People with health anxiety tend to use unhelpful coping mechanisms when anxious about their health. These are called safety-seeking behaviors/avoidant behaviors and they ultimately make health anxiety worse over time. There are many types of these problematic behaviors. People with health anxiety tend to fall into one of two categories: the care-avoidant or care-seeking subtype.
As you might expect, people who tend to be care-avoidant are more likely to use avoidant behaviors when their health anxiety is triggered and people who tend to be care-seeking are more likely to use safety behaviors such as reassurance-seeking from the health care system. Notably, you might also be someone who engages in both care-seeking and care-avoidant, depending on your particular fears and the situation.
Avoidance of Medical Visits (or the Care-Avoidant Subtype)
People who lean toward the care-avoidant subtype tend to avoid getting physicals or regular check-ups at the doctor because they fear being told that there is something wrong with their health. Or if they have a concerning symptom, they might avoid or put off getting it examined by a doctor, again, because they fear being told that something is wrong. I had a client who was significantly overweight, smoked and drank excessively, and had a long family history of heart disease. Still, he had not gotten a physical/check-up in over 10 years because he was terrified of what he might learn.
If being care-avoidant describes you, you likely recognize this as a problem, especially if it has started to significantly impact your life. But, even if you recognize it as a problem, it is hard to know how to stop doing it, right? Obviously, if it were that easy you would have done it by now. No one intentionally chooses to live in avoidance because they are consumed by health anxiety.
Experiential Knowledge Is Key
Although it is important to challenge your thoughts, experiential learning is a necessary step as well. There is something incredibly powerful about putting yourself in real-life situations and learning, over time, that what you fear is not as scary as you thought it was. It is also important to learn that, in these feared situations, you are able to handle the anxiety much better than you thought you could. A behavioral strategy to help you gain this experiential knowledge is the use of exposure tasks. Through exposure, you can slowly and systematically reduce your use of avoidance and face your fears.
Essentially, you want to create an exposure hierarchy (typically between 10-15 items), ordering them from least to most difficult. Difficulty level is typically recorded as “subjective units of distress” or SUDS, ranging from 0 (provoking no anxiety, like you are asleep) to 100 (provoking the most anxiety). You will be working your way up the hierarchy as you build confidence. Below is an example of an exposure hierarchy that I have used with a client to overcome their avoidance. In their case, they avoided check-ups/physicals and standard screenings. We decided to start by tackling the fear of going to get a physical. In addition, You will see a list of tips for the successful implementation of exposure tasks (below the hierarchy).
Source: BChesworth
Tips for Successful Implementation of an Exposure Hierarchy
- Find balance in terms of task difficulty (you want it to be at least a little anxiety-provoking but not so anxiety-provoking that you don’t follow through);
- Make socratic dialogue your best friend during exposure tasks. It is important that you challenge any problematic thoughts during exposure tasks to reduce/manage the anxiety. A few helpful questions if you start feeling anxious or want to quit:
- What am I worried will happen during the exposure?
- Have I worried about this happening before and everything turns out to be OK?
- If something negative does happen during the exposure, how could I respond and deal with it? For example, even if they do find a concern during this physical, isn’t it good that I now know the issue and can manage/treat it with medication, procedures, or lifestyle changes? How could I cope well with this?
- Is it possible that everything will turn out OK and I will experience a sense of relief after it is over? For example, in getting a physical I will be relieved to know that I am in overall decent health?
- Repeat exposures often. The more you do it, the more effective this will be. You can also add in more exposure tasks by breaking up one task into two or three exposures (for example, you can break the task of going to your physical appointment into three tasks: imagining going to the appointment, going to a doctor’s appointment with a friend, and then going to your physical alone);
- Try to accept/tolerate anxiety during the tasks. Anxiety is not dangerous, just uncomfortable. One of the main goals of exposure is to become more comfortable with anxiety;
- Beware of any inclination to use safety behaviors. Ultimately, we want to help you reduce your use of safety behaviors whenever possible;
- Before you start your exposure task, be sure to document your prediction about what will happen. You will then be comparing this to the outcome in your exposure log;
- Remember to reflect on and document your experience in your exposure log after every exposure task.
Documenting Your Experiences
Remember, prior to completing your exposure task, I want you to write down your prediction about what will happen during the exposure task:
- What do I predict will happen during this exposure task?
- You might predict that you won’t be able to handle the anxiety.
- You might predict that something bad will happen.
Again, documenting your experiences after each task is critically important, as you need to be given the chance to compare predictions with outcomes and reflect on your experiences. Reflection will solidify your learning experiences. See the log below, with an example.
CBT thought record for health anxiety
Source: BChesworth
Give this a try. You can start small with baby steps. Using the sample hierarchy as inspiration, create a basic exposure hierarchy. Don’t overcomplicate it. Just think of it as a simple process in which you take several baby steps toward going to the doctor. After you’ve created your hierarchy, tackle one exposure task at a time. Typically, my clients will finish two or so exposure tasks in a given week, depending on the task and their time. Again, take it slow enough to make it manageable but not so slow that you aren’t challenged enough.
