How to overcome health anxiety and let your fears go

One of the occupational hazards of being a health journalist is a serious dose of health anxiety. But I’ve noticed lately that many of my generation have started to fret about their wellbeing, too.

"I used to feel invincible but since I had breast cancer 12 years ago I’m hyper alert to every ache and pain," says 65-year-old personal trainer Dianne Jones.

"Recently when a client and a friend both developed atrial fibrillation I noticed a buzzing feeling in my own chest and an irregular heartbeat and convinced myself I had it too."

Five per cent of people suffer health anxiety, previously known as hypochondria, a term largely abandoned because it trivialises a genuine problem, according to consultant psychiatrist and author Professor David Veale from South London and Maudsley NHS Trust.

"Those affected will search out information on the internet, check for signs of illness, seek reassurance from friends and relatives and book doctors’ appointments in the fear that something terrible is wrong," he says.

"When a test result comes back negative, it tends not to relieve their fears. Instead, they may worry that something has been missed and seek a second opinion."

Health anxiety can become more troublesome as we age and accrue more long-term conditions, such as arthritis, diabetes, COPD and heart problems.

"Older people with long-term conditions are more likely to develop physical sensations and interpret them wrongly as caused by something serious," says Professor Veale.

Symptoms they may have shrugged off without a thought when younger get blown out of proportion: a run of palpitations spells an imminent heart attack, a bout of dizziness a sign that we’re about to have a stroke, forgetting someone’s name a terror of impending dementia.

However, anyone suffering from rapid heartbeat or dizziness for the first time should get it checked out, he stresses.

What causes those anxious feelings?

"At the heart of health anxiety is 'catastrophising', thinking the worst is going to happen, plus an intolerance of uncertainty, as well as perhaps a degree of 'magical thinking' where people think that fearing something bad is going to occur causes it to do so," explains Professor Veale.

An inability to tolerate uncertainty often originates in previous experiences. Childhood illness and an anxious mother were triggers for John Nolan, 70, who started to worry about his health when he had a haemorrhage following a tonsillectomy aged five. A few years ago he had a panic attack and ended up on a cardiac ward.

"Even the doctors thought I’d had a heart attack until further tests revealed I hadn’t. Since then, I haven’t been able to let go of the nagging fear that there is something seriously wrong with my heart."

Another trigger for health anxiety, noted by Associate Professor Renée El-Gabalawy of the University of Manitoba, is a period of stress, serious illness, a significant loss or being exposed to media stories about disease.

This was the case for Helen Barton, 61, from Bath, who became anxious about her health after the death of her father and grandmother: "Because you’re so worried, you end up reading everything online, and it’s not always rooted in fact, making you even more concerned and anxious."

The pandemic has not helped either, fuelling fears of illness and an explosion of ‘cyberchondria’, exacerbated by lack of social support and loneliness, according to a report in the International Journal of Cognitive Therapy.

What can you do?

Author Peter Tyrer, emeritus professor of psychiatry at Imperial College London, says most doctors don’t have the training to treat health anxiety.

"There is an understandable tendency to reassure and thereby detract from the severity of the psychological condition and to expect that tests showing absence of pathology will satisfy the patient," he writes. "These actions are counter-productive as they reinforce abnormal health beliefs."

Words intended to be reassuring such as ‘There is really nothing wrong with you that we can detect’ are interpreted as, ‘I must be in the wrong clinic – I will ask my GP to make a new referral’ while, ‘I think it might be best for you to see a psychologist’ can be seen to infer that their problem is all in the mind, he notes.

What to do if you're afflicted

Cognitive Behavioural Therapy (CBT), which involves challenging anxious thoughts and learning to behave differently, is the mainstay of treatment.

A vital first step is to banish so-called ‘safety-seeking behaviours’ by stopping checking symptoms, seeking reassurance from friends, family or the doctor or spending hours on the internet.

Professor Veale also recommends ditching books, test kits, apps, health trackers, monitors and alternative remedies aimed at fending off illness. Learning to refocus attention outwards and away from yourself is a key tactic.

So is facing fears of ill health and death – for example, by mentally rehearsing a feared event such as being told you only have a few months to live, by writing it down on paper and reading it back to yourself.

You can train yourself to detach your brain from anxiety-provoking thoughts and allow them to pass through your mind without hooking onto them. And sit out uncomfortable feelings such as a rapid heartbeat and recognise that they are caused by anxiety rather than disease.

Once free of health anxiety’s clammy claws, fill the gap with pleasurable pastimes such as going to a dance class, learning a language or volunteering.