Doubt and Uncertainty in Health Anxiety

Health anxiety and Obsessive-Compulsive Disorder (OCD) share a common thread: the need for certainty in the face of doubt. I’ve mentioned before how they can share some characteristics even though they are separate diagnostic categories¹ in DSM-5 (which is the manual we use to diagnose mental health conditions.) This shared theme is extremely important in trying to understand and recover from health anxiety, as it is the doubt and uncertainty that feeds the health anxiety.

In OCD, this doubt might manifest as an obsession with contamination, leading to endless handwashing and cleaning rituals. Or it might take the form of intrusive thoughts about harming oneself or others, causing immense distress and guilt. In health anxiety, the doubt centres around the body, with every sensation, ache, or perceived abnormality becoming a potential sign of serious illness.

Important point; in my clinical practice, people with health anxiety focus on a possible illness, whereas one of the first steps to recovery is educating them to focus on the role of doubt and uncertainty and then, show them what to do about it. In my two decades of practice, I’ve come to understand that health anxiety is more than just a fear of illness; it’s a profound struggle with uncertainty.

Take, for instance, the case of Darragh, an accountant who came to see me several years ago. He was always in control, always prepared, always anticipating the next move and then he developed a twitch in his eyelid, which turned his world upside down.Doubt crept in, and he found himself googling the symptoms of neurological diseases. He consulted doctors, underwent tests, and received reassuring results. Yet, the doubt lingered. He was now forced to live with doubt and uncertainty, which is managed by more googling and more questions,
“What if they missed something?” “What if it’s the beginning of something irreversible?” until his GP referred him to myself for therapy.

Darragh’s story, like countless others I’ve encountered, underscores the profound impact of doubt and uncertainty in health anxiety.

The fear isn’t necessarily about being ill right now; it’s about the possibility of future illness, the nagging suspicion that something is wrong, even when medical tests provide no evidence.

Awareness is the first step towards change. Start by paying close attention to the specific triggers that activate your doubt-uncertainty cycle, which I shall explain below.

The Doubt-Uncertainty Cycle:

1. Trigger: For example feeling something in your body, or getting a pain behind your eye.
2. Doubt: “What if that headache is a brain tumour?”This is the start of the doubt.
3. Compulsions: To try to alleviate the doubt, you might start researching brain tumours
4. Temporary Relief: The compulsions provide temporary relief from the anxiety, but this relief is fleeting.
5. Reinforcement: The cycle reinforces the belief that the doubt is valid and that the compulsions are necessary to prevent catastrophe. This strengthens the anxiety in the long run, making it even more difficult to tolerate uncertainty, whereas the key is being able to sit with the uncertainty.

You can use techniques from cognitive behavioural therapy (CBT) to challenge and reframe your thoughts, particularly the thoughts that start with, what if? You can read more on what if thinking and health anxiety here.

“What if” thinking is the fuel that keeps the doubt-uncertainty cycle burning. When you notice these thoughts arising, challenge them directly. Ask yourself:

• What is the evidence for and against this thought?
• Is there a more realistic explanation?
• What is the likelihood of this worst-case scenario actually happening?
• What would I say to a friend who had this same worry?

Learn more about how CBT can help with health anxiety.

Name your doubt.Give your doubt a name or a persona. This can help you to create some distance from it and reduce its power over you. I use this technique myself and use names like Ethel and Mabel – there’s Ethel trying to tell me something about my health, there’s Mabel annoying me again.

Acceptance is the real key to doubt and uncertainty. Acceptance doesn’t mean giving in or resigning yourself to a life of fear. It’s about acknowledging the presence of uncertainty, the very real possibility that our bodies might throw us a curveball now and then. It’s about making peace with the “not knowing,” recognising that we can’t control every aspect of our health, but we can control how we respond to those anxieties.

And how do we respond? Well, that’s where cognitive defusion comes in. This technique, borrowed from Acceptance and Commitment Therapy (ACT), is about learning to detach from those anxious thoughts, to see them for what they are – just thoughts, not facts.

Imagine your mind is a stage, and those anxious thoughts are actors vying for your attention. Cognitive defusion is like dimming the spotlight on those actors, allowing you to observe them without getting caught up in their drama. You might say to yourself, “Ah, there’s that thought again, the one about that weird twitch being a sign of a brain tumour. Thanks for sharing, brain, but I’m not going to give that thought the starring role today.”

Of course, dimming the spotlight on anxious thoughts doesn’t mean ignoring your physical health altogether. It’s about finding a balance between mindful awareness and proactive care. This might involve scheduling regular check-ups with your doctor, engaging in healthy lifestyle habits, and staying informed about health concerns without falling down the rabbit hole of online symptom checkers.

If you’re struggling to manage your health anxiety on your own, consider seeking professional support from a therapist specialising in anxiety disorders. They can provide you with evidence-based tools and strategies to navigate the doubt-uncertainty cycle and reclaim your life from fear.

Further reading on health anxiety

NHS

MayoClinic

1. https://www.ocduk.org/related-disorders/health-anxiety/#:~:text=Whilst%20OCD%20is%20listed%20in,300.7)%2C%20depending%20on%20the%20specific ↩︎