The key that unlocks Health Anxiety is being able to understand what happens between getting a twinge or sensation to thinking you have a brain tumour. This understanding is also the key to what therapy will help, as the link between the twinge and brain tumour in this case could be catastrophic thinking, which is dealt with effectively by a model of therapy called Cognitive Behavioural Therapy. The jump to catastrophic thinking is caused by a misinterpretation of normal bodily sensations.

This misinterpretation and catastrophic thinking style is the hallmark of health anxiety. A simple stomachache morphs into stomach cancer; a racing heart becomes an impending heart attack.

But why do we misinterpret these signals so readily? Why does a headache become a brain tumour, a cough lung cancer, a fleeting dizziness a sign MS? I am going to answer those questions now and encourage you to take a different direction the next time you see it happening, as being able to spot the pattern gives you a chance to interject.

The Anatomy of a Health Anxiety Spiral

The Trigger: It all begins with a seemingly innocuous sensation – a headache, a twinge in your chest, a moment of dizziness. Maybe you’re feeling a bit more tired than usual, or you notice a new mole on your skin. This ordinary bodily sensation becomes the trigger, the unexpected guest that sets the anxiety in motion. For example, you feel a muscle twitch in your arm. Immediately, your mind jumps to: “Could this be the start of motor neurone disease?”

The Thought: Almost instantly, a thought, unwelcome and intrusive, pops into your head: “What if this is something serious?” That headache… could it be a brain tumour? That fatigue… the first sign of a chronic illness? This thought is the catalyst, the spark that ignites the flame of fear.

The Physical Response: Your body, ever vigilant, responds to the perceived threat. Your heart starts to race, your breathing becomes shallow, you might feel a knot in your stomach or a wave of nausea. These physical sensations, triggered by anxiety itself, ironically mimic the very symptoms you fear, creating a feedback loop that only strengthens your worry. For example. you feel a bit lightheaded after standing up quickly. Your anxiety spikes, causing your heart to race, which further convinces you that something is wrong with your heart.

The Mental Magnification: Your mind, now hyper-focused on the perceived threat, starts to magnify the sensation. That headache feels more intense, that twinge in your chest more ominous. You might start to scrutinize your body, searching for other signs of illness, further fueling the anxiety. It’s like looking at the sensation through a magnifying glass, distorting its true size and significance. You notice a small skin blemish. You obsessively check it in the mirror, convinced it’s growing larger and darker, a sure sign of skin cancer.

The Internet Dr google: Desperate for answers (and reassurance), you turn to the internet, the land of infinite information and often, misinformation. You type your symptoms into a search engine, and suddenly you’re bombarded with a litany of terrifying possibilities. Every website seems to confirm your worst fears, and the anxiety spirals further out of control. Dr. Google, while sometimes helpful, can be a formidable foe when it comes to health anxiety. For example, you experience a brief episode of heart palpitations. A quick internet search leads you to articles about heart arrhythmias and sudden cardiac death, sending your anxiety through the roof.

The Reassurance Seeking: You might call your doctor, schedule an appointment, or seek reassurance from loved ones. While seeking medical advice is important when appropriate, excessive reassurance-seeking can actually backfire. It can reinforce the belief that something is seriously wrong and create a dependence on external validation.

The Avoidance: To cope with the anxiety you feel when you think professionals are missing a serious health concern, you could well start to avoid the things that trigger your fears – this type of avoidance is common in all forms of anxiety; it’s called a behavioural symptom. If you’re worried about your heart, you might avoid exercise. If you’re afraid of a brain tumour, you might avoid anything that could cause a headache. It only gives short term relief, and in long run, the avoidance is one of the things that keeps your health anxiety going. I have a video explaining this in the free preview of my course.

The Vicious Cycle: The more you focus on the sensation, the more intense it seems. The more you seek reassurance, the more convinced you become that something is wrong and I have a little behavioural experiment for you to try to, hopefully show you, that the more you focus on a sensation, the more intense it becomes.

Bring your attention to your right hand. Notice the sensations in your fingers. Are they warm or cool? Tingling or numb?

Now, I want you to focus your attention on your index finger. Really hone in on it. Can you feel the subtle pulsations of your heartbeat? The texture of your skin? Keep your attention focused on that finger for the next 30 seconds.

What do you notice? Does the sensation in your index finger feel more intense? Perhaps it feels warmer, or you notice a tingling sensation that wasn’t there before. This is a simple demonstration of how focused attention can amplify bodily sensations.

When we’re anxious, our attention tends to narrow, focusing on potential threats while filtering out reassuring information. This can make even minor sensations feel more intense and alarming. In the case of health anxiety, this can lead to a vicious cycle where focused attention on a bodily sensation amplifies it, further fueling the anxiety.

That’s just one quick experiment, but it makes a valid point that I hope you found helpful.

The Roots of Health Anxiety

This vicious cycle is often fueled by a combination of factors:

• Cognitive Distortions: Health anxiety thrives on cognitive distortions – those catastrophic thoughts that I mentioned at the top of this article and CBT really helps with the thought process behind the fear.
• Intolerance of Uncertainty: Many people with health anxiety have a low tolerance for uncertainty.  They struggle with the ambiguity of bodily sensations, needing definitive answers and guarantees about their health.This intolerance can lead to excessive reassurance-seeking and a constant need for certainty.   
• Past Experiences: If you’ve had a health scare in the past, or witnessed a loved one struggle with illness, your mind may be primed to interpret any unusual sensation as a sign of danger. It’s like your internal alarm system has been set to maximum sensitivity, constantly scanning for threats.
• Reinforcement: Every time you engage in reassurance-seeking or avoidance behaviours, you inadvertently reinforce the anxiety. You’re essentially telling your brain, “See, I was right to be worried! Something is wrong.” This reinforcement strengthens the cycle, making it harder to break free.   

The OCD Connection

While health anxiety is a distinct condition, it does share some similarities with Obsessive-Compulsive Disorder (OCD). Both involve intrusive thoughts and repetitive behaviours.  In health anxiety, the obsessions revolve around fears of illness, while the compulsions might include excessive body checking, reassurance-seeking, and avoidance.Understanding this overlap can be helpful, as some of the therapeutic techniques used for OCD can also be effective for health anxiety.   

Thankfully, there are effective therapies that can help you break free from this cycle and reclaim your life from health anxiety.

• Cognitive Behavioural Therapy (CBT): This is often the first-line treatment for health anxiety. CBT helps you identify and challenge those negative thought patterns that fuel your fears. It teaches you to question those catastrophic thoughts (“This headache must be a brain tumour”) and replace them with more realistic and balanced perspectives.  CBT also helps you develop coping strategies for managing anxiety and reduce your reliance on reassurance-seeking and avoidance behaviours.
  • In my clinical practice, I often use behavioural experiments with clients to help them test out their fears in a safe and controlled way. For example, if someone is afraid that exercise will trigger a heart attack, we might gradually increase their activity level while monitoring their anxiety and physical sensations. This allows them to gather evidence that challenges their fears and build confidence in their body’s resilience.
• Acceptance and Commitment Therapy (ACT): ACT helps you develop a different relationship with your thoughts and feelings. Instead of trying to control or eliminate anxiety, you learn to accept its presence and focus on living a meaningful life in spite of it. This can be particularly helpful for those with health anxiety who find themselves constantly struggling against their fears.
  • In my clinical opinion, ACT can be particularly effective for individuals who have become “stuck” in the cycle of health anxiety. It helps them shift their focus from trying to eliminate anxiety to living a values-driven life, even in the presence of uncomfortable sensations.   
• Mindfulness-Based Therapies: Mindfulness practices, such as meditation and body scan meditations, can help you cultivate a greater awareness of your body and your thoughts in the present moment. This can help you observe those anxious thoughts without getting swept away by them, reducing their power to dictate your actions and emotions.
  • For those in Ireland, the Mindfulness Centre of Ireland (link: [insert relevant link]) offers a range of mindfulness-based programmes and resources that can be helpful for managing anxiety.   

Health anxiety is a challenging condition, but it doesn’t have to rule your life. By understanding how your mind interprets bodily sensations, and by developing strategies to challenge those anxious thoughts, you can break free from the cycle of fear and live a fuller, more present life.