I’ve been writing recently about Health Anxiety, and in one of my last articles was talking about how your thinking style, particularly all the ‘what if’ questions contributed to health anxiety and today I want to show you a technique called cognitive restructuring to deal with them.

Cognitive Restructuring is part of Cognitive Behavioural Therapy (CBT), and at the centre of this style of working is understanding the connection between your thoughts, feelings and behaviours. Your thoughts are powerful stuff if you think that any one of your ‘what if’ style thoughts can make you feel anxious in your body and affect what you do next (behaviours) which could be researching your symptoms on google. These three things happen so quickly you probably won’t stop to consider that you are stuck in some sort of health anxiety cycle. Learn more about Health Anxiety.

I love this analogy and hope it makes sense to you; think of your brain as a command centre, constantly receiving and interpreting information from both the outside world and within your own body. When you have a “what if” thought, like “What if this chest pain is a heart attack?”, your brain interprets this as a potential threat. This in turn sets off your nervous system, particularly the sympathetic nervous system, which is responsible for the “fight-or-flight” response.

I think it’s worth me explaining this in more detail as I know I certainly hear a lot about the connection between thoughts and feelings, and if you have been in therapy or reading about CBT you will have to, but here’s how it should be explained so you get it and to highlight the importance of being able to work with ‘what if’ thoughts. You get your ‘what if’ thought; what if it’ a brain tumour, what if it’s cancer. Your brain sees this as a potential threat and rings the alarm – the amygdala (an area associated with processing emotions), assesses the “what if” thought as a potential danger. This happens incredibly fast, often outside of conscious awareness. Learn more about the amygdala.

In case it’s a real threat, as better safe than sorry, your amygdala notifies the hypothalamus which can activate your sympathetic nervous system filling you with adrenaline, this is where you start to actually feel the anxiety in your body, and remember the point of this is to explain the thought feeling connection in CBT; your what if thought can result in real changes in your body – you feel it.

Specifically what you are feeling is your body gearing up to defend itself, the fight or flight and your heart is beating faster, you are breathing faster, you might start to sweat and be acutely aware of your surroundings; as your senses are sharper. Your thoughts have done all of this. Take a moment and fully understand that, your thought processes alone can be responsible for all of that. In case you need more convincing of the power of thoughts on the body, think of what your body feels like if you are watching a scary movie, you are terrified, you feel the terror in your body, it’s a real physical thing and too powerful a thing to be happening over your what if thoughts. Cognitive restructuring helps you “rewrite the script” of your internal movie. By challenging and reframing those anxious thoughts, you can calm the alarm bells in your brain and reduce the physiological symptoms that fuel your anxiety.

How to do cognitive restructuring.

1. Thought Identification: This initial step involves cultivating a mindful awareness of your “what if” thoughts. It’s about noticing these thoughts as they arise, without judgment, and acknowledging their impact on your emotions and behaviours. Journaling can be an invaluable tool in this process. By recording your anxious thoughts, you gain a clearer understanding of their triggers, their frequency, and their associated feelings. This self-awareness lays the foundation for effectively challenging and reframing them.
2. Thought Challenging: This is where the real work of CR begins. It involves critically examining the validity of your “what if” thoughts. Here are some key questioning techniques:
   • Evidence-based questioning: “What is the actual evidence supporting this thought? What is the evidence against it?” Often, health anxiety thrives on misinterpreting bodily sensations for example, ask yourself what are the chances that your headache really is a brain tumour? Just because you are feeling the effects of high emotions, i.e. fear, that doesn’t mean your thoughts are true. This is another thing I shall speak about in another post, it’s called emotional reasoning where how you are feeling affects your thoughts.
   • Perspective shifting: “What would I tell a friend who had this thought? How would a doctor view this situation?” Stepping outside of our own anxious mind and adopting a different perspective can often shed light on the irrationality of our fears.
   • Decatastrophising: This involves exploring the feared outcome and evaluating its true impact. “What’s the worst that could happen? Could I cope with it? What resources and support systems do I have?” Often, the imagined consequences are far more catastrophic than the reality. By breaking down the fear and developing a plan for coping, we can significantly diminish its power.
3. Thought Reframing: This final step involves consciously replacing the negative “what if” thought with a more realistic and balanced alternative. It’s not about denying the possibility of illness, but rather putting it into perspective and focusing on more probable explanations. For instance, instead of “What if this dizziness means I have a brain tumour?”, you might reframe it as, “Dizziness can be caused by many things, including dehydration, low blood sugar, or even inner ear problems. I’ll drink some water and see how I feel.”
   • Developing Adaptive Thoughts: This involves creating a repertoire of alternative explanations for your physical sensations. For example with the headache example, a more balanced thought could be, I haven’t been drinking much water, it could be dehydration or staring at the computer screen too long.
   • Affirmations and Positive Self-Talk: Incorporating positive self-statements can help counteract the negative bias often present in health anxiety. Statements like, “My body is strong and resilient,” or “I can handle whatever challenges come my way,” can foster a sense of self-compassion and empowerment.

Cognitive restructuring is not a quick fix, but rather a process that requires patience, practice, and self-compassion but it is one that is worth doing as research consistently shows the effectiveness of CBT for anxiety disorders. It’s like learning a new language or musical instrument; it takes time and dedication to master.