Health anxiety presents unique challenges compared to other forms of anxiety, requiring specific modifications in therapeutic approaches. Here’s an exploration of these differences and how therapists adapt their strategies.
Unique Challenges of Health Anxiety
- Compulsive Behaviours: Unlike many other anxiety disorders that compel you to not do things, health anxiety and Obsessive Compulsive Disorder (OCD) often compel you to do things. Health anxiety therapist operates through obsessional fear about health issues, driving compulsive behaviours such as checking, researching, reassurance-seeking, discussing, and imagined prevention. These compulsions can be exceedingly difficult to resist, as individuals believe they must engage in them to stay protected from irrational health-related obsessions.
- “Yeah, but…” and “What if?”: Health anxiety can be particularly challenging because logically arguing with clients often results in them becoming even more caught up in spirals of “Yeah, but…” and “What if?”.
- Misinterpretation of Bodily Sensations: People with health anxiety tend to focus on physical sensations and interpret them as signs of serious illness.
- Cycle of Reassurance-Seeking: Reassurance seeking is common, but the relief is often temporary, leading to a repetitive cycle of anxiety and reassurance.
- Overlapping with Other Conditions: Health anxiety can overlap with other mental health conditions, such as depression, which complicates the presentation and treatment.
- Fear of Fear: A core component of most anxiety disorders, including health anxiety, is “fear of fear”, which can maintain and exacerbate the anxiety cycle.
- Avoidance and Safety Behaviours: Individuals may avoid medical appointments or certain activities, while also engaging in safety behaviours that maintain anxiety.
- Difficulty Accepting Uncertainty: Health anxiety often involves a low tolerance for uncertainty regarding one’s health.
Therapeutic Adaptations for Health Anxiety
- Process-Focused Approaches:
- Recent research suggests that process-based approaches, like Acceptance and Commitment Therapy (ACT), can be more effective than disputing the content of anxious thoughts.
- ACT focuses on acceptance, mindfulness, values, and quality of life, rather than just symptom alleviation and control.
- ACT aims to foster psychological flexibility, experiential acceptance, and movement towards valued goals, helping clients live a rich and meaningful life despite anxiety.
- Acceptance and Willingness:
- Encourage clients to recognise that anxiety is a part of being alive and that struggling with it only exacerbates the problem.
- Promote willingness to experience anxiety without trying to control or avoid it.
- Help clients understand that willingness is a choice to experience what is there to be experienced without trying to change the experience.
- Values-Based Action:
- Help clients clarify their values and take action consistent with those values, even in the presence of anxiety.
- Focus on what clients can control with their “hands and feet,” guiding them towards valued life directions.
- Mindfulness and Defusion:
- Use mindfulness to observe anxiety-related responses fully for what they are, increasing response options and flexibility.
- Employ defusion techniques to help clients relate to urges and thoughts from a mindful, accepting stance.
- Experiential Exposure:
- Guide clients to deliberately bring about physical sensations and images that normally elicit distress to create a context where avoidance is unworkable.
- Help clients travel with their anxieties and fears, integrating them into their lives alongside joys and dreams.
- Address Avoidance and Control Efforts:
- Identify patterns of experiential avoidance and experiential control efforts at cognitive, emotional, and behavioural levels.
- Explore the workability of strategies clients have used to cope with anxiety and reduce suffering.
- Help clients experience the futility of past avoidance and control efforts, fostering a sense of “creative hopelessness”.
- Collaboration and Trust:
- Create a strong therapeutic alliance based on trust and collaboration.
- Model acceptance of anxiety and avoid inadvertently teaching avoidance.
- Focus on the Present:
- Encourage clients to explore anxiety with curiosity, moving into the anxiety itself to understand it better.
- Shift the focus from content to process when clients experience strong reactions, asking about physical sensations and thoughts.
Health Anxiety Summary
Health anxiety presents unique challenges related to compulsive behaviours, reassurance seeking, and misinterpretation of bodily sensations. Therapeutic adaptations involve process-focused approaches such as ACT, emphasizing acceptance, values-based action, mindfulness, and experiential exposure. The therapist helps clients address avoidance and control efforts, fostering a collaborative relationship to navigate anxiety and live a more meaningful life.
Tags: health anxiety, ACT, acceptance, mindfulness, values, experiential exposure, avoidance, compulsive behaviours, anxiety management, therapy adaptations