Health Anxiety Treatments: The Cognitive-Behavioral Interventions

Research has shown that there are effective methods for treating health anxiety disorders. However, it is a major challenge to make treatments acceptable to people who are reluctant to acknowledge that their health concerns are excessive.

What Is Health Anxiety?


Health anxiety is characterized by excessive anxiety about one’s health, stemming from beliefs that one’s physical integrity is threatened. Like other forms of anxiety, health anxiety is a multifaceted phenomenon, consisting of distressing emotions (e.g., fear, dread), physiological arousal and associated bodily sensations (e.g., palpitations), thoughts and images of danger, and avoidance and other defensive behaviors.


Virtually all of us have experienced health anxiety at times in our lives. Often the anxiety is adaptive because it motivates us to seek appropriate medical care. Health anxiety, on the other hand, is maladaptive if it is out of proportion with the objective degree of medical risk.


For example, excessive worry about minor, harmless bodily changes (e.g., spots or rashes) or bodily sensations (e.g., muscle twinges) can cause undue suffering and impairment in social and occupational functioning.


Cognitive-Behavioral Interventions


There are several treatment packages that are similar to one another in that they incorporate one or more cognitive-behavioral interventions. These treatments include psychoeducation, explanatory therapy, exposure and response prevention, behavioral stress management, and cognitive-behavioral therapy.


For mild or short-lived health anxiety, psychoeducation may be sufficient, delivered either by the primary care physician or in the form of educational courses. If that does not prove effective, then more intensive interventions could be considered.


It should be noted that for patients with delusional disorder (somatic type), it remains to be seen whether cognitive-behavioral methods are helpful in these cases.


Psychoeducation

The psychoeducation programs involve a mix of mini-lectures, demonstrations, video illustrations, focused group discussions, and brief exercises. Homework assignments are brief and optional (e.g., monitoring and challenging thoughts, identifying avoidance behaviors, monitoring daily hassles).


Explanatory Therapy

Explanatory therapy includes a number of interventions intended to persuade the patient that there is nothing wrong with her or his physical health. It involves repeated physical examination, whenever the patient requests one, or when new bodily complaints arise. Patients are also repeatedly told that there is nothing wrong with them.


Exposure and Response Prevention

People with severe health anxiety are often fearful and avoidant of stimuli that they associate with disease. Accordingly, clinicians have used various forms of exposure therapy to reduce severe health anxiety, including in vivo exposure (e.g., exposure to hospitals), interoceptive exposure (e.g., physical exercise to induce rapid heartbeat), and imaginal exposure (e.g., imagining that one has developed a feared disease). Exposure is conducted in treatment sessions and as homework assignments.


Behavioral Stress Management

Behavioral stress management emphasizes the role of stress in producing harmless but unpleasant bodily sensations and changes. It involves training the patient in various stress management exercises (e.g., relaxation training, time management, effective problem solving), as well as reintroducing regularly scheduled pleasurable activities that promote a healthy lifestyle as a means of managing stress.


Cognitive-Behavioral Therapy

Cognitive-behavioral therapy incorporates psychoeducation as well as exposure and response prevention along with cognitive restructuring and behavioral exercises. Cognitive restructuring is used to examine beliefs about the meaning of bodily sensations and changes, whereas behavioral exercises are used to further test the consequences of these beliefs and to examine the effects of behavior patterns that maintain and exacerbate severe health anxiety (e.g., to test the effects of reassurance seeking vs not, to test the effects of directing attention toward rather than away from bodily sensations and changes).

Sources consulted:

Asmundson, Gordon J. G., el al. “Health Anxiety: Current Perspectives and Future Directions.” Current Psychiatry Reports, vol. 12, 2010, pp. 306–312.

Taylor, Steven, and Gordon J. G. Asmundson. Treating Health Anxiety: A Cognitive-Behavioral Approach. Guilford Publications, 2004.

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