How to deal with health anxiety

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1:06Kimberley Wilson:I'm Kimberly Wilson. I'm a counselling psychologist and this is Complex. The psychology podcast that helps you navigate your way through the twists and turns of information and misinformation that's out there about our mental health. In today's episode, I'm exploring health anxiety. And I'd like to start this episode by reassuring you that it is completely normal to worry or be concerned about your health. But sometimes attention to it becomes so intense that your day-to-day life is impacted. And that's when we, as psychologists, become concerned.

1:49Kimberley Wilson:And here's a little bit of irony for you. the anxiety itself can make you feel physically unwell and so you can fall into a vicious cycle you notice a symptom you worry about it and then the symptoms increase if this is you then my dear listener you are not alone it is hard to get exact figures because it's not something people like to admit to but somewhere between two and thirteen percent of the population experience it. In this episode, I've invited an expert guest to help give health anxiety a thorough examination, and I'll be sharing a listener email from someone who's struggling with it themselves.

2:33So let me be your guide from the brown banana skin of misinformation

2:38Kimberley Wilson:to the overflowing fruit bowl of understanding.

2:46Kimberley Wilson:my guest today is dr kieran schnack who is a clinical psychologist kieran welcome to the show i'm so excited to be here thank you for having me can you tell our listeners a little bit about your work please yeah so i'm a clinical psychologist and i've been working in a gp practice where we see a lot of patients that may be health anxiety related so that's been a big part of my work. And is health anxiety something that you have personal experience with or something that you've seen in people around you? I know a lot of people that have had health anxiety, sometimes because they've got a legitimate health issue and sometimes it's classic health anxiety.

3:28But lots and lots of patients with quite severe and sometimes moderate health anxiety.

3:35Kimberley Wilson:And I've seen your many lovely videos on social media. They're helping to educate people about mental health. It's what we're all about here. What is it that got you into it? I got into it because of the amount of people that I was seeing with such an intense level of distress and suffering from having health anxiety and that sense of feeling so under threat because with health anxiety comes the fear of either you will die or you will suffer immense pain and chronic disability and I think to live in that reality is so distressing and disturbing I just felt this real need to help people that were coming in with this presentation.

4:17Kimberley Wilson:Thank you well it sounds like you are the ideal guest to be talking to us about health anxiety so I think this is going to be a fascinating and incredibly helpful episode.

4:32Kimberley Wilson:okay karen so we know that people have been documenting and discussing health anxiety since at least the 1600s so it's not a new issue and it used to be known as hypochondriasis or hypochondria but it was renamed as illness anxiety disorder or iad in 2013 now that is a complicated sounding term. So please can you help us out with a nice clear clinical definition of health anxiety? So health anxiety is a constant worry about being seriously ill or becoming seriously ill when you're not. It results in checking behaviours, so you may check your body, you may check your temperature, your blood pressure.

5:14You also check online and research the health problem that you're afraid of. A lot of people end up with an encyclopaedic knowledge of medical conditions, Reassurance seeking where you're constantly asking either the internet, Google, friends, relatives, partner, parents for reassurance that you're safe and well. Not everybody seeks reassurance. Some people avoid. So they may avoid looking at a certain part of their body if they think they've got a lump somewhere because they don't want to find it. Or they avoid hospitals or avoid attending doctor's appointments because they fear they'll be told the worst.

5:47And the last one is acting as if you're a ideal or taking on the persona of somebody who has an illness. So you may slow down your movements, you stop exercising. So you're treating yourself and your body and mind as if you are already ill.

6:02Kimberley Wilson:Gosh, so that can be really debilitating, not just psychologically in terms of the constant worry and concern and preoccupation, but you're not engaging perhaps in health-seeking behaviours and self-care type behaviours. Yeah, absolutely. And we know, don't we, from all the exercise and movement that we recommend to people that come to see us for help, that all the hormonal benefits that you get from movement and exercise, you don't have anymore. So that in itself can bring on more anxiety symptoms. And it's a vicious cycle because then you see those symptoms as proof of illness and then over-identify even more with being unwell when you're not.

6:37Kimberley Wilson:And I mean, I don't think there's anyone among us that hasn't kind of jumped online when we've had that weird twinge or a tingling or my eyelids been twitching for a couple of days. So what is the difference between a bit of curiosity and health anxiety? Yeah, that's a great question because there is a real difference between having normal health concerns that actually should be checked out by a GP or do warrant investigation and believing that you have an illness when you don't. And you've had medical clearance or you've had tests that prove otherwise and sometimes repeated tests. I see patients sometimes that have had 100 tests or 200 or have been banned from going to their local A &E because of the amount of testing.

7:23So there is a real difference. It's very difficult. People sometimes say, well, should I go to the doctor or not? And I say, well, generally speaking, the GP say, if it's not gone away within two weeks, come and see us if it's new and concerning and we'll check that out. if then you've had those symptoms checked and there isn't anything medically wrong then we move on from it but it's when you go and see somebody and there is a conclusion that test results are clear but you still don't believe that you're safe in your body and that there

7:53Kimberley Wilson:is something wrong so that persistent sense of yeah doubts in the results or the conclusions and concern or worry about your not just your symptoms but as you were describing your your sense of safety in your body. Yeah, it is about safety and integrity. And often it's that's driven by there's been sometimes an experience in that person's life where actually something's happened along the line that has made this person sitting in front of me feel unsafe at some point. And health anxiety is sometimes a manifestation of that. It's very hard to trust that I'm okay. And I'm okay in my body. It's hard to trust what this doctor is telling me.

8:36Kimberley Wilson:that's really helpful because I feel like now we have a solid understanding those checkpoints of what health anxiety looks like from a clinical perspective so now what I'd like to do is to bring in an email that's been sent in to us by a listener and I suppose I should say to everybody listening that we have had so many emails come in about health anxiety it's one of our most requested topics so far so thank you everyone who sent us their experiences and Kieran I'd like to share one of them with you. I am calling this listener Jasmine to protect her identity. Have a listen and tell me what you think.

9:13Kimberley Wilson:So Jasmine says, hello, I'm a big fan of the podcast. Thanks for making such nuanced but accessible content, exactly what we all need. You are very, very welcome, Jasmine. She says, I love an episode on health anxiety. I struggle with this quite a bit, feeling small aches and pains or sensations and catastrophizing in my head. I'd be interested to know if there are any ways to help ease anxiety during moments like this, why they arise, and how to balance being aware of our body alongside not becoming overly anxious and worried. So thank you so much for sharing your experience with us, Jasmine.

9:52Kimberley Wilson:Kiran, what did you make of the email? Yeah, I think that's a common experience. Thank you to Jasmine for sending that in. And the trigger point is often the sensations. So you might have a resting level of health anxiety and worry about your health and then you get twitches and feelings in your body and you assign meaning to them which if you're prone to health anxiety you're more likely to do and you know bodies are noisy your body makes noise my body makes noise and what happens when you have health anxiety you pay attention to that noise which somebody without health anxiety may not do and then when you do your experience of those sensations can become amplified and then you feel more frightened.

10:33Kimberley Wilson:So you focus more attention and it's almost as if that thing gets bigger in that focused attention. Absolutely yeah and sometimes people have it about a particular symptom let's say they've developed a lump in their throat and they might worry about thyroid cancer but then there are other people whose experience of health anxiety is something on their skin, a mole, a lump, a temperature or feeling off or their memory it can just move from thing to thing and I say it's like a track that's been laid down and it's like putting a vehicle on that track and that track just gets deeper and deeper until it becomes the only path or route for your brain to take.

11:09Kimberley Wilson:That's really helpful. Thank you Kieran. This feels like an incredibly important and under discussed given how many people it affects topic so let's get into the complexity.

11:25Kimberley Wilson:Okay, so let's start from the very beginning. What age does health anxiety typically emerge? So the youngest person I've seen is around 12, 13. And children can become quite anxious about really minor things sometimes. They might have a stomachache and think that they're dying. Sometimes there's something in the family that may have contributed to that, or it can be things that they've seen online. And when you say something in the family, what do you mean? If they've had a parent or relative that's been ill and they've had exposure to illness and disease and seen the trajectory of that and also it can be if they've got parents that work in the health service.

12:07You know, a long time ago people used to take their children to work or they'd come to work after school and hang around in the hospital or wait in the offices. So there's that cohort of people that have had exposure to health information and illness that they may not have had.

12:23Kimberley Wilson:Yes, so a kind of precocious encounter with health information that perhaps they can't quite place or process at such a young age. Is there a higher prevalence of health anxiety in health workers themselves or does the knowledge inoculate people against health anxiety? I see a good proportion of doctors and nurses and other allied health professionals that because of their knowledge of disease and illness, they've become anxious. But then there are many that don't care and are not affected. But yes, there definitely is. So you've spoken about very young people starting to get and present with health anxiety.

13:05Kimberley Wilson:When does health anxiety peak? There is a well-documented peak in middle age, which clinically, in my experience and in some of the research, is tied to people becoming parents. When you become a parent, the meaning of life and health changes for a lot of people. And people suddenly feel like I've got to stay alive because I've now got this child who's dependent on me for their survival. So that can really heighten health anxiety. and we also know that health anxiety is associated with other common mental health conditions depression and anxiety but that it sits within obsessive compulsive disorders is that right yeah that's right there is a real link and that's partly because of the symptoms it shares which is the obsessional worry so in OCD we say you know the O is the obsession the thing that you're worried about so in health anxiety that's the health anxious thought and then there are we're ritualistic behaviours which are body checking, researching the internet, asking for reassurance.

14:04So they're almost like compulsions that we have in OCD. So we've got the obsessional thought which we try to neutralise or get rid of by carrying out a compulsion.

14:14Kimberley Wilson:Yes, but I guess that doesn't really work. You know, there's something about the striving for reassurance and no reassurance is ever quite enough. No, absolutely. And the same as with OCD because what reassurance does is it gives your brain that temporary relief that oh gosh thank goodness I'm okay and then what happens the anxiety is still there because your brain still holds those beliefs so your nervous system is still activated with those fears and so it builds back up and then you need reassurance again. And the research shows us that health anxiety has been on the rise since the 1990s but there was a particular increase since the COVID pandemic.

14:57Kimberley Wilson:Do you have any sense as to why that would be? Yeah, the pandemic was one of the first times in my lifetime and many people's where we have got the message from government and the world that you are in danger. And I think if the belief in health anxiety is that fundamentally I'm unsafe and I'm in danger, this is now being reinforced by what's really happening in the world and that you must take precautions, you must wash your hands, you must, you know, wear a mask. And I think in those early days, it was really terrifying for people. It was very frightening. And I suppose it was the first kind of digital pandemic, you know, there was a huge amount of information that I don't think people could really make good use of.

15:39But I think the pandemic, it was really difficult for a lot of people. And many people that I saw post pandemic is the time that I did the most home visits that I've ever done in my career. Because people couldn't leave their homes even a year, two, three years after the pandemic, because they were still afraid. And you know, my main job was just to get these people back out of their homes.

16:00Kimberley Wilson:Yes, that's a good point, because we had clear messages of when to start worrying. You know, we're going into lockdown now. You should be disinfecting this and such and washing your hands. I don't know if we ever got a clear message of when we could stop worrying, if that ever came. We didn't. Nobody ever said, right, you can go out now and just go back to normal. Your life.

16:24Kimberley Wilson:Thank you. That's really clarifying, because now we have a sense really of those risk factors and the environmental factors and the situational factors that can kind of reinforce or trigger someone's symptoms. Now, I'd like to put our topic on a scale. At what point does curiosity about our physical or mental symptoms tip over into actual health anxiety? When should we be worried about our anxiety? if you have a symptom and you are worried about it like I said if it's new and concerning and it doesn't go away you should not assume that checking the internet or reading information on the NHS is a sign of health anxiety because that's responsible health behaviour if you have new concerning symptoms you should pay attention to them if you do that excessively or it continues beyond the symptom settling, then that is concerning.

17:21And there's a pattern of it happening again and again. Sometimes it can be there at a low grade, medium and severe. And if it's there at low grade and it stays at low, there may be a reason for that. That person may have had an experience in their life and they know, oh, you know, I can be a bit worried about my health. And I know it's because of this thing that happened, but it doesn't interfere with their daily life. So that might be something that they've accepted and they can live with. But a medium and severe where it's taking up more time it's affecting your functioning it's affecting your sleep and your appetite all the basic things that you need for well-being that it's become a problem

17:58Kimberley Wilson:okay so so maybe part of the question is can i put this worry down yeah is it possible for me to kind of leave it alone and go out with friends for a pizza or does it interfere does it stop me from going out in the first place does it mean that i instead i decide to stay online and research symptoms and treatments and interventions. Yeah, because if you're at home and not doing things because of it, it's become quite severe and it's going to get perpetuated because you're sitting with just it. So you've got time and space to give it more attention. And the message you give to your brain is life must stop because this horrendous thing here is happening.

18:33If you take it with you, then you're telling your brain, yeah, that's there, but we're going to go and do this thing anyway. And actually the byproduct of that behavior is that it ends up reducing in intensity. But, you know, in terms of the scale, as you were saying, I do sometimes say to people, if we said zero is not distressed at all and 10 is the most distressed I could be. And if it's 8, 9, 10, if it's at that end and it stays at that end for, you know, more than a few weeks, then that's a problem.

19:07Kimberley Wilson:OK, so now let's talk about possible solutions, things that can help. I love this bit. So if our listeners are concerned, they're worried about the relationship to their health, what can you advise? Where can they start? So I think the really important thing is what meaning you attach to those sensations. And we have a choice. So I might say, oh, I have a twitch in my side. That means it could be ALS or MS or something else. And oh my goodness, I'm going to die. And then I look up information, which then terrorizes my brain and then I go down that spiral. So I always say to people one really simple tip is to give your brain more than that one thing on the menu.

19:52What else can I offer my brain as a possibility even if you don't believe it? Actually I've been sitting in this chair for quite a long time and my body's just become a bit stiff or I've drank three cups of coffee and sometimes that gives your body a nervous system and the nerves extra energy and they just fire off to expend that energy. And just even if you don't believe that at first, just giving your brain the possibility to think a bit more wider is a good way to deal with your interpretation of those sensations. Thank you. So that's the first one. The second one was reassurance seeking, just reducing that if you can.

20:28You know, a really easy way is to say, okay, I'm only going to ask my partner, say at nine, 12 and six, and only once each time. So there are, you know, really simple ways to just gradually wean yourself off the reassurance. Yes, absolutely.

20:43Kimberley Wilson:And that puts a nice bracket around it. It kind of stops it from seeping out into the rest of your day, into the rest of your life. Yeah, exactly. And it also shows your brain. We don't need to keep asking because between 12 and 6, nothing bad happened. You're still alive and you're still well. And your brain naturally starts to rewire its own thinking because it thinks oh um you know they're not doing this anymore maybe it's not that bad so you get one the effect of your change in behavior but also the way your brain adapts to what it learns during that process the third one was about avoidance if you're avoiding going to the doctor or avoiding looking at certain things we do a hierarchy what's the easiest thing that i can try to you know face and not avoid and then just working from there and then the last one was stop over-identifying with illness stop taking on that persona by just going back to doing the things that you used to do really small simple steps baby steps and just doing one thing and then building up from there lovely thank you that's a real kind of plethora of ways in for people to just start readjusting and shifting their thinking and their behaviors around their health anxiety I think that's really, really helpful.

21:56Kimberley Wilson:And thinking back to Jasmine's email, she asked, what could she do to ease anxiety in the moment? So what would you suggest to her? Yeah. So in the moment when anxiety is really high, it's very difficult to logic your way out of it at that point. It's about your body. And I say, you need something that helps your body in that moment. So that can be a quick burst of movement. It can be, you know, three sets of 10 star jumps on the spot because it burns the adrenaline and cortisol that's built up in your system ready for fight flight because you become frightened of whatever health anxiety is presented to you or it can be you know using your sensory system so something cold holding an ice cube or something that has a very strong taste a sour taste something spicy you know people that are listening please don't get blisters on your tongue but sometimes some of my patients find you know a slice of chilli that's not too spicy on the end of the tongue because when your sensory system is stimulated it can help dial down your nervous system and there's also a simple breathing technique that I teach people I'll just demonstrate if that's okay absolutely so you take a really long slow inhale for your nose like this and then you hold it and then you take another inhale sharp and slow and then you exhale with a sigh and that really helps reset your nervous system in the moment and it can calm down stress because that second inhale really opens up those tiny air sacs in your lungs that when you're in shallow breathing have stopped working in the way that they should lovely and there's a kind of direct feedback yes your nervous system instant and direct feedback that can reduce stress