health all week, which creates anxiety and physical symptoms

Alternative Explanations:

  • This is an anxiety response to the stressful email
  • I've had three coffees this morning—caffeine can cause heart racing
  • I've been sitting still for two hours; sudden movement can increase heart rate
  • I didn't sleep well last night, which can affect heart rate
  • This is a normal stress response, not a medical emergency

Balanced Thought: "My heart is racing, which feels uncomfortable, but this is most likely an anxiety response to stress rather than a heart attack. I've had this sensation many times before and been medically checked. The most probable explanation is that I'm anxious about the email from my boss, and my body is having a normal stress response. I can let this feeling pass without assuming it's dangerous."

Worksheet 4: Thought Challenging Record

Use this worksheet each time you notice health anxiety rising. The more you practise this, the more automatic balanced thinking will become.

Common Thinking Errors in Health Anxiety

Understanding the specific thinking patterns that maintain health anxiety can help you spot them more easily in your own experience. These thinking errors aren't character flaws—they're simply habitual ways your mind has learned to interpret health-related information. Recognising them is the first step to changing them.

Thinking Error What It Is Example in Health Anxiety Challenge
Catastrophising Assuming the worst possible outcome will occur "This headache must be a brain tumour" What's the most likely explanation? What's the probability of the worst case?
Black and White Thinking Seeing things in extremes with no middle ground "Either I'm completely healthy or I'm dying" What's in between these extremes? Can both perspectives contain some truth?
Probability Overestimation Overestimating the likelihood of negative outcomes "I'm certain I have motor neurone disease" What are the actual statistics? What would a doctor say about the probability?
Selective Attention Focusing only on information that confirms fears Noticing every article about young people getting cancer whilst ignoring statistics showing it's rare What evidence am I ignoring? What contradicts my fear?
Emotional Reasoning Believing something must be true because you feel it's true "I feel terrified, so there must be something seriously wrong" Is this feeling a fact? Could I feel anxious even if everything is okay?
Mind Reading Assuming you know what others are thinking "The doctor didn't seem concerned, but they're probably just not telling me the truth" What evidence do I have for this? What else might explain their reaction?
Fortune Telling Predicting negative outcomes with certainty "I know this will turn out to be something serious" Can I really predict the future? What's actually likely to happen?
Discounting the Positive Dismissing reassuring information or evidence "The tests were normal, but that doesn't mean they didn't miss something" Why am I dismissing this evidence? Would I do the same if it confirmed my fears?

Reducing Safety Behaviours: Breaking Free from the Cycle

Whilst challenging anxious thoughts is important, research shows that the most powerful intervention for health anxiety is gradually reducing safety behaviours. This process, often called "behavioural experiments" or "exposure," involves purposefully doing less of the things you've been doing to manage anxiety, allowing yourself to learn that you can cope without them and that the feared outcomes don't actually occur.

We understand that this sounds frightening. The behaviours you're using—checking your body, seeking reassurance, researching symptoms—feel essential to your safety. The thought of stopping them can provoke intense anxiety. However, these behaviours are actually maintaining your health anxiety rather than protecting you. They prevent you from discovering that you would be okay without them.

Understanding Why Safety Behaviours Maintain Anxiety

Consider someone who checks their body for lumps every morning. Each time they check and don't find anything alarming, they feel temporarily relieved. However, their mind learns "I stayed safe because I checked," rather than "I was safe anyway." This means they feel compelled to keep checking—they can't test whether they'd be fine without checking because they never give themselves the chance to find out.

Additionally, safety behaviours often create or worsen the very symptoms feared. Repeatedly pressing on an area of your body can make it sore or tender. Constantly checking your pulse can make you hyper-aware of your heartbeat and notice normal variations that you'd otherwise ignore. Researching symptoms online exposes you to frightening information and worst-case scenarios that increase anxiety rather than provide reassurance.

The Reassurance Trap

Seeking reassurance is one of the most common safety behaviours in health anxiety, yet it's also one of the most problematic. When you ask someone "Do you think this lump is serious?" or visit a doctor asking "Could this be cancer?", you might feel better temporarily. However, reassurance has several problems:

  • It's never enough: You might feel better for hours or days, but doubt creeps back in. "Maybe they missed something." "But what if..."
  • You need it more often: Each time you seek reassurance, you strengthen the belief that you need external validation to feel safe.
  • It maintains hypervigilance: Constantly checking in with others keeps your attention focused on potential illness.
  • It affects relationships: Loved ones may become frustrated, which then creates more anxiety.
  • It prevents trust in yourself: You never learn that you can tolerate uncertainty or trust your own judgment.

Creating Your Personal Hierarchy

Reducing safety behaviours doesn't mean stopping everything at once—that would be overwhelming and potentially lead to giving up. Instead, we'll work gradually, starting with behaviours that provoke moderate anxiety and building up to more challenging ones. This approach, called "graded exposure," allows you to build confidence progressively.

Worksheet 5: Safety Behaviour Hierarchy

List all your safety behaviours and rate how anxious you'd feel if you stopped each one (0-100, where 100 is the most anxious you could possibly feel). Then organise them from lowest to highest anxiety.

Conducting Behavioural Experiments

Behavioural experiments are structured ways of testing your beliefs about what will happen if you reduce safety behaviours. Rather than simply trying to stop a behaviour and hoping for the best, you'll approach it as a scientist conducting an experiment—you'll make a prediction, test it out, and see what actually happens.

Example Behavioural Experiment: Reducing Body Checking

Current Safety Behaviour: Maria checks a mole on her arm approximately 15 times daily, comparing it with photos on her phone to see if it's changed.

Belief Being Tested: "If I don't check the mole constantly, I'll miss dangerous changes and die from melanoma."

Prediction: "If I reduce checking to twice daily (morning and evening), I'll feel unbearable anxiety all day, won't be able to concentrate on anything else, and I'll miss important changes to the mole."

Alternative Prediction: "Checking less frequently might be difficult initially, but the anxiety will probably reduce over time. I'll gradually learn that I can cope without constant checking, and the mole won't change significantly between morning and evening checks."

The Experiment: Maria agreed to reduce checking to twice daily for one week, recording her anxiety levels and what she noticed.

Results:

  • Day 1-2: High anxiety (70-80/100), strong urges to check, frequently thought about the mole
  • Day 3-4: Anxiety reducing (50-60/100), urges still present but more manageable
  • Day 5-7: Anxiety much lower (30-40/100), less preoccupied with thoughts about the mole, starting to trust that twice-daily checking was sufficient
  • The mole appeared exactly the same at each check; no dangerous changes occurred
  • Gained more time and mental space to focus on work and relationships

Conclusion: "I could cope with reduced checking better than I predicted. The anxiety was high initially but decreased significantly. My worst fear (missing dangerous changes) didn't occur. Checking less frequently is difficult but manageable, and it's improving my quality of life."

Next Step: Maria then planned to further reduce checking to once daily for another week.

Worksheet 6: Planning Your Behavioural Experiment

Choose a safety behaviour from your hierarchy (start with one rated 40-60 in anxiety) and plan an experiment to test what happens when you reduce it.

Tips for Successful Behavioural Experiments

Making Experiments Work for You
  • Start small: Begin with behaviours that cause moderate anxiety (40-60/100). Success builds confidence for tackling harder challenges.
  • Be specific: Vague plans like "worry less" don't work. Instead, specify exactly what you'll do: "I'll check my pulse once in the morning instead of every hour."
  • Expect anxiety: Feeling anxious during experiments is normal and expected. The anxiety typically peaks and then decreases. This is progress, not failure.
  • Repeat experiments: One experiment isn't enough. Repeat the same reduction multiple times to solidify learning.
  • Don't seek reassurance during experiments: Part of the learning is discovering you can cope without reassurance. Resist asking "Is this okay?" or "Do you think I'm alright?"
  • Keep records: Write down what happens. Memory is unreliable, especially when anxious. Written records show progress you might otherwise miss.
  • Use anxiety management techniques: When anxiety is high during experiments, use the breathing and mindfulness techniques described later in this guide.

Breaking the Reassurance Habit

Reassurance-seeking deserves special attention because it's so common in health anxiety and can be particularly difficult to reduce. The temporary relief it provides makes it highly reinforcing, yet it perpetuates the problem. Here's how to gradually break free from reassurance-seeking.

Strategies for Reducing Reassurance-Seeking
  1. Notice the urge without acting on it: When you feel the urge to ask "Do you think this is serious?", pause. Recognise this is an urge, not an emergency. The urge will pass even if you don't act on it.
  2. Delay reassurance-seeking: If the urge feels overwhelming, delay rather than eliminate. Tell yourself "I'll wait 30 minutes before asking." Often, the urge diminishes during the delay.
  3. Gradually reduce frequency: If you currently seek reassurance multiple times daily, reduce to twice daily, then once daily, then every other day.
  4. Ask family/friends to stop providing reassurance: This is crucial but challenging. Explain to loved ones that you're working on health anxiety and that providing reassurance, whilst well-intentioned, maintains the problem. Ask them to supportively decline: "I care about you, but I'm not going to answer that because we agreed it keeps the anxiety going."
  5. Replace reassurance with self-soothing statements: Instead of asking others, remind yourself: "I've been checked medically," "This feeling will pass," "I can tolerate not knowing for certain."
  6. Limit doctor visits to genuinely concerning symptoms: Establish clear criteria with your GP about when to seek medical attention. Resist making appointments for reassurance purposes.

Stopping Dr. Google: Managing Internet Research

Researching symptoms online is one of the most common and problematic safety behaviours in health anxiety. The internet provides endless information about diseases, symptoms, and worst-case scenarios. No matter how much you research, you never feel reassured for long—there's always another symptom to check, another rare disease that matches your experience, another frightening forum post to read.

Online symptom checking is particularly problematic because medical information requires context and expertise to interpret accurately. Symptoms are non-specific—the same symptom can indicate dozens of conditions ranging from completely benign to serious. Without medical training, it's impossible to accurately assess probability. Additionally, people experiencing health anxiety tend to focus on the most serious potential explanations whilst dismissing more likely benign ones.

The Problems with Online Symptom Checking
  • It increases anxiety rather than reducing it: Research shows that online symptom checking increases health anxiety in 80% of cases.
  • Information is taken out of context: You read about symptoms without understanding base rates, probability, or how rare conditions actually are.
  • It's never conclusive: There's always more to read, another possibility to consider, another forum where someone had similar symptoms.
  • It maintains hypervigilance: The more you read about symptoms, the more you notice them in your own body.
  • Confirmation bias dominates: You selectively focus on information that confirms your fears whilst dismissing reassuring information.
  • Medical forums show worst-case scenarios: People who are fine don't post on health forums; you're reading about the exceptions, not the norm.
Worksheet 7: Stopping Symptom Googling Plan

Create a specific plan for reducing or eliminating online symptom checking.

Worksheet 2: Identifying Your Safety Behaviours

Safety behaviours keep health anxiety going. Identifying yours is an important step towards change. Tick all that apply and add any others specific to you.

Understanding the Cost of Health Anxiety

Health anxiety doesn't just cause distress—it has wide-ranging effects on your life. Before we move on to learning new strategies, it's important to recognise what health anxiety is costing you. This isn't about making you feel bad; rather, it's about clarifying your motivation for change. When the work of overcoming health anxiety feels difficult (and it will at times), remembering what you're working towards can help you persevere.

Worksheet 3: The Cost of Health Anxiety

Consider how health anxiety has affected different areas of your life.

Challenging and Changing Anxious Thoughts

One of the most powerful components of CBT for health anxiety involves learning to identify and challenge the anxious thoughts that fuel your worry. This isn't about "positive thinking" or pretending everything is fine—it's about developing a more balanced, realistic way of interpreting bodily sensations and health information.

When you're experiencing health anxiety, your thoughts feel like facts. "I have cancer" or "Something is seriously wrong with me" feel like truths rather than interpretations. However, these are actually predictions or beliefs rather than established facts. Learning to recognise them as thoughts—and to evaluate them objectively—is a skill that can dramatically reduce anxiety.

The Process of Cognitive Restructuring

Cognitive restructuring is the CBT technique for identifying and challenging unhelpful thoughts. It involves several steps: first, catching the anxious thought; second, examining the evidence for and against it; third, considering alternative explanations; and finally, developing a more balanced perspective. Let's explore each step in detail.

Step 1: Catching Your Anxious Thoughts

The first challenge is simply noticing your thoughts. When anxiety strikes, thoughts can be so automatic that you barely register them consciously. You might just feel overwhelming anxiety without being fully aware of the specific thoughts driving it. Learning to pause and ask yourself "What was just going through my mind?" is the essential first step.

Helpful questions to identify thoughts:

  • What was going through my mind just before I started feeling anxious?
  • What does this sensation/symptom mean to me?
  • What am I predicting will happen?
  • What's the worst thing that could happen?
  • What am I imagining?
Step 2: Examining the Evidence

Once you've identified an anxious thought, the next step is to evaluate it objectively. This means looking at both the evidence that supports the thought and—crucially—the evidence against it. People with health anxiety tend to focus exclusively on information that confirms their fears whilst dismissing or overlooking contradictory evidence.

Questions for examining evidence:

  • What actual evidence do I have that supports this thought?
  • What evidence contradicts this thought?
  • Am I confusing a feeling with a fact?
  • What would a doctor say about this evidence?
  • Am I paying more attention to evidence that confirms my fear?
  • What have I been told by medical professionals?
  • Have I had similar worries before that turned out to be unfounded?
Step 3: Generating Alternative Explanations

Health anxiety involves jumping to catastrophic conclusions about bodily sensations. An important skill is learning to generate alternative, more likely explanations for what you're experiencing. This doesn't mean pretending there's definitely nothing wrong—it means acknowledging that there are usually multiple possible explanations, and the catastrophic one is typically the least probable.

Questions for alternative explanations:

  • What else could explain this sensation or symptom?
  • What would I tell a friend who had this worry?
  • Could this be caused by anxiety itself?
  • Could this be a normal bodily variation?
  • What's the most likely explanation, based on probability?
  • Could this be related to stress, sleep, diet, or exercise?
Worked Example: Challenging Health Anxious Thoughts

Situation: James, 42, notices his heart racing whilst sitting at his desk.

Anxious Thought: "My heart is racing. This must mean I'm having a heart attack. I'm going to die."

Evidence Supporting the Thought:

  • My heart is definitely racing—I can feel it
  • Heart attacks are serious and can happen to people my age
  • My uncle had a heart attack at 45
  • Racing heart is a symptom of heart problems

Evidence Against the Thought:

  • I had a full cardiac workup six months ago and everything was completely normal
  • My blood pressure and cholesterol are both in the healthy range
  • I don't have any other symptoms of a heart attack (no chest pain, arm pain, shortness of breath)
  • My heart has raced like this before many times and nothing bad happened
  • This happened when I was anxious, and I know anxiety causes rapid heartbeat
  • The racing started after I received a stressful email from my boss
  • I've been worried about my health all week, which creates anxiety and physical symptoms

Alternative Explanations:

  • This is an anxiety response to the stressful email
  • I've had three coffees this morning—caffeine can cause heart racing
  • I've been sitting still for two hours; sudden movement can increase heart rate
  • I didn't sleep well last night, which can affect heart rate
  • This is a normal stress response, not a medical emergency

Balanced Thought: "My heart is racing, which feels uncomfortable, but this is most likely an anxiety response to stress rather than a heart attack. I've had this sensation many times before and been medically checked. The most probable explanation is that I'm anxious about the email from my boss, and my body is having a normal stress response. I can let this feeling pass without assuming it's dangerous."

Worksheet 4: Thought Challenging Record

Use this worksheet each time you notice health anxiety rising. The more you practise this, the more automatic balanced thinking will become.

Common Thinking Errors in Health Anxiety

Understanding the specific thinking patterns that maintain health anxiety can help you spot them more easily in your own experience. These thinking errors aren't character flaws—they're simply habitual ways your mind has learned to interpret health-related information. Recognising them is the first step to changing them.

Thinking Error What It Is Example in Health Anxiety Challenge
Catastrophising Assuming the worst possible outcome will occur "This headache must be a brain tumour" What's the most likely explanation? What's the probability of the worst case?
Black and White Thinking Seeing things in extremes with no middle ground "Either I'm completely healthy or I'm dying" What's in between these extremes? Can both perspectives contain some truth?
Probability Overestimation Overestimating the likelihood of negative outcomes "I'm certain I have motor neurone disease" What are the actual statistics? What would a doctor say about the probability?
Selective Attention Focusing only on information that confirms fears Noticing every article about young people getting cancer whilst ignoring statistics showing it's rare What evidence am I ignoring? What contradicts my fear?
Emotional Reasoning Believing something must be true because you feel it's true "I feel terrified, so there must be something seriously wrong" Is this feeling a fact? Could I feel anxious even if everything is okay?
Mind Reading Assuming you know what others are thinking "The doctor didn't seem concerned, but they're probably just not telling me the truth" What evidence do I have for this? What else might explain their reaction?
Fortune Telling Predicting negative outcomes with certainty "I know this will turn out to be something serious" Can I really predict the future? What's actually likely to happen?
Discounting the Positive Dismissing reassuring information or evidence "The tests were normal, but that doesn't mean they didn't miss something" Why am I dismissing this evidence? Would I do the same if it confirmed my fears?

Reducing Safety Behaviours: Breaking Free from the Cycle

Whilst challenging anxious thoughts is important, research shows that the most powerful intervention for health anxiety is gradually reducing safety behaviours. This process, often called "behavioural experiments" or "exposure," involves purposefully doing less of the things you've been doing to manage anxiety, allowing yourself to learn that you can cope without them and that the feared outcomes don't actually occur.

We understand that this sounds frightening. The behaviours you're using—checking your body, seeking reassurance, researching symptoms—feel essential to your safety. The thought of stopping them can provoke intense anxiety. However, these behaviours are actually maintaining your health anxiety rather than protecting you. They prevent you from discovering that you would be okay without them.

Understanding Why Safety Behaviours Maintain Anxiety

Consider someone who checks their body for lumps every morning. Each time they check and don't find anything alarming, they feel temporarily relieved. However, their mind learns "I stayed safe because I checked," rather than "I was safe anyway." This means they feel compelled to keep checking—they can't test whether they'd be fine without checking because they never give themselves the chance to find out.

Additionally, safety behaviours often create or worsen the very symptoms feared. Repeatedly pressing on an area of your body can make it sore or tender. Constantly checking your pulse can make you hyper-aware of your heartbeat and notice normal variations that you'd otherwise ignore. Researching symptoms online exposes you to frightening information and worst-case scenarios that increase anxiety rather than provide reassurance.

The Reassurance Trap

Seeking reassurance is one of the most common safety behaviours in health anxiety, yet it's also one of the most problematic. When you ask someone "Do you think this lump is serious?" or visit a doctor asking "Could this be cancer?", you might feel better temporarily. However, reassurance has several problems:

  • It's never enough: You might feel better for hours or days, but doubt creeps back in. "Maybe they missed something." "But what if..."
  • You need it more often: Each time you seek reassurance, you strengthen the belief that you need external validation to feel safe.
  • It maintains hypervigilance: Constantly checking in with others keeps your attention focused on potential illness.
  • It affects relationships: Loved ones may become frustrated, which then creates more anxiety.
  • It prevents trust in yourself: You never learn that you can tolerate uncertainty or trust your own judgment.

Creating Your Personal Hierarchy

Reducing safety behaviours doesn't mean stopping everything at once—that would be overwhelming and potentially lead to giving up. Instead, we'll work gradually, starting with behaviours that provoke moderate anxiety and building up to more challenging ones. This approach, called "graded exposure," allows you to build confidence progressively.

Worksheet 5: Safety Behaviour Hierarchy

List all your safety behaviours and rate how anxious you'd feel if you stopped each one (0-100, where 100 is the most anxious you could possibly feel). Then organise them from lowest to highest anxiety.

Conducting Behavioural Experiments

Behavioural experiments are structured ways of testing your beliefs about what will happen if you reduce safety behaviours. Rather than simply trying to stop a behaviour and hoping for the best, you'll approach it as a scientist conducting an experiment—you'll make a prediction, test it out, and see what actually happens.

Example Behavioural Experiment: Reducing Body Checking

Current Safety Behaviour: Maria checks a mole on her arm approximately 15 times daily, comparing it with photos on her phone to see if it's changed.

Belief Being Tested: "If I don't check the mole constantly, I'll miss dangerous changes and die from melanoma."

Prediction: "If I reduce checking to twice daily (morning and evening), I'll feel unbearable anxiety all day, won't be able to concentrate on anything else, and I'll miss important changes to the mole."

Alternative Prediction: "Checking less frequently might be difficult initially, but the anxiety will probably reduce over time. I'll gradually learn that I can cope without constant checking, and the mole won't change significantly between morning and evening checks."

The Experiment: Maria agreed to reduce checking to twice daily for one week, recording her anxiety levels and what she noticed.

Results:

  • Day 1-2: High anxiety (70-80/100), strong urges to check, frequently thought about the mole
  • Day 3-4: Anxiety reducing (50-60/100), urges still present but more manageable
  • Day 5-7: Anxiety much lower (30-40/100), less preoccupied with thoughts about the mole, starting to trust that twice-daily checking was sufficient
  • The mole appeared exactly the same at each check; no dangerous changes occurred
  • Gained more time and mental space to focus on work and relationships

Conclusion: "I could cope with reduced checking better than I predicted. The anxiety was high initially but decreased significantly. My worst fear (missing dangerous changes) didn't occur. Checking less frequently is difficult but manageable, and it's improving my quality of life."

Next Step: Maria then planned to further reduce checking to once daily for another week.

Worksheet 6: Planning Your Behavioural Experiment

Choose a safety behaviour from your hierarchy (start with one rated 40-60 in anxiety) and plan an experiment to test what happens when you reduce it.

Tips for Successful Behavioural Experiments

Making Experiments Work for You
  • Start small: Begin with behaviours that cause moderate anxiety (40-60/100). Success builds confidence for tackling harder challenges.
  • Be specific: Vague plans like "worry less" don't work. Instead, specify exactly what you'll do: "I'll check my pulse once in the morning instead of every hour."
  • Expect anxiety: Feeling anxious during experiments is normal and expected. The anxiety typically peaks and then decreases. This is progress, not failure.
  • Repeat experiments: One experiment isn't enough. Repeat the same reduction multiple times to solidify learning.
  • Don't seek reassurance during experiments: Part of the learning is discovering you can cope without reassurance. Resist asking "Is this okay?" or "Do you think I'm alright?"
  • Keep records: Write down what happens. Memory is unreliable, especially when anxious. Written records show progress you might otherwise miss.
  • Use anxiety management techniques: When anxiety is high during experiments, use the breathing and mindfulness techniques described later in this guide.

Breaking the Reassurance Habit

Reassurance-seeking deserves special attention because it's so common in health anxiety and can be particularly difficult to reduce. The temporary relief it provides makes it highly reinforcing, yet it perpetuates the problem. Here's how to gradually break free from reassurance-seeking.

Strategies for Reducing Reassurance-Seeking
  1. Notice the urge without acting on it: When you feel the urge to ask "Do you think this is serious?", pause. Recognise this is an urge, not an emergency. The urge will pass even if you don't act on it.
  2. Delay reassurance-seeking: If the urge feels overwhelming, delay rather than eliminate. Tell yourself "I'll wait 30 minutes before asking." Often, the urge diminishes during the delay.
  3. Gradually reduce frequency: If you currently seek reassurance multiple times daily, reduce to twice daily, then once daily, then every other day.
  4. Ask family/friends to stop providing reassurance: This is crucial but challenging. Explain to loved ones that you're working on health anxiety and that providing reassurance, whilst well-intentioned, maintains the problem. Ask them to supportively decline: "I care about you, but I'm not going to answer that because we agreed it keeps the anxiety going."
  5. Replace reassurance with self-soothing statements: Instead of asking others, remind yourself: "I've been checked medically," "This feeling will pass," "I can tolerate not knowing for certain."
  6. Limit doctor visits to genuinely concerning symptoms: Establish clear criteria with your GP about when to seek medical attention. Resist making appointments for reassurance purposes.

Stopping Dr. Google: Managing Internet Research

Researching symptoms online is one of the most common and problematic safety behaviours in health anxiety. The internet provides endless information about diseases, symptoms, and worst-case scenarios. No matter how much you research, you never feel reassured for long—there's always another symptom to check, another rare disease that matches your experience, another frightening forum post to read.

Online symptom checking is particularly problematic because medical information requires context and expertise to interpret accurately. Symptoms are non-specific—the same symptom can indicate dozens of conditions ranging from completely benign to serious. Without medical training, it's impossible to accurately assess probability. Additionally, people experiencing health anxiety tend to focus on the most serious potential explanations whilst dismissing more likely benign ones.

The Problems with Online Symptom Checking
  • It increases anxiety rather than reducing it: Research shows that online symptom checking increases health anxiety in 80% of cases.
  • Information is taken out of context: You read about symptoms without understanding base rates, probability, or how rare conditions actually are.
  • It's never conclusive: There's always more to read, another possibility to consider, another forum where someone had similar symptoms.
  • It maintains hypervigilance: The more you read about symptoms, the more you notice them in your own body.
  • Confirmation bias dominates: You selectively focus on information that confirms your fears whilst dismissing reassuring information.
  • Medical forums show worst-case scenarios: People who are fine don't post on health forums; you're reading about the exceptions, not the norm.
Worksheet 7: Stopping Symptom Googling Plan

Create a specific plan for reducing or eliminating online symptom checking.

Managing Physical Sensations and Anxiety

A crucial component of overcoming health anxiety involves changing how you relate to physical sensations in your body. Currently, you likely notice bodily sensations and immediately interpret them as threatening—your attention focuses intensely on the sensation, which amplifies it and triggers more anxiety. This section will teach you alternative ways of responding to physical sensations.

Understanding Attention and Bodily Sensations

Your body produces countless sensations every moment—your heart beats, your muscles contract and relax, your digestive system processes food, your skin registers temperature and pressure, your joints move. Most of the time, you're completely unaware of these sensations because your attention is directed elsewhere. However, in health anxiety, you develop heightened internal attention—a tendency to scan your body constantly for signs of problems.

This heightened attention creates two significant problems. First, it leads you to notice normal bodily variations that everyone experiences but most people never register. Your heart rate naturally varies throughout the day, your digestion creates sounds and sensations, your muscles occasionally twitch or ache—these are all completely normal, but health anxiety makes you hyper-aware of them. Second, focused attention actually amplifies sensations. When you concentrate intensely on a sensation, it feels stronger and more noticeable. This is why repeatedly checking an area of your body often makes it feel worse rather than providing reassurance.

Attention Experiment: Try This Now

Let's demonstrate how attention affects bodily awareness. Right now, focus your attention on your left foot. Notice any sensations—pressure where it touches the ground, temperature, any tingles or feelings. Spend 30 seconds paying close attention to your left foot.

What did you notice? Before I directed your attention there, you probably weren't aware of your left foot at all. Yet once you focused on it, you likely became aware of multiple sensations. This demonstrates that attention alone creates awareness of sensations that were always present but previously unnoticed. This same principle applies to health anxiety—constant body scanning makes you notice normal sensations that other people simply don't register.

Shifting from Threat Monitoring to Mindful Awareness

The goal isn't to ignore your body entirely—that would be neither possible nor helpful. Instead, you'll learn to shift from anxious body monitoring (scanning for threats) to mindful body awareness (noticing sensations without judgment or interpretation). This fundamental shift changes your relationship with physical sensations from one of fear and suspicion to one of acceptance and neutrality.

Anxious Body Monitoring vs. Mindful Body Awareness
Anxious Body Monitoring Mindful Body Awareness
Searching for problems Simply noticing what's present
Interpreting sensations as threatening Observing sensations neutrally
Trying to control or eliminate sensations Allowing sensations to be present
Analyzing and comparing sensations Experiencing sensations directly
Believing sensations mean something dangerous Recognizing sensations are just sensations
Increased anxiety and tension Decreased reactivity and calm acceptance

Breathing Techniques for Anxiety Management

When anxiety strikes, your breathing pattern changes—you breathe faster and more shallowly, often from your chest rather than your diaphragm. This hyperventilation can cause numerous physical symptoms including dizziness, light-headedness, tingling in extremities, chest tightness, and feelings of unreality. These symptoms then fuel more health anxiety, creating a vicious cycle.

Learning controlled breathing techniques provides a practical tool for managing anxiety symptoms. Slow, diaphragmatic breathing activates your body's relaxation response, counteracting the stress response. It's not about "breathing away" anxiety—it's about preventing the escalation of physical symptoms and giving yourself a moment of calm to respond more skillfully.

Diaphragmatic Breathing Exercise

This simple breathing technique can be used any time anxiety rises. Practise it daily when calm so it becomes automatic when you're anxious.

  1. Find a comfortable position, sitting or lying down. Place one hand on your chest and one on your abdomen.
  2. Breathe in slowly through your nose for a count of 4. Your abdomen should rise while your chest remains relatively still. Imagine filling your belly with air.
  3. Hold the breath gently for a count of 2.
  4. Breathe out slowly through your mouth for a count of 6, feeling your abdomen fall. Imagine releasing tension with each out-breath.
  5. Pause for a count of 2 before the next breath.
  6. Repeat this cycle for 5-10 minutes, or until you feel calmer.

Important: If you feel dizzy or uncomfortable, return to normal breathing. Don't force the breathing—it should feel natural and comfortable.

Progressive Muscle Relaxation

Anxiety creates significant muscle tension, which can cause aches, pains, and discomfort throughout your body—sensations that can then be misinterpreted as signs of illness. Progressive muscle relaxation (PMR) systematically releases this tension while teaching you to recognize the difference between tension and relaxation.

Progressive Muscle Relaxation Script

Set aside 15-20 minutes in a quiet space. This exercise involves tensing and then relaxing different muscle groups. The tension phase should last about 5 seconds, followed by 10-15 seconds of relaxation.

  1. Hands and forearms: Make tight fists with both hands, hold the tension... then release. Notice the difference between tension and relaxation.
  2. Upper arms: Bend your arms at the elbow and tense your biceps, hold... then release and let your arms drop.
  3. Shoulders: Raise your shoulders up towards your ears, hold the tension... then let them drop and relax.
  4. Neck: Gently press your head back (if lying down) or tilt it back slightly (if sitting), hold... then relax to neutral position.
  5. Face: Scrunch up your entire face—squeeze eyes shut, wrinkle nose, clench jaw, hold... then release and let your face soften.
  6. Chest and abdomen: Take a deep breath and hold it while tightening stomach muscles... then exhale and relax.
  7. Upper legs: Tighten thigh muscles by straightening legs and tensing, hold... then release.
  8. Lower legs: Point your toes away from you to tense calf muscles, hold... then relax.
  9. Feet: Curl your toes downward tightly, hold... then release and relax.

Finish by scanning through your body, noticing any remaining areas of tension and consciously releasing them.

Mindfulness for Health Anxiety

Mindfulness—the practice of paying attention to the present moment without judgment—is particularly powerful for health anxiety. Rather than trying to eliminate anxious thoughts or physical sensations, mindfulness teaches you to observe them without reacting, recognizing them as temporary mental events rather than facts requiring immediate action.

The core principle of mindfulness for health anxiety is this: you don't have to believe every thought that enters your mind, and you don't have to act on every urge you experience. You can notice "I'm having the thought that this sensation means I'm seriously ill" without believing it's true. You can observe "I'm experiencing an urge to check my body" without acting on it. This creates space between stimulus and response—a moment where you can choose how to react rather than being swept along by automatic anxiety patterns.

Mindfulness Exercise: Observing Thoughts and Sensations

This exercise helps you practice mindful awareness of thoughts and sensations. Set aside 10 minutes and follow these steps:

Mindfulness in Daily Life: Body Sensation Check-Ins

Instead of anxiously scanning your body for problems multiple times daily, try scheduled mindful body check-ins—perhaps once in the morning and once in the evening. The difference is in the quality of attention:

Anxious Scanning: "Is that lump bigger? Does my chest feel tight? Is my heart racing? Is that pain worse? I need to check again..."

Mindful Check-In: "I'm noticing various sensations in my body right now. There's some tension in my shoulders, warmth in my hands, my heart beating at a steady pace. These are just sensations—arising and passing, changing moment to moment. I can observe them without needing to analyse or fix them."

Tolerating Uncertainty: The Core Challenge

At the heart of health anxiety lies a fundamental difficulty: the inability to tolerate uncertainty. You want absolute certainty that you're not ill, that you won't develop illness, that you'll notice any problems early enough. This desire for certainty is completely understandable—who wouldn't want to be certain they're healthy? However, this level of certainty is impossible to achieve, and the quest for it maintains health anxiety.

Medical certainty doesn't exist in the way health anxiety demands. Even after comprehensive medical testing, there remains some tiny degree of uncertainty—tests can miss things, new symptoms can develop, rare conditions exist. Doctors operate within the realm of probability, not certainty. They make decisions based on what's most likely, not what's absolutely certain. Learning to tolerate this inherent uncertainty is perhaps the most challenging but most crucial aspect of overcoming health anxiety.

Why the Quest for Certainty Backfires

Every time you seek reassurance, check your body, or research symptoms, you're attempting to achieve certainty. The problem is that certainty is always temporary and incomplete. You might feel reassured after a doctor's appointment, but within hours or days, doubt creeps back in. "But what if they missed something? What if new symptoms develop? What if this is the one rare case?" The mind can always generate another "what if."

The Certainty Paradox

The more you seek certainty about your health, the less certain you feel. This seems contradictory, but here's why it happens:

  • Each reassurance-seeking behaviour reinforces the belief that you need certainty to feel safe
  • You become less tolerant of normal uncertainty, requiring more and more reassurance
  • The bar for "certain enough" keeps rising—what reassured you yesterday isn't sufficient today
  • You train your mind that uncertainty is dangerous rather than normal
  • Your distress intolerance decreases, making uncertainty feel increasingly unbearable

Uncertainty Is Not Your Enemy

One of the most transformative shifts in overcoming health anxiety is reframing your relationship with uncertainty. Currently, uncertainty feels threatening—something to be eliminated or escaped from. But uncertainty is actually a neutral, unavoidable feature of human existence. Everyone lives with uncertainty about their health every single day; people without health anxiety simply don't experience it as threatening.

Consider this: right now, at this very moment, you have no absolute certainty about your health. You could have a condition that hasn't been detected yet. You could develop new symptoms tomorrow. This is true for literally everyone on the planet. Yet most people navigate this uncertainty without overwhelming distress. The difference isn't that they have more certainty—it's that they've accepted uncertainty as a normal part of life rather than viewing it as a threat.

Practising Uncertainty Tolerance

Building tolerance for uncertainty is like building physical strength—it requires regular practice with gradually increasing challenges. Here are strategies to develop this crucial skill:

  1. Notice uncertainty in other life areas: You tolerate uncertainty constantly—you don't know if your car will start tomorrow, if your job will exist in 5 years, if your relationships will last forever. Yet you function despite this uncertainty. Recognizing that you already tolerate uncertainty in many domains can help you see it's possible with health too.
  2. Practice uncertainty statements: When anxious, explicitly acknowledge uncertainty rather than trying to eliminate it: "I can't know for certain, and that's okay," "Uncertainty is uncomfortable, but not dangerous," "I can live a full life without complete certainty about my health."
  3. Resist certainty-seeking: Each time you resist checking, researching, or seeking reassurance, you're practicing uncertainty tolerance. The anxiety will be high initially, but it decreases with repeated practice.
  4. Embrace "good enough" rather than "perfect": In decision-making about health, aim for "probably fine" rather than "definitely fine." This is how people without health anxiety navigate health decisions.
  5. Delay certainty-seeking: If the urge for certainty feels overwhelming, practice delaying. "I'll wait 30 minutes before checking." Often the urge passes, and you learn that immediate certainty isn't necessary.
Worksheet 8: Building Uncertainty Tolerance

Building a Healthy Relationship with Healthcare

People with health anxiety often have complicated relationships with healthcare services. Some attend frequent appointments seeking reassurance, whilst others avoid healthcare entirely due to fear of discovering something serious. Both patterns are problematic—neither excessive checking nor complete avoidance represents a balanced, healthy approach to medical care.

Developing a healthy relationship with healthcare means learning when medical attention is genuinely warranted versus when you're seeking reassurance. It involves trusting medical professionals whilst also recognising that repeated consultations for reassurance purposes maintain rather than resolve health anxiety.

When to Seek Medical Attention: Establishing Clear Guidelines

One of the most helpful strategies is establishing clear guidelines, ideally with your GP, about when to seek medical attention. This removes the constant decision-making that fuels anxiety—you have predetermined criteria rather than making anxious decisions in the moment.

Red Flag Symptoms That Warrant Medical Attention

These guidelines are general principles. Discuss specific criteria with your GP based on your individual circumstances:

  • Sudden onset: Symptoms that appear suddenly and severely (e.g., sudden severe headache, sudden chest pain, sudden difficulty breathing)
  • Persistent symptoms: Symptoms that don't resolve within 2-3 weeks despite home management
  • Progressive worsening: Symptoms that steadily worsen over days/weeks rather than fluctuating
  • Functional impairment: Symptoms that significantly interfere with daily activities, work, or sleep
  • New and unexplained: Genuinely new symptoms that you've never experienced before and that don't fit patterns of anxiety
  • Associated concerning features: Such as unexplained weight loss, night sweats, blood in urine/stool, persistent fevers

Symptoms That Generally DON'T Require Immediate Medical Attention:

  • Symptoms that come and go, especially in relation to stress or anxiety levels
  • Symptoms you've had checked multiple times with reassuring results
  • Symptoms that match known anxiety physical symptoms
  • Minor aches, pains, or sensations that don't worsen or interfere with function
  • Symptoms that appear immediately after reading about an illness

Working Collaboratively with Your GP

Having an open, honest conversation with your GP about health anxiety can be transformative. Many people with health anxiety feel embarrassed or ashamed, fearing their doctor will dismiss them or think they're wasting time. In reality, GPs encounter health anxiety regularly and can be supportive partners in your recovery—but only if they understand what you're experiencing.

Talking to Your GP About Health Anxiety

Consider scheduling a dedicated appointment to discuss health anxiety (rather than bringing it up when seeking reassurance about symptoms). You might say something like:

"I've recognised that I have health anxiety. I worry excessively about illness, interpret normal bodily sensations as dangerous, and find myself seeking reassurance frequently. I'm working on overcoming this using CBT techniques. I'd like to establish some guidelines about when I should genuinely seek medical attention, because currently, I struggle to distinguish between anxiety and real concern. I'd also appreciate your support by not providing excessive reassurance when I'm seeking it for anxiety rather than medical reasons."

This approach:

  • Demonstrates self-awareness and responsibility for your recovery
  • Helps your GP understand the context of your appointments
  • Establishes collaborative guidelines rather than leaving decisions to anxious moment-by-moment judgment
  • Reduces the likelihood of unnecessary tests or referrals
  • Helps your GP support your recovery rather than inadvertently maintaining health anxiety

The Role of Medical Tests in Health Anxiety

Medical tests rarely provide lasting relief in health anxiety. You might feel temporarily reassured by a clear test result, but within days or weeks, doubt returns. "What if the test missed something? What if I've developed something new since the test? What if they need to do more tests?" The problem is that tests are being used to achieve psychological certainty rather than medical diagnosis.

Moreover, tests themselves can create new worries. Incidental findings (minor abnormalities that have no clinical significance) are common and can trigger fresh waves of anxiety. Slight variations from "normal" ranges can become new obsessions. The more you test, the more potential there is to find benign variations that feed health anxiety.

Questions to Ask Before Requesting Tests

Before requesting medical tests, ask yourself:

  • Am I requesting this test because of genuine new symptoms, or am I seeking reassurance?
  • Have I had similar or related tests recently that were normal?
  • If the test is clear, will I genuinely feel reassured long-term, or will doubt return within days?
  • Has my GP actually recommended this test, or am I requesting it?
  • Am I willing to accept the test result and move on, or will I find reasons to doubt it?
  • What would I tell a friend in this situation—would I genuinely think they needed this test?

Scheduled Health Maintenance vs. Anxiety-Driven Checking

There's an important distinction between appropriate health maintenance (routine check-ups, screening programmes, vaccinations) and anxiety-driven checking. Health anxiety often makes this distinction blurry, but understanding the difference helps you engage appropriately with healthcare.

Appropriate Health Maintenance Anxiety-Driven Checking
Following evidence-based screening guidelines (e.g., cervical screening every 3-5 years as recommended) Requesting screening more frequently than guidelines recommend due to anxiety
Annual check-ups or as recommended by your GP for chronic conditions Multiple appointments for reassurance about the same issue
Seeking attention for new, persistent, or worsening symptoms Seeking attention for symptoms you've had checked multiple times
Following medical advice about monitoring a known condition Self-monitoring beyond medical recommendations
Feeling appropriately reassured by clear test results Briefly reassured but needing repeated testing
Planned, scheduled healthcare Urgent, anxiety-driven healthcare seeking
Worksheet 9: My Healthcare Plan

Create clear guidelines for your healthcare engagement. Consider discussing this plan with your GP.

Maintaining Progress and Preventing Relapse

Recovery from health anxiety isn't linear. You'll have good days and difficult days, periods of progress and occasional setbacks. Understanding this from the outset helps you navigate challenges without becoming discouraged. The goal isn't to never experience health worry again—it's to develop skills and strategies that prevent health anxiety from dominating your life.

Recognising Progress

Sometimes progress is obvious—you might go days without obsessive health worry, successfully resist checking behaviours, or feel generally calmer. Other times, progress is subtle and easy to miss. You might still experience anxiety, but recover from episodes more quickly. You might notice symptoms but not immediately catastrophise. You might seek reassurance but catch yourself and stop. These small victories matter enormously.

Signs of Progress in Health Anxiety Recovery
  • Spending less time thinking about health concerns
  • Experiencing health-related thoughts without immediate intense anxiety
  • Successfully resisting urges to check, research, or seek reassurance (even if the urges still occur)
  • Noticing body sensations without immediately interpreting them as dangerous
  • Recovering from anxious episodes more quickly
  • Engaging more fully in activities and relationships
  • Accepting uncertainty more comfortably
  • Trusting medical reassurance for longer periods
  • Distinguishing more clearly between genuine medical concern and anxiety
  • Feeling more confident in your ability to cope with health worries
Worksheet 10: Tracking My Progress

Complete this worksheet weekly to monitor progress. Sometimes we don't notice gradual improvement until we deliberately look for it.

Understanding and Managing Setbacks

Setbacks are a normal part of recovery, not a sign of failure. You might be progressing well when suddenly a new symptom triggers intense anxiety, or you find yourself back in old patterns of checking and reassurance-seeking. This doesn't mean you're back to square one—the skills and understanding you've developed remain intact. Setbacks are opportunities to practise your coping strategies rather than evidence that recovery isn't possible.

Common Triggers for Setbacks
  • Life stress: When generally stressed, health anxiety often resurfaces as a focus for worry
  • Illness in others: Hearing about someone else's illness can trigger fears about your own health
  • Media coverage: News stories about diseases or health crises
  • Genuine minor illness: A cold or flu can trigger disproportionate anxiety
  • Medical appointments: Even routine appointments can reactivate health anxiety
  • Life transitions: Major changes (new job, relationship changes, moving) can increase general anxiety
  • Fatigue or poor self-care: When tired, hungry, or unwell, coping skills are harder to access
Your Setback Action Plan

When you notice health anxiety increasing again:

  1. Recognise it early: The sooner you notice old patterns returning, the easier they are to interrupt. Warning signs might include increased body checking, researching symptoms, or seeking reassurance.
  2. Don't catastrophise the setback: Having a difficult period doesn't erase your progress. Tell yourself: "This is a temporary setback, not a return to the beginning. I've learned skills that will help me through this."
  3. Return to basics: Review this guide. Complete the thought-challenging worksheets. Reinstate behavioural experiments. Use breathing and mindfulness techniques.
  4. Identify the trigger: What sparked this increase in anxiety? Understanding the context helps you respond appropriately.
  5. Resist safety behaviours: The urge to check, research, and seek reassurance will be strong—this is when resisting them matters most.
  6. Reach out for support: Contact your therapist, GP, or trusted friend. You don't have to manage setbacks alone.
  7. Be compassionate with yourself: Setbacks are part of recovery. Treat yourself with the kindness you'd offer a friend in the same situation.

Creating Your Relapse Prevention Plan

A relapse prevention plan is a personalised document you create whilst feeling relatively well, outlining warning signs and coping strategies. When health anxiety increases, you can refer to this plan rather than trying to remember strategies whilst anxious.

Worksheet 11: My Relapse Prevention Plan

Long-Term Strategies for Wellbeing

Maintaining recovery from health anxiety involves more than just managing anxious thoughts—it requires building a life that supports overall psychological wellbeing. When your life feels meaningful, engaging, and connected, there's less space for health anxiety to dominate.

1

Physical Health

Regular exercise, adequate sleep, balanced nutrition, and limiting caffeine/alcohol support both physical and mental health.

2

Stress Management

Continue practising relaxation, mindfulness, and breathing techniques. High stress levels make health anxiety more likely to resurface.

3

Meaningful Activities

Engage in hobbies, interests, and activities that provide purpose and enjoyment. These redirect attention away from health monitoring.

4

Social Connection

Maintain relationships and social activities. Isolation increases rumination and anxiety.

5

Continued Practice

Keep practising CBT skills even when feeling well. This maintains progress and prevents old patterns returning.

6

Self-Compassion

Treat yourself kindly throughout the recovery journey. Progress isn't linear, and setbacks are opportunities for learning.

Moving Forward: Your Journey Beyond Health Anxiety

If you've worked through this guide, completed the worksheets, and implemented the strategies, you've taken significant steps toward overcoming health anxiety. Recovery is a journey rather than a destination—there will be ups and downs, but with each challenge you face and manage, you build greater confidence and resilience.

Remember that the goal isn't to never worry about health again. Some health concern is normal, appropriate, and adaptive—it motivates us to seek necessary medical care and take care of ourselves. The goal is for health concerns to be proportionate, manageable, and not to dominate your life. You're aiming for a relationship with your health and body characterised by trust and balance rather than fear and hypervigilance.

Key Principles to Remember

Core Lessons from This Guide
  1. Health anxiety is maintained by your responses to it, not by actual illness. The cycle of anxious thoughts, physical sensations, and safety behaviours keeps the problem going.
  2. Anxiety creates physical symptoms that mimic illness. Many sensations you fear are actually produced by anxiety itself.
  3. Safety behaviours provide temporary relief but maintain long-term anxiety. Checking, researching, and reassurance-seeking prevent you from learning you can cope without them.
  4. Thoughts are not facts. "I think I'm ill" is different from "I am ill." Learning to observe thoughts without believing them is transformative.
  5. Certainty is impossible and unnecessary. Everyone lives with health uncertainty; people without health anxiety have simply accepted this rather than fighting it.
  6. Gradual exposure to what you fear (reducing safety behaviours) is the most powerful intervention. It's difficult but ultimately liberating.
  7. Progress isn't linear. Setbacks are normal and don't erase your progress. Each time you face a setback and use your skills to manage it, you strengthen your recovery.
  8. You can live a full, meaningful life whilst tolerating health uncertainty. Millions of people do this every day.

When to Seek Professional Help

This guide provides comprehensive self-help strategies, but many people benefit from professional support. Working with a qualified CBT therapist can provide personalised guidance, accountability, and expert support throughout your recovery journey.

Consider Professional Therapy If:
  • You've tried implementing these strategies but continue to struggle with overwhelming health anxiety
  • Health anxiety significantly impairs your daily functioning, work, or relationships
  • You feel unable to reduce safety behaviours without support
  • Depression or other mental health difficulties accompany your health anxiety
  • You'd benefit from professional guidance to work through the strategies systematically
  • You need accountability and support to maintain progress

Talking Therapies UK offers specialist CBT for health anxiety. Our qualified therapists provide compassionate, evidence-based treatment delivered conveniently online. We understand health anxiety deeply and can guide you through the recovery process with expertise and support.

Worksheet 12: My Action Plan Moving Forward

Create a clear action plan for continuing your recovery from health anxiety.

A Final Message of Hope

Health anxiety can feel all-consuming, exhausting, and hopeless. The constant worry, the hypervigilance to every bodily sensation, the time lost to checking and researching—it takes a tremendous toll. If you're reading this whilst in the grip of health anxiety, it might be hard to believe that things can genuinely improve.

But they can. Thousands of people have overcome health anxiety using the principles and strategies outlined in this guide. Research consistently demonstrates that CBT is highly effective for health anxiety—not just in reducing symptoms, but in genuinely transforming how people relate to their health and their bodies. Recovery is possible, and you deserve to live a life not dominated by health fears.

The journey won't always be easy. There will be days when implementing these strategies feels overwhelming, when the urge to check or seek reassurance feels irresistible, when setbacks make you question whether you're making progress. In those moments, remember: difficulty is part of the process, not evidence that it's not working. Every time you resist a safety behaviour, challenge an anxious thought, or tolerate uncertainty, you're rewiring your brain's response to health-related anxiety. Change happens gradually, often in ways too subtle to notice day-to-day, but when you look back over weeks and months, the transformation can be profound.

You've taken an important step by engaging with this guide. Continue taking small steps forward. Be patient with yourself. Seek support when you need it. And trust that with consistent application of these strategies, you can reclaim your life from health anxiety.

Your Recovery Journey Starts Today

Don't wait until you feel "ready" or until anxiety is lower. Start now, exactly where you are:

  • Choose one small safety behaviour to reduce this week
  • Complete one thought-challenging exercise when health anxiety arises
  • Practise mindfulness or breathing exercises for 10 minutes daily
  • Have an honest conversation with your GP about health anxiety
  • Share this guide with a trusted friend or family member who can support your recovery
  • Consider reaching out to Talking Therapies UK for professional CBT support

Recovery is built on small, consistent actions. Each step forward matters, no matter how small it feels.

Additional Resources and Further Reading

Recommended Books on Health Anxiety

  • "Overcoming Health Anxiety" by Rob Willson and David Veale – A comprehensive self-help guide based on CBT principles
  • "The Anxiety and Worry Workbook" by David A. Clark and Aaron T. Beck – Includes excellent strategies for health-related worry
  • "When Panic Attacks" by David D. Burns – Contains helpful techniques for managing anxiety and panic symptoms
  • "Mind Over Mood" by Dennis Greenberger and Christine Padesky – An excellent CBT workbook with practical exercises
  • "The Worry Cure" by Robert Leahy – Addresses excessive worry, including health-related concerns

Online Resources

  • NHS Every Mind Matters – Free resources for mental health, including anxiety management
  • Anxiety UK – Charity providing information, support and resources for anxiety disorders
  • Mind – Mental health charity with information about anxiety and how to access support
  • British Association for Behavioural and Cognitive Psychotherapies (BABCP) – Find accredited CBT therapists
  • No Panic – Support for panic attacks, phobias, and anxiety disorders

Mobile Apps for Anxiety Management

  • Headspace or Calm – Guided mindfulness and meditation
  • MindShift CBT – CBT-based anxiety management tools
  • Sanvello – Mood and anxiety tracking with CBT techniques
  • Dare – Specifically designed for anxiety and panic
  • iBreathe – Breathing exercises for anxiety relief

When to Seek Emergency Help

Whilst health anxiety can cause intense distress, it's important to distinguish between anxiety and genuine medical emergencies. Seek immediate medical attention if you experience:

  • Chest pain with breathlessness, nausea, or pain radiating to arms, jaw, or back
  • Sudden severe headache unlike any you've experienced before
  • Sudden confusion, slurred speech, or facial drooping
  • Severe difficulty breathing that doesn't improve with relaxation techniques
  • Severe abdominal pain
  • Signs of severe allergic reaction (swelling of face, throat closure, severe rash)
  • Any symptom your GP has specifically asked you to seek emergency care for

If in doubt about whether symptoms require emergency attention, call NHS 111 for guidance.

Quick Reference Summary

Use this summary as a quick reminder of key concepts and strategies when you need them.

Area Key Points
Understanding Health Anxiety • Health anxiety is maintained by the cycle of anxious thoughts → anxiety → physical symptoms → safety behaviours → temporary relief → maintaining the problem
• Anxiety itself creates physical symptoms that mimic illness
• The problem isn't your physical health—it's how you interpret and respond to bodily sensations
Challenging Thoughts • Catch the anxious thought: "What was going through my mind?"
• Examine evidence for and against the thought
• Generate alternative explanations
• Develop balanced perspective based on evidence
• Remember: thoughts are not facts
Safety Behaviours • Identify all your safety behaviours (checking, researching, reassurance-seeking, avoiding)
• Understand that they provide temporary relief but maintain long-term anxiety
• Create a hierarchy from easiest to hardest to reduce
• Start with moderate-difficulty behaviours
• Use behavioural experiments to test predictions
Managing Physical Symptoms • Practice diaphragmatic breathing (4 in, 2 hold, 6 out, 2 pause)
• Use progressive muscle relaxation
• Shift from threat monitoring to mindful awareness
• Recognize that attention amplifies sensations
• Accept sensations without trying to control them
Tolerating Uncertainty • Absolute certainty about health is impossible and unnecessary
• Everyone lives with health uncertainty; it's normal
• The quest for certainty maintains anxiety
• Practice "good enough" rather than "perfect" certainty
• Use uncertainty statements: "I can tolerate not knowing for certain"
Healthcare Engagement • Establish clear guidelines for when to seek medical attention
• Distinguish between appropriate health maintenance and anxiety-driven checking
• Have an honest conversation with your GP about health anxiety
• Recognize that medical tests rarely provide lasting reassurance
• Trust medical reassurance rather than repeatedly seeking it
Maintaining Progress • Recovery isn't linear—setbacks are normal
• Create a relapse prevention plan
• Continue practising skills even when feeling well
• Build general wellbeing through exercise, sleep, stress management, meaningful activities
• Seek professional help when needed

Emergency Coping Strategies

When health anxiety strikes intensely and you feel overwhelmed, use these quick strategies:

5-Minute Emergency Response

1. PAUSE
Stop what you're doing. Recognize this is health anxiety, not a medical emergency.
2. BREATHE
Use diaphragmatic breathing: 4 counts in, 6 counts out. Repeat for 2 minutes.
3. LABEL
"I'm having the thought that...", "This is anxiety creating these sensations"
4. RESIST
Do NOT check, research, or seek reassurance. These will make it worse long-term.
5. DISTRACT
Engage fully in an activity: call a friend, go for a walk, do a task requiring concentration.
6. REMEMBER
This feeling will pass. You've felt this before and been okay. Anxiety is uncomfortable, not dangerous.
Helpful Statements for Acute Anxiety

Memorise a few of these to use when anxiety is high:

  • "This is anxiety, not illness. Anxiety creates physical symptoms that mimic illness."
  • "I've been medically checked and reassured. My body is responding to anxiety, not disease."
  • "This feeling will pass. It always has before."
  • "I don't need to know for certain right now. I can tolerate this uncertainty."
  • "Checking/researching/seeking reassurance will only make this worse. I'm going to resist."
  • "Discomfort isn't danger. I can feel anxious and be safe."
  • "I've learned skills to manage this. I'm going to use them."
  • "The urge to check will pass if I don't act on it."
  • "Recovery means feeling anxious sometimes without acting on it."

Professional Support from Talking Therapies UK

Whilst this guide provides comprehensive self-help strategies, professional therapy can significantly enhance your recovery journey. Talking Therapies UK specialises in evidence-based CBT for health anxiety, delivered conveniently and compassionately online.

What We Offer

Specialist Expertise

Our therapists are highly qualified and experienced in treating health anxiety specifically. We understand the nuances of this condition and how to guide you effectively through recovery.

Evidence-Based Treatment

We use CBT, the gold-standard treatment for health anxiety, with proven effectiveness in research and clinical practice.

Online Convenience

Access therapy from the comfort of your home via secure video sessions. No travel, no waiting rooms, just effective, confidential support.

Personalised Approach

We tailor treatment to your specific health anxiety patterns, triggers, and goals. Your therapy is designed around your unique needs.

Compassionate Support

We understand how distressing health anxiety is. You'll receive non-judgmental, empathetic support throughout your journey.

Flexible Scheduling

We offer appointments that fit your schedule, including evenings and weekends.

What to Expect in Therapy

Initial Assessment (First Session): Your therapist will conduct a comprehensive assessment of your health anxiety—understanding your specific fears, safety behaviours, triggers, and how health anxiety impacts your life. Together, you'll develop personalised treatment goals.

Treatment Sessions (Typically 8-16 Sessions): You'll work systematically through CBT strategies, similar to those in this guide but adapted to your needs. Sessions include:

  • Detailed understanding of your personal health anxiety cycle
  • Cognitive restructuring tailored to your specific anxious thoughts
  • Guided development and implementation of behavioural experiments
  • Structured reduction of safety behaviours at a manageable pace
  • Learning and practising anxiety management techniques
  • Building uncertainty tolerance skills
  • Developing relapse prevention strategies

Between-Session Work: Recovery happens through consistent practice. Your therapist will set collaborative homework tasks—thought records, behavioural experiments, mindfulness practice—that consolidate learning between sessions.

Progress Review: Regular monitoring of progress ensures treatment is effective and allows adjustments when needed.

How to Get Started

Taking the Next Step

If you'd like to explore professional therapy for health anxiety with Talking Therapies UK:

  1. Visit our website to learn more about our services, therapists, and approach
  2. Complete our online enquiry form or call us to discuss your needs
  3. We'll match you with an appropriate therapist based on your specific requirements
  4. Schedule your initial assessment at a time convenient for you
  5. Begin your recovery journey with expert, compassionate support

Don't let health anxiety control your life any longer

Our Approach

We offer evidence-based therapies to help you manage and overcome your mental health difficulties. 

Our approach includes:

CBT helps identify and change negative thought patterns that contribute to maintaining depression and anxiety. By reframing these thoughts, you can improve your mood and overall mental health. CBT also teaches practical skills to manage stress and improve problem-solving abilities.

IPT focuses on improving interpersonal relationships and social functioning to help reduce depressive symptoms. It addresses issues such as unresolved grief, role transitions, and interpersonal conflicts, helping you build stronger, healthier relationships.

This approach encourages you to engage in activities that you once found pleasurable or meaningful, helping to break the cycle of depression by increasing positive experiences. Behavioural activation can help you reconnect with activities and hobbies that bring joy and satisfaction.

Our holistic approach ensures that you receive comprehensive care that addresses all aspects of your mental health.

Why Choose Talking Therapies UK?

Talking Therapies UK

Expert Care

Our therapists are experienced in treating depression with the latest evidence-based methods. They are committed to providing personalised care tailored to your unique needs, ensuring that you receive the most effective treatment.

Confidentiality & Compassion

We provide a safe, confidential space for you to talk about your feelings without judgment. Our therapists offer a supportive and understanding environment to help you feel comfortable and heard, prioritising your privacy and comfort.

Convenient Online Sessions

Access therapy from the comfort of your home, making it easier to get the support you need. Our online platform is secure and designed to facilitate effective therapy sessions, ensuring you can receive help when and where you need it.

Start your journey towards healing today

It’s important to seek help from a GP if you think you may be struggling with your mental health. Many people wait a long time before seeking help, but it’s best not to delay. The sooner you see a doctor, the sooner you can be on the way to recovery.

Contact Us

Take the first step towards recovery with Talking Therapies UK. Our compassionate therapists are here to support you on your journey to better mental health and a brighter future. Contact us today to start your path to healing and wellbeing.

Talking Therapies UK

Book a Session

Schedule your online therapy session with one of our experienced therapists at a time that suits you. Flexible evening and weekend appointments are available to accommodate your busy lifestyle.