How to cure health anxiety
November 14, 2017 4:49 AM   Subscribe

Fellow health-anxiety sufferers, can you share some successful thinking techniques or self-talk that helped ease your anxiety to do with health and doctors?

I'm hesitant to make this tl;dr but I've suffered from various degrees of health anxiety ever since university. I am sure I'm not the only one? So I am asking for helpful self-talk and other calming techniques - by which I mean ways to specifically target anxiety about health as opposed to general anxiety-calming techniques. These could be ways of thinking about health, ways of talking to yourself - whatever's helped you.

This question has been hard to write, so apologies if it's a little hard to parse. It's a big and complex part of my life.

Snowflakery: I get mysterious symptoms and diagnose myself with horrible illnesses. I've also been known to have actual physical symptoms for which doctors could not find a cause despite running multiple tests, which cleared up when my anxiety about seemingly-unrelated things cleared up. It's difficult when your body has a habit of doing that. You feel like you can't trust your body to tell you the truth about what is going on.

Going to the doctor, even for a rote visit, terrifies me. I usually try to manage my health anxiety by burying my head in the sand and hoping that whatever I am worried about will go away by itself. I try to NEVER google, but sometimes I give into the temptation. Lately I have had a bad chest infection/asthma flare-up which has necessitated multiple doctor visits and made my anxiety about health and doctors flare up as well.

I've had CBT counselling for general anxiety issues, but not this. I find self-directed CBT better than going to workshops and speaking with counsellors; I'm fairly well-educated about this so sometimes it feels like they're just telling me what I already know. CBT has been helpful with other aspects of my life but not my health anxiety. It's difficult to get free-flowing talk therapy on the NHS. I know the knee-jerk response is 'therapy' but it just isn't that easy here.

After thinking about it a lot, I've realised that the reason I get worried about being sick is that at some level I feel like I 'deserve' to get sick because I'm overweight. (I know that the 'duh!' answer is 'lose weight', but as a former eating disorder sufferer, I can't go on a diet without severely risking my mental health, and I try to live a healthy life in a fat body as much as possible. I do yoga (although I stopped a couple of months due to bad life-stuff happening and am getting back into it as part of my recovery from the bad life-stuff), don't binge-eat anymore, never smoke and have quit drinking, not that I ever drank much in the first place. I haven't done proper regular cardio for a few months. When I fail to properly fit in exercise into my schedule I get extremely nervous about the effect that might have on my health.

Another reason I get anxious about health is that I've seen people, including healthy people of my age, get diagnosed with horrible illnesses just out of the blue, and I know it is a thing that happens and not an outlandish concern.

I hate that I have this stupid anxiety when there are people living bravely and uncomplainingly with serious chronic illnesses. It's just so selfish and ridiculous.

So yeah, to reiterate, my main question is what self-talk I can use to combat my thoughts of 'this weird sensation is OBVIOUSLY a horrible illness' and 'well, you're fat and you deserve to get sick anyway'.

Thanks in advance and I hope this question hasn't been too rambly.
posted by Ziggy500 to Health & Fitness (10 answers total) 6 users marked this as a favorite
Hi Ziggy 500!

I have a lot of the same issues as you regarding diagnosing myself with things and feeling guilty about not exercising. so I'll be following this question.

I see a good place to start with combating negative self-talk:

I hate that I have this stupid anxiety when there are people living bravely and uncomplainingly with serious chronic illnesses. It's just so selfish and ridiculous.

There is no need to castigate yourself for feeling anxious---- because anxiety itself IS a real illness. Start by taking your anxiety seriously as a real health issue.

One thing that has helped me has been what a counselor once suggested to me, which is to imagine that negative thoughts come from a "demon" that sits on my shoulder and tries to sabotage me. whenever a negative thought arises, the idea would be to TALK BACK to the demon. Sometimes I even imagine myself shouting at it. And I find when I do shout at it, it gets scared and shrinks into a measly little pea. (Yes, I know I'm a bit crazy :P) there is something about personifying the negativity that makes it easier to tackle.

For example:

Demon: "This weird sensation is OBVIOUSLY a horrible illness."
Me: Oh, demon, seriously? Will you shut up with that nonsense already? I've heard that one a million times. I wasn't aware that you were a doctor with a medical degree?? What qualifications do you have to be able to make that conclusion? Just LET ME LIVE MY FUCKING LIFE!


Demon: "Well, you're fat and you deserve to get sick."
Me: what did you say? WHAT DID YOU SAY? Who the fuck do you think you are? go fuck yourself, demon! I may be fat, but at least I'm not an ASSHOLE!

Or, sometimes I take a different tack, and try to LISTEN to see if the anxiety is trying to help me with something. I try to comprehend the root behind the anxiety and see if there is a possible action i can take (In your situation I think the first tactic is more applicable). Sometimes I imagine the anxiety is like an anxious mother who just wants to protect me.

For example:

Anxiety: this weird sensation is a horrible illness!!
Me: Thank you for your concern. I hear what you are saying. You are trying to protect me by making sure I think about living a healthy lifestyle and visiting a doctor when necessary. I know you have my best interests at heart and I thank you sincerely for caring enough about me that you bring these things to my attention. I have great news, though. The human body is pretty weird, and weird sensations happen all the time. Unless I am feeling acute pain, the most likely thing is that this is just another weirdness arising from the general weirdness that is being human. But be sure that thanks to your warnings , I will make sure to take the necessary steps to find the cause of any acute pain that may arise. For the moment, though, I need to turn my attention to more concrete problems.

Obviously I don't usually say these things out loud (I'm not THAT kooky). But I DO sometimes write to the anxiety sometimes in the form of a letter.
(I find that sometimes listening to the anxiety makes it feel "heard" and then it lessens... Or talking to it like a demon sort of allows me to step out of it and look at it from the outside.. Sometimes I even write to the anxiety
posted by winterportage at 5:21 AM on November 14, 2017 [1 favorite]

I had health anxiety problems for many years. I think the root of them lay in hitting 30, becoming quite unfit, and dealing with a number of life changes (moving to a new place and a new job).

What helped a lot for me was being diagnosed with anxiety. It got to the point where I was getting heart palpitations, cold sweats and shortness of breath - all of which of course made me more anxious, leading to the physical symptoms getting worse. I ended up making an emergency appointment with my doctor. She was great - listened to my concerns, then gently explained that all of this was classic anxiety. I'd never appreciated before how mental state can have such a wide range of real physical effects.

Anyway, a couple of years of relatively mild medication, along with learning how to gauge my anxiety level and talk myself out of all the catastrophising I'd been doing, and it all got a lot better. Sixteen years down the line, I still find myself mentally "what-if"-ing sometimes when I feel a pain or get a cough of feel a little dizzy for a moment. But I'm now more likely to just say to myself "you've felt things like this before, many times, and you're still here - it's just a headache/pulled muscle/virus/anxiety symptom".

I agree with winterportage about talking to yourself as if from an outside voice. Be the person who isn't anxious, talking to the other person who is. Negative self-talk doesn't help, but learning to gently tease yourself about your tendency to see every ache and pain as the first sign of a terminal illness may help. Be gently with yourself, and as winterportage says, try to identify what else in your life might be leading to the anxiety - for me it's usually stress, lack of sleep, or too much caffeine.
posted by pipeski at 6:36 AM on November 14, 2017

Health anxiety is complicated and probably multi-determined. Maybe you feel you "deserve" to get very sick because you are overweight, but there's often a more vicious cycle to it -- e.g. you feel you deserve to get sick because you are "bad," but then you find out that you're not sick, and you feel tremendous relief (maybe you're *not* bad after all!).

It also ties into issues about being take care of, not being taken care of, that is, dependency, autonomy, etc. So, from a relationship perspective, let's not forget that health anxiety isn't just about you -- it's about all those doctors -- the authority figures, the "experts," who serve as stand-ins for the caretakers of our childhoods -- and their "tests". Are they capable of seeing what's wrong with you? Are they kind to you? Do they "absolve" you with their negative test results? Is the next one going to find you "guilty" (of what?) and sentence you to death or a life of pain?

Is it important to take the anxiety seriously (it is, after all, an anxiety disorder), but the anxiety itself is a symptom and not an explanation in itself. So what is the anxiety about? That's very hard to figure out all by yourself, and, in my opinion, cognitive-behavior therapy is quite inadequate in its ability to understand symptoms -- it's not bad at providing little "techniques" that can help for a little while (like yelling at the "stupid" you who thinks the "wrong", "illogical" things (yikes)).

I believe it's much better to have compassion for yourself. When it comes to illness, who really gets it right? Who is not afraid of our (universal) mortality? "We are all bozos on this bus" -- Firesign Theatre.

I have found that the best book by far for health anxiety is "WORRIED SICK? The Exaggerated Fear of Physical Illness," by Dr. Fredric Neuman. He might run a cognitive-behaviorally-based clinic, but his understanding of the dynamics behind health anxiety run deeper than that. He will give you "techniques" for combating your anxiety that are concrete and cognitively-based, but he also talks about the need for certainty (that is impossible, ever, to fulfill), the pumped-up valuation we put on doctors, with a chapter on "how doctors think" (they know a lot less than we imagine), and he suggests that, contrary to what you might think, it's better to look *more* deeply into the illnesses that you're afraid of (we lay people generally have distorted views of the symptoms of these illnesses -- when we learn more about them we realize that).

Neuman also stresses that it's important to look more deeply into the state of incapacity and to death itself than we would like to do. He says that, behind fear of death, there lies other fears: fear of being left, fear of leaving others, etc. It sounds strange because our culture tells us that lots of fears are stand-ins for fear of death (see, e.g. "The Denial of Death" by Becker, a classic book), which is seen as "real" and ultimate, but it turns out that fear of death is itself a metaphor! Because, really, who knows what death actually is? So, a metaphor for what? Well, in general, for separation from loved ones, from our concept of Self, from Ego , etc. And all of these things are *not* things. They are **feelings** that we have reified into these concepts that put us into terror states.

To sum up, health anxiety is about massive insecurity. Neuman says that, without exception, when he works with somebody, he finds out that somewhere in their life there was a time when security of the patient was intensely threatened -- or their parent's security was threatened, and that sense that the world is a dangerous place was "passed on" to the child. Now the patient is living in a state where he is waiting for the "other shoe to drop."

The real answer is *not* to try to convince yourself that you are safe (because nobody (sorry to say)) really is, 100%, ever. It's to learn to live with the uncertainty and not have it cripple you. This existential task is very very hard and most of us would rather yell at our insecure little selves and tell ourselves how dumb we are for feeling scared -- most of us have experienced a lifetime of hearing that sort of thing from others, rather than facing our fears, seeing where they come from, and working to achieve some sort of peace with them. "You're fine" ultimately doesn't work, because none of us *are* fine within the context of the culture in which we've grown up. The only way to feel fine is to widen that context -- to learn to feel "fine" *given* that life is difficult and strange and insecure and often painful. But it's a different sort of "fine," one we're not used to, and one that we will protest "forever," unless we're willing to make a HUGE emotional (and cognitive) shift -- and the only way to do that, I think, is if you feel that somebody is with you -- either a real person, in real life (like a therapist), or maybe Dr. Fredric Neuman, in his book. You need to believe that somebody really "gets" what you're going through, and doesn't think you're stupid for feeling that something is wrong with you all the time (you're not*).

*You know all those people who think they're fine and everything's great? Well it's possible that *they're* wrong.

(I am not your therapist. This post is informational, not therapy.)
posted by DMelanogaster at 6:42 AM on November 14, 2017 [7 favorites]

Read up on pain science. Emotional and physical pain are easily conflated by the body's alert systems, and chronic pain especially is hard to trace! Sometimes your body gets stuck in a negative feedback loop of hyperarousal, where ordinary sensations rise to awareness when they shouldn't, and hurt more and more.

For example, I tell myself, "My joints hurt and there's pain in my gut because of outside stress and inner turmoil. My body is trying to warn me to chill out, tend to my well-being and do what I can to take care of these stressors!" That's often enough to make the mysterious pains subside. In the absence of overwhelming or escalating symptoms, I assume there's no reason to worry– my doctor has already run the tests and assured me there is no joint damage, weird inflammation, gut problems or allergies. So, even if it feels bad, carrying on with my day won't hurt me. I workout hard, see friends and ignore the symptoms. It's very much about acknowledging the sensation and letting it pass from your mind. Basically, your body is hallucinating pain.

I also remind myself that Humans are Space Orcs, and we're literally designed to keep going forever until we fall apart.
posted by fritillary at 6:58 AM on November 14, 2017

I have medical anxiety, mostly around the actual doctor visits. The things that have most helped me are:

- keeping a symptom diary. This lets me see patterns over time, and then I have a record that I can take to the doctor.

- making a written list to take to the doctor with symptoms and questions. I type it up and make two copies, so that I can give one to the doctor to read and I don't have to start off by talking. One for an asthma visit looked something like this:
Consultation with Dr. Mydoctor
Medusa the Gorgon

Asthma symptom flare-up. Starting on 10/1/17 I have experienced an increase in asthma symptoms, particularly coughing and shortness of breath: 10-20 coughing attacks a day, 3-5 times a day of noticeable shortness of breath. Coughing usually wakes me up at night. I'm using my rescue inhaler 5 times a day. This is limiting my exercise and significantly impacting my quality of life.

- taking a health advocate with me to medical appointments. This could be a family member, friend, or even a patient advocate if they have those in the UK. My advocate is in charge of making sure all the key points are communicated and asking questions if I get too panicked. Then when the doctor says, "I recommend we do XYZ test to rule out Horrible Chronic Disease," my advocate can say, "What makes you think it might be HCD? How likely is HCD with these symptoms?" while I sit there thinking "AAAAH I PROBABLY HAVE HCD."
posted by medusa at 7:34 AM on November 14, 2017

Your question really resonates with me, I could've written the same question myself about 15 years ago. You ask about ways you can calm yourself with self-talk when you're feeling anxious about your health, but that never worked too well for me. What did work incredibly well was taking an antidepressant (an SSRI, Lexapro). After taking it for a month I had zero recurrences of anxiety about my health, and previously I would spend weeks convinced I was having a stroke or a heart attack. If medication isn't something you've pursued in the past, I would encourage you to discuss it with your primary care provider.

The other thing that helped me a lot was going to nursing school and learning that most serious health conditions develop very very slowly, and most symptoms are not emergent/life-threatening. I also learned that being overweight doesn't necessarily mean that you're unhealthy, and that internalizing sexist anti-fat cultural messaging creates an extra layer of anxiety that can lead to believing that someone "deserves" an illness. It is neither selfish nor ridiculous for you to have anxiety, and in fact your symptoms have likely been exacerbated by existing in a world where people (especially women) are constantly shamed and policed about their bodies. Please be kind to yourself as you're dealing with these issues.
posted by little mouth at 12:05 PM on November 14, 2017 [1 favorite]

It's really hard when you feel like you can't trust your own perceptions of what you're feeling.

(1) Anti-anxiety meds can help a lot with this.

(2) In the moment, relaxation breathing can break the spiral into physical panic symptoms that exacerbates your sense of unwellness. Google "7-11 breathing."

(3) You can also think of these worries as an old tape playing in your head. It's just a tape. It's not you. Let it run its course. Don't try to ignore it, but don't engage with it, either. It's just a tape! There it goes again. Whatever! It's not you.
posted by praemunire at 1:49 PM on November 14, 2017

hello friend are you me??

As someone with health anxiety and a chronic illness, I am giving you permission to feel like it SUCKS. Because it does.

I'm also going to take a completely different direction here, and suggest what has worked really well for me: learning more about medicine. I've spent some time, in small chunks, as things have come up, learning about the differences between symptoms that are actually a sign of something scary and those that are probably just A Thing Bodies Do Sometimes. I'm still quicker to go to the doctor than the average person, but knowing that, say, a low-grade fever is only worrying for an otherwise healthy adult if it persists for more than a few days or has certain other obviously scary symptoms with it, has helped me stay calmer. There are books out there I've seen people recommend for this, but I couldn't handle a whole book and just tried to learn in little chunks from doctors and very careful googling over the years. (Oh, and asking my mom things that she learned when I was a kid.)

This is not really an anxiety-oriented approach, because I know I don't always respond well to normal anxiety work. It doesn't necessarily get to the root of the anxiety. But I favor the practical/coping mechanism method and the therapy I had the best luck with did too. Maybe you're like me? If so, this might help?
posted by dust.wind.dude at 3:32 PM on November 14, 2017

I've gone through a couple bouts of health anxiety -- one really bad one, about a decade ago, that lasted, on and off, for a couple of years. I have in the last 8 or 9 years become a pretty regular mindfulness meditator (daily sitting and occasional retreats) and I can say that this has benefited my mental health in every conceivable way. I am in general a steadier person. So that's a long-term suggestion. Happy to offer tips on getting started if you want to memail me.

When I was having bad health anxiety, I'd have a symptom of some kind and then google it, looking for reassurance. I would often get it, and feel calm for a little while, but then I'd look for MORE reassurance, and this would often backfire. I'd stumble upon something that would stoke my fears. Ugh, it was awful. One thing that helped me was going to some forums where people talked about their HA fears. It was pretty clear to me that most of those people were worrying needlessly, that the only malady they were suffering from was HEALTH ANXIETY. Somehow, I could see myself in them and it helped loosen the grip of my fears. I could see how I was just like them, and that my fear was a repetitive pattern. I don't know if this would be useful to you, but you could try it.
posted by swheatie at 4:36 PM on November 14, 2017 [1 favorite]

What great answers - thank you all so much.

DMelanogaster, that was fascinating. It certainly gives some shape to my own experience, as I only began experiencing health anxiety shortly after (1) going away to university and living by myself for the first time and (2) losing a family member in a traumatic accident. I suppose it makes sense. Your point about 'waiting for the other shoe to drop' rang very true.
posted by Ziggy500 at 3:08 AM on November 15, 2017

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