Episode #91

Health Anxiety & CBT

Health anxiety can be especially challenging to deal with because, to some extent, it is rooted in reality because we all get sick at some point!

Over 200’000 people are diagnosed with health anxiety each year. If you’re one of them, you are not alone!

How can you use CBT to cope with health anxiety?

How can you identify and challenge your core beliefs around health & illness anxiety?

Join me, Dr Julie Osborn, as I share with you the answers to these questions.

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Full Episode Transcript

Hi! This is Dr. Julie Osborn. Welcome to My CBT Podcast! I'm a Doctor of Psychology and a licensed clinical social worker, specializing in Cognitive Behavioral Therapy.

I'm here to help you bring the power of CBT into your life.

I appreciate you being with me today. So as many podcasts I start off with the email from you guys that have reached out, which I really appreciate and I'm going to keep the person's name confidential but to read the story because she gave me a great idea for my podcast today.

So I thought it'd be a good way to start out.

So it says,

“Dear Doctor Osborn, I recently found your my CBT podcast on Spotify and I found it very helpful. You're so warm and reassuring and I find myself feeling better each time I listen. I especially appreciated your episode on core beliefs. I struggled with anxiety for years and have been to therapy off and on.

My biggest struggle is with health anxiety. I live in constant fear that something awful is going to happen to me health wise and that I won't be able to handle it. My mother died suddenly at age 50 of a heart attack. I am now 59 and generally healthy but live in fear of the same or other devastating health issues happening to me. I realized that one of my core beliefs is that if I'm just disciplined enough with nutrition and exercise, I can control my health and avoid negative outcomes.

I know intellectually that some things are simply out of our control no matter what we do, but I'm struggling to change my thinking and overcome the anxiety I feel around doctors appointments, receiving test results, et cetera. Anyway, I would love to hear podcasts and health anxiety and how to identify and change core beliefs related to that specific issue. Many thanks for your wonderful work and sharing your knowledge and encouragement with all of us.”

So thank you very much for that email and this is a great podcast to talk about with health anxiety because I actually had many clients who have had health anxiety and it's a real tough one because health is a real thing, right? It's not just some imagined fear that we all have health issues.

At some point we probably will most likely have a health issue and how do I cope with that? I also wanted to make note of the fear that my writer mentioned about her mom dying at 50. She's 59 now, but I can tell you my mom's parents died very young and I remember her and my aunt talking about kind of this milestone once they got to their parents'age and they still live far longer than their parents ever did. But it's this anxiety that comes up of like, oh, my parent died at this age, what about me? So I totally get that too.

I just wanted to share that because I remember my mom talking about that often and always worrying about what your outcome is going to be, comparing it to maybe what your parents went through. So as I was saying, health anxiety is a very common anxiety. And if you listen to my podcast on just anxiety and CBT, I do talk about looking at anxiety like an umbrella, right? And there are umbrellas above the umbrella might say anxiety disorders. And then underneath you have generalized anxiety, you have phobias, you have OCD, you have panic disorder.

There's lots of different types of anxieties. And this is another one, illness anxiety.

I'm going to share with you a little bit more about what it looks like. So you can see, is this something I'm struggling with? And obviously giving you tools to walk away with so that you can start feeling better and be relieved of this health anxiety so it's not affecting your life so strongly. So let me tell you just a little quick little statistic here that the research shows that there are more than 200,000 persons diagnosed with this per year. And around 80% of the people with anxiety, health anxiety, sorry, also struggle with generalized anxiety or depression.

And that's important to understand because you'll see when I start talking about the CBT tools is that the health anxiety or quote, illness anxiety they call it as well, is usually really not about that, but something underline that's going on that we're just not acknowledging to ourselves. So that's why it's important to understand that about 80% of people also struggle with anxiety and depression if they're having illness anxiety, if that's their focus. So I'm going to give you a little story here and see if this is something you relate to or of course, you might know somebody with illness anxiety and please share this podcast with them. So Susie felt great after her yearly physical, but her doctor wanted to follow up in six months for mold that she noticed on her back. Her doctor reassured her that it was fine, but just wanted to be safe and have her check in one more time because he had not noticed them all before and just want to make sure it wasn't getting growing.

So that night, Susie went home and she couldn't fall asleep. Being hyper focused on the mold that her doctor noticed, she had catastrophic thoughts that she was probably going to have melanoma and die. She can't wait six months. She needs to go see somebody else. What if you missed something?

What if you diagnose it? What if it's too far, already gone and all of these thoughts were running through her head and she couldn't fall asleep and then going on the internet, right, and she's trying to diagnose herself. What else could it be? All of these things. So if this is what happens to you when you try to go to bed at night and you start thinking about things, or maybe after a doctor's appointment and they just said oh, let's just follow up just to make sure everything's okay.

Your mind can just race, right? Just race and it can overtake your life. That is one sign that you may have this illness, anxiety going on. And that's how a lot of people start thinking that any little feeling in their body, instead of like, okay, there's a lot of things going on with my body, but maybe that's a horrible thing, and they go to the worst case scenario, like cancer, I'm going to die, I'm going to have a heart attack. This is really severe, and you just get completely wrapped up in that and it just amps your anxiety.

So the definition of health anxiety is when someone has an obsession with the idea of having a serious but undiagnosed mental condition. It usually develops during your adult years. And symptoms could include something long term regarding your anxiety and intense fear of having a serious condition. And you worry that minor symptoms indicate something serious. So this is when, whether it's yourself or someone you know, you may visit the doctor's often self diagnosed, as I was mentioning earlier, research on the Internet go to urgent cares.

Just always running and running around trying to find someone to say, yes, this is what it is. Even though that's your biggest fear, right? You don't want to have the diagnosis, but you think you do. So you can imagine when you're going through this, it can affect your ability to function on a daily basis because you're so afraid of being sick and you're preoccupied with it. So you might obsess just about regular body functions like your heart rate or your breathing.

There are physical issues, like I mentioned in Susie's story, about a mole or having physical discomfort, like if your stomach is bothering you or you feel dizzy or having a headache. You might even worry about specific organs like your heart, or worry about having diabetes or Ms or different things like that that you've heard about in the social media. Also, I think most of us are a little hypersensitive with Covet that as soon as we have a sore throat, we're kind of going to that worst case. Oh God, I have Covet, I have to go get tested. And that's just because we know what the symptoms are.

We worry about it. We were about getting other people sick. So that's just a really good example about, you know, something that's around and that's real. But we tend to go to the worst case scenario, right? So you might think you'll get sick or you already are sick, and this cycle just continues each time you quote, feel something, and then you think the worst.

So you can just hearing this and saying it out loud, you can imagine the amount of stress that either you're going through or somebody else is going through. It's just exhausting. Instead of kind of going through your day and saying, okay, I got a headache today. Let me take some aspirin. Like, oh, my God, I might have a brain tumor.

And that's when people start to think, right? Or they ate something a little spicy and their stomach's upset. And instead of taking that into consideration, I think now I have stomach cancer or I have an ulcer or what might be happening. I have to go get it checked out and not just kind of going through their day realizing that they're going to have different feelings and things happen to your body, and it's all within normal range. So I once heard someone say that the body is a very noisy place, which I thought I wanted to repeat that and share that with you because I thought the body is a very noisy place.

But what that means is that it's normal to feel things in your body that might be a bit uncomfortable, but it doesn't mean that you're in danger. And to really remember, like, oh, that's normal. That's normal. I think if you had a friend or maybe your kids says, oh, mom, my stomach's bugging me, the first thing you might say is like, oh, what did you eat? Right?

And you might say, oh, I had a whole bag of chips. And your first thought might be like, well, you probably ate too much of the junk food, and you know your stomach's bugging you. But when it happens to you personally, you go to the worst case scenario. So that's where all the anxiety just gets fed into, right? And the part of the problem here, too, I want to see is these sensations like the sep stomach are real.

And I understand that, but your thoughts are not. And your thoughts are what we call your hot thoughts, right? We talk about this all the time. That your hot thoughts, your thoughts that are not 100% true. So it is true that my stomach's upset, but it's also true that I ate an entire bag of chips.

And when I do that, my stomach gets upset. So the sensations are real, but you have to work on differentiating that from something serious and saying, okay, what's going on? Maybe I didn't sleep well last night. Maybe that's why I have a headache, right? Maybe I'm really worried about something.

Maybe that's why I have a headache. Or my muscles are tight, my shoulders are tight because I'm stressing about something. It doesn't mean I have a physical problem. When you're looking for symptoms, you will find them. It's kind of like, you know, when you have a paper cut and you focus on it, it just hurts more and more.

So these are some of the telltale signs that you're probably dealing with illness, anxiety, and to be starting able to ask yourself, are these some things that I'm doing to myself? Or sometimes I could put this on my family, right? If I'm really scared about myself, I might be scared about everything with my family members and then make them anxious as well. So remember what I teach you guys all the time with kind of behavioral therapy, right, is that our thoughts create our moods, which affects our behaviors and our physical reactions based on what's going on also in our environment, right? So one of the behaviors that people do here because they're thinking, I need to make sure if something's wrong, I'm figuring it out, is what I call you do like this body scan.

So you might wake up in the morning and just kind of scan your whole body, right? Looking for something. Does everything feel okay? Oh, that doesn't feel like you're looking for something. But then that increases the physical sensations, which makes everything worse, makes you more anxious, and then it just feeds into all of your hot thoughts.

So it's right there. It's everything I teach you guys about cognitive behavioral therapy. I think I need to be aware of what's happening. So my behavior is to scan my body. I feel a little something uncomfortable, right?

My anxiety goes up, and now I got all these hot thoughts, these catastrophic thoughts that are just feeding and making my anxiety worse. So I have to go run and do something to get rid of this. So I'm going to go call a doctor. I'm going to go to urgent care. I'm going to go on the Internet and look things up.

And you're never really going to find the answers, and you're kind of wanting to find an answer. You're not really going to say, oh, everything's okay. You're looking because you really think something's wrong. So of course that's going to make everything worse.

So what would be a specific hot thought? Maybe I need to be aware of my body so I can identify a problem. And remember this, that your thoughts are also your interpretations of what's going on. And then you give meaning to it, and you give meaning to your physical sensations, and then that's what causes the anxiety, right? We all have thoughts.

We got 80, 90,000 a day. So of course, none of them I'm sorry, most of them are not going to be correct, but it's how we give meaning to them versus like, okay, that's a thought. I tend to get anxious. I have a headache. I'm just going to take two aspirin and get on with my day.

I need to be mindful of that. Not that that's just going to fix everything, but it's my interpretation of what's going on with my body. I've given this example before in my panic disorder podcasts, and I say if I'm walking up the stairs with somebody, both of our heart rates are going to go up because we're exerting ourselves. And I might say, oh, I need to go to the gym more. And the other person might say, oh, my God, I'm having a panic attack.

Right? That is all about the interpretation you're giving to your physical symptoms and the meaning you give to the situation. So that's something really to be mindful of. That's where CBT can really help because that's what we're doing. And we need to kind of take a breath and say, okay, what's really going on here?

Am I allowing my illness anxiety to just take over? Are there any other reasons that maybe I'm feeling this way right now? So you might ask, what are some of the reasons it's even happening to somebody? Right? So a couple of possibilities are major.

Life stressors may be a trigger again, maybe the death of somebody that's maybe your age that you're thinking, oh my God, I could really have this illness if she got it or he got it, right. Passing by the time when your parent or loved one passed away, someone that you're related to, thinking, I could have the same issues. Also, if you've had a threat of a serious illness, even if it turns out not to be serious, that could be a trigger. And if you did have a serious childhood illness, that could also be a trigger for you. So I can share with you having my history of cancer.

I'm a little more mindful about things, but I've really worked on not letting myself get anxious about, like, oh my God, is there something going on related to my cancer? Right? I've gone and done a couple of appointments here and there that I needed to do just to rule things out, and then I've let it go. And I feel very confident and healthy and everything is going well. And I know that I'm doing everything I can do to be healthy, but I went through a life and death experience, meaning the fear of, is the cancer going to get worse?

Is it going to be serious? All those kind of things. That can be something if you went through, see, it happened to me, it can happen. Of course it can happen. I actually went through it.

I need to be hypervigilant now. I don't need to be. But that's something you could be telling yourself, and I'm sure many of you that are listening to me have been through your own health issues, and we want to be able to enjoy the rest of our lives once we get past that, not allow it to just continue to affect us out of this fear. Also, if you're constantly worrying about your health, that can also be a trigger in itself.

Asking people for assurance that you're not ill, it might feel good in the moment, but you don't really believe it down the road because this is within yourself. It's not from somebody just being able to say, no, you're fine. Just like I was talking about the example with Susie that even though her doctor goes, everything looks fine, no biggie. But he was being a good doctor and said, hey, just come back in six months. Let's just double check, right?

That's a good doctor. She took it to this whole other level, so him saying don't worry didn't really mean much to her. So let me clarify, though. What I'm talking about is not obsessive compulsive disorder, because I know it might sound like that a little bit, and reassurance can be a symptom of OCD, but someone with OCD may also obsess about their health. But health anxiety, again, is not OCD.

It can be separate. So you want to kind of be able to understand my health anxiety is literally just about my health. OCD can be much bigger than that. And as I was saying before, that umbrella that we want to look at and see, there's lots of types of anxiety. So some people might say, oh, you need to just go distract yourself, take your focus off your health, go for a walk, do some gardening, maybe watch a movie.

But those of you that know me well enough will say those are fine things to do, but they're really bandaids to the bigger problem. So not to take walks or garden or do things that bring you pleasure and distraction can be a tool, but it's not a solution, right? We don't want bandaids. We want some solutions.

And again, just to repeat a little bit that having the health anxiety can cause real physical reactions, right? Because when we're anxious and we start focusing on our physical reactions, like an increased heart rate, you might feel dizzy, your chest might get tight, maybe you have an upset stomach or you have tingling in your arms and feet. These are all symptoms, but they're symptoms of someone going through anxiety, not that you have a major health issue. And that when we have these physical symptoms and our interpretation is negative, it makes our anxiety go up, and then all of our thoughts continue to feed on themselves. So there's some research that says medications can be helpful if you want to go see a doctor, but they really recommend cognitive behavioral therapy to address health anxiety, which is exactly what I would say.

So as you can see, there are lots of reasons why someone might have health anxiety. And as I was saying earlier, it can be challenging because someone may already have had health issues, so they see that it is possible.

But I believe the fear of your health isn't the real issue, but the underlying issues that are going on in your life that might be just too scary to address. So instead of you focusing on that, you focus on your health, thinking you can have some control over it, because maybe you don't think you have control over other parts of your life.

So let me start off by saying I just want to give credit where credit definitely is due. Dr. David Burns, who I've had a lot of training with, has wrote the book feeling great. He also wrote a book, When Panic Attacks. And in those books, there are some of these tools that I'm talking to you about which have been very helpful regarding helping others who have the illness anxiety.

I know I keep going back between health anxiety, illness, anxiety, same thing, just back and forth. And these are some tools, some cognitive behavioral tools that can help you overcome it. So let's first talk about cognitive distortions, right? I have a podcast on that. Your cognitive distortions, there are ten of them, but one of them that stands out to me here is should statements.

So when you have a physical sensation, you may have that thought, I shouldn't feel this way, I shouldn't feel uncomfortable, my stomach shouldn't hurt me, that type of thing. So those cognitive distortions can really feed into the health anxiety. So you want to go over and just say, okay, I'm saying should. So I need to look at that because it's a distortion in the first place. Is it realistic for me to not feel well or not?

Is this something that I do to myself on a regular basis? Always worrying about my health, obviously, using a thought record, what's your situation? However you're feeling, what are your moods? And then what are your thoughts connected to it? Which ones are hot?

And being able to look at the evidence for and against that. So doing a whole thought record can also be helpful to kind of get some things in perspective regarding behavioral things that I would really encourage you to not do is if you're one of those people that goes on the Internet searching and searching for an answer, I really would stop. It's kind of going down into a black hole. You're always going to find something. We could all be diagnosed with something if we go on the Internet.

And that's not the goal. It's to inform us. But usually it makes things worse. And you can always find nightmare stories also that you can personalize to yourself. It's just going to feed and feed and feed the anxiety.

So I know, I believe in my heart that your intention is to feel better. I don't think anybody wants to be going through this. But you have to understand that the more you research, the more you look for answers. You're feeding that little monster in your head that's just looking for something to worry about. And then that ends up causing more symptoms, which just feeds into your belief.

It turns into a vicious cycle for yourself. It's very sad. People are very sad. They really struggle with this. They don't want it to take over their lives.

People in their lives get frustrated with them. It's a big problem. So it's really important to be able to work on that. And using the fall record, using identifying your cognitive distortions, saying, I shouldn't feel this way. Why not?

I have a headache. Okay. It's not a big deal. It's not that you shouldn't feel this way. I feel bad you feel that way.

But again, let's go take some aspirin, maybe take a nap, go relax, see if it decreases, do some deep breathing, that kind of stuff. So see if you can do something to have the symptoms go away. I think that can be some evidence that okay, it was just something that was passing. A really cool tool that, again, Dr. David Burns has created is called a hidden motion technique.

This one works really well for the health anxiety. So what it kind of explains is that you may have a human problem, but not a medical problem. And I was mentioning earlier that it's maybe due to underlying issues that you're not willing or ready to address. So example could be that you could be angry towards a family member. You could be unhappy at work, you could be wanting something not supposed to want.

For example, if you're a college student, a lot of times you might be going after a career that your family's really pushed you and you really want something else, and you're not willing to talk to them or bring it up because you're so scared of how they'll feel about it. Or maybe they won't pay for college anymore, right? So instead, you're having all of this anxiety and worrying about your health because you're not really being honest with yourself about what's important to you and what you want.

So I'm going to quote something Dr. David Burns wrote that I just thought is beautiful, about understanding how the hidden emotion technique can help with the illness anxiety. So he says, quote, the hidden emotion model shows us the real cause of anxiety. It's the fear of the self of who we are and how we feel as human beings. We're not simply overcoming an illness anxiety.

Instead, we are learning more about what it means to be a human being and that it's okay to have feelings, even seemingly crazy and irrational ones, and to express them, end of quote. So I thought that was beautiful, how he wrote that, and I wanted to share that with you. So what I would ask you to do regarding using this technique for yourself is to ask yourself, is there anything going on in my life that I'm unhappy with, that I'm angry about, that I don't think I, quote, should feel this way, or I shouldn't express this to somebody. I shouldn't let them know how I'm feeling, right? Or I'm at a job, it's paying good, it pays the bills.

But I am just unhappy. Even though my boss is nice, I mean, there's no problems at the job. It's not fulfilling me. It doesn't maybe meet my values or my passion, but everyone's going to tell me, are you crazy? You got a good job.

Why would you leave it, right? It's breaking out of those role models that we've been maybe raised with is you get a job and you stay regardless of if you're happy or not or meets your needs, right? Or your passion, I should say. So those are just some examples I'm giving you. If there's a relationship issue with someone you're close to, maybe have issues with inlaws you don't want to bring up to your partner, do you think they'll be upset?

Anything that you can come up with to really think about, right. And really say, okay, what other issues are going on in my life outside of these health concerns that I'm really scared about to share with others because they're going to judge me or they'll be unhappy or it's scary to make change, right. Someone's going to judge me, maybe. There's so many possibilities. I can't go over all of them right now, but I'm just trying to give you guys some ideas to start thinking in those terms.

And Dr. Burns shares a lot of stories in that book when Panic Attacks, and also he has another one called Feeling Good Together, which is a great one for communication and sharing stories with other clients where he's used this technique. And once people really get to that underlying issue and are honest with themselves and resolve it, that their illness anxiety has disappeared. So it's not always that easy. It's not just a couple of sessions and we're done.

But sometimes things can change for you pretty quickly when you get honest and real with yourself and the illness anxiety, I find that it's more about trying to control something in your life because you feel other parts of your life are out of control, but it's just too scary to go there, and it's easier to just keep the status quo. And I'll just worry about my health anxiety and thinking it's only affecting you, which isn't really true because everybody in your life is being affected because you're so anxious and upset and worried. And it's hard to be present with others and in your life when you're always worried there's some physical symptom or I have to be prepared so that I don't have a heart attack.

What are your safety behaviors in the Mind Over Mood book that I use with everyone that we talk about what safety behaviors are? So, for example, I know some clients that have used their smartwatches because it tells you what your heart rate is. Now, I know that sounds wonderful, but if you got health anxiety, take them off your wrist because you can just end up being obsessed about that. And then that just feeds all the physical symptoms, and that feeds into your belief something is wrong, right? That type of thing, you have to walk away and start saying, what's really going on in my life that I'm not dealing with?

And what can I do to fix that? And really seeing a professional for this, I think, can be really helpful because these. Underlying issues can be pretty deep and pretty scary. And even when we do identify them, how do I address them? How do I communicate to other people?

How do I make those changes? What would my game plan be? If I want to change careers? That's where a professional therapist who specializes in cognitive behavioral therapy can really help you not just identify it, but now what do I do to go forward so I can start feeling better? And there's a good chance this health anxiety will alleviate itself because I'm being more real with myself.

So again, if you want to read more about it, it's called The Hidden Emotion Technique by Dr. David Burns. It's a CBT tool. It's not the only one. It's very helpful for this particular diagnosis.

But again, all the other things I've taught you guys already is doing your thought records, identifying what your hot thoughts, understanding what your cognitive distortions are, and how those are feeding into this fear. Also see who's in your environment. That's a huge important aspect of CBT. Do you have someone else who has health anxiety and you guys just feed each other, worrying about it? Or if you complain about a little something, they're like, oh, you need to go to the doctor.

You should get that checked out. I had that before it turned into cancer. Right? I mean, we can have people like that in our lives too, and people can just feed each other's fears. And you don't need to go through life struggling in this way.

I do want to say, if you think you have a medical issue, of course go to a doctor and get it ruled out. So that's always good to import. I'm not saying you ignore things by any means. If there's something that you think is a real problem, go see a doctor, see if you need to get tests, all those types of things, right? I've been there.

I've had real health issues. But if you get a clean bill of health and you're still obsessing and worrying, that's when you want to start focusing on the other things that I'm talking about today. And go get some professional help and do some reading about using some tools and changing your behavior and to help change how you're thinking and your moods and all of your physical reactions, right? So let's rule out any medical issues, and if that doesn't become a problem or you're not diagnosed with anything that you have to address and you're still anxious, start taking better care of yourself and give yourself permission to go get help. Don't be embarrassed.

As I said earlier, 200,000 plus people a year deal with health anxiety. It's very common. There's so many health issues out there. It's understandable as well. I want to say it's understandable that you may end up going down this road for many different reasons, but you deserve to be happy, and you deserve to have joy in your life and you can get there and not have to carry this elephant on your back with all this worry and concern.

So I hope this has been helpful. I hope I answered some questions to my listener who emailed me. As always, I'm grateful for your emails. You can send them to me at mycbtpodcast@gmail.com. I'm hoping this is a helpful podcast to get you thinking, especially if it's for you again, someone you know.

Please share with others so they can get the benefits as well and start learning the CBT tools.

Continue to send me suggestions and questions and feedback. I really appreciate it. The podcast is really growing and I want to thank you. My instagram, if you're following me on that under My CBT Podcast.

I share with you that it really has exploded in the recent weeks and I'm so grateful and excited about that because that just means I'm reaching more people. Which I always tell you is my intention that I feel like more people that can learn the CBT tools can really. Really benefit and you can have a happier. More joyful life. Any of the books I mentioned today will be on my link.

You can scroll down and you will see them. You can click on and order those books. Those can be helpful as well.

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