Calming Health Anxiety

One of four people with a chronic medical condition such as back pain, heart disease or multiple sclerosis becomes so obsessed and worried about their health problem that they suffer health anxiety.

Left untreated, this preoccupation with their medical problem could spiral into hypochondriasis, according to Heather Hadjistavropoulos, Ph.D., a professor of psychology at the University of Regina, Saskatchewan, Canada. She presented her findings about how to help health anxiety last week at the annual conference of the Association of Behavioral and Cognitive Therapies in Orlando, Fl.

“When they become overwhelmed with the condition, they start to seek out either more reassurance, or spend a lot of time on the internet looking for information on their condition, to do everything they can to reduce their worry about the condition,” she said of patients afflicted with health anxiety.

But she has developed a four-step program to help these health-anxious patients see things in a new light, reduce their anxiety, and perhaps ward off hypochondriasis.

For patients who already have hypochondriasis, expressive writing just one day a week can help them improve, according to another researcher at the conference, Femke Buwalda PhD, an assistant professor of clinical psychology at the University of Groningen.

The Four-Step Program

In her study, Hadjistavropoulos assigned 60 people age 65 and above who had a chronic medical condition either to the treatment group or no treatment. Those in the treatment group were guided through four steps, including:

• Set appropriate limits on seeking reassurance. To do this, mental health professionals must educate patients to recognize when they become so overwhelmed and preoccupied with their condition that the results are negative. In the study, Hadjistavropoulos helped patients work with medical providers, she said, “to figure out such things as how often they should get follow up and what’s a reasonable amount of time to spend on the internet seeking medical information.”
• Build confidence in the medical system. People with health anxiety often don’t trust their doctors, Hadjistavropoulos has found, whether that mistrust is based on a bad experience or is groundless. She worked on helping them improve their relationship with their providers so they would have more confidence in them.
• Change the way they focus on symptoms. “Often they will have a symptom and become very focused,” she said. “We give them education on how tending to a symptom and spending a lot of time focused on it can actually make it worse.”
• Challenge their beliefs about their ability to cope. One way: she reminds patients about statistics, telling them: “75% of patients who have a chronic medical condition don’t become preoccupied. It is possible to have this condition and not be extremely overwhelmed by it.” That information often opens a conversation, she said, about how those patients manage to do it, so the other 25% can learn, too.

The Four-Step Program: Results

So far, the program results look good, H said. In the initial follow up, right after treatment ended, there was a reduction in anxiety or health worries, based on a questionnaire. She is working on a three-month followup but doesn’t have those results yet.

The study is ongoing, with an eventual enrollment goal of 90. “Patients are highly interested in this approach,” Hadjistavropoulos said. “They are highly satisfied with this kind of a program.”

Reducing the worries about health can help these patients, who tend to be generally anxious, reduce the anxiety about other aspects of their lives, too, she said.

When Anxiety Becomes More: Write it Away

When the diagnosis over health worries is hypochondriasis, expressive writing, just once a week for a half hour, can help, said Buwalda.

Expressive writing has been shown by other researchers to reduce stress, boost self-esteem and have other benefits. So Buwalda wanted to see its effect on the health anxiety associated with hypochondriasis.

She assigned 22 patients with diagnosed hypochondriasis to the writing group and another 20 to a wait list group which got treatment with the writing exercise later.

Patients picked their own writing time and were told to keep that “appointment” each week at the same time and on the same day, writing for 30 minutes about their health worries and fears. They did this for six weeks and did it at home.

At the three-month followup, those who wrote had fewer hypochondriacal complaints, less anxiety and fewer complaints of depression.

“The ones in the wait list group didn’t experience any difference,” she said. But “they did equally well when the wait list group went on to the intervention.”

Buwalda doesn’t know exactly why writing about health anxiety helps, but offers several possibilities. When they write down their fears, patient may begin to see how all the anxiety has impacted their lives for a long time and decide to spend less time worrying. Or, the opportunity to express their anxiety may help them move on from it.

Or the writing may result in what mental health professionals call cognitive restructuring — changing the way they think about things, mainly their health.

Source: Association of Behavioral and Cognitive Therapies

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