Improve Health Anxiety by Examining the Evidence for Your Thoughts

A new symptom popped up this week and sent you into a downward spiral again. Maybe you felt a pain in your side, got a stomach ache, noticed a new mole or experienced some dizziness or chest pain.

Whatever it was, this sudden realization sucked the joy out of your day and took you from point A (noticing the symptom) to point B (envisioning yourself collapsed on the floor from a heart attack or in the hospital with cancer) in just a few short minutes. You know this probably isn’t accurate but that knowledge isn’t enough to stop yourself from spiraling.

Before we dive into how to fix this, if you are interested in taking the first step toward improving your health anxiety, grab my free guide! 

One useful strategy we use in CBT for all types of anxiety is called "examining the evidence." I’ll explain what this is in a second. But first, keep in mind what the research says about people with health anxiety.

Health-anxious people tend to:

• Overestimate the likelihood of becoming seriously ill;

• Overestimate the severity of the illness if it were to happen;

• Underestimate their ability to cope with the illness 

Examine the Evidence

Examining the evidence is a strategy used to evaluate specific thoughts or beliefs in order to better understand the accuracy of these thoughts and beliefs. The whole goal of CBT is not positive thinking, but realistic and logical thinking. And, because our anxious minds can lead us to overestimate threat and underestimate coping, it is critically important to put these thoughts to the test. Think of yourself as a scientist who is collecting data.

In the context of health anxiety, this intervention is helpful to examine the evidence for and against dysfunctional beliefs, such as cognitive distortions about bodily changes or sensations. We will use an example to walk us through the exercise.

Let’s say that, in a conversation with a colleague, you were discussing someone else on the team and randomly forgot their name.Your automatic thought is: I have early-onset dementia. Of course, this prompts you to spend the next couple of days searching for other dementia symptoms. Well, I did have a hard time finding my keys when leaving for work this morning. I do seem to be having a harder time concentrating this week. 

Before you'd spend the rest of the week going down a bunch of rabbit holes, I'd want you to examine the evidence. First, I'd ask you to evaluate how much you believe this thought on a scale of 1-100.

FRIGHTENING THOUGHT:
I have early-onset dementia. 
Degree of belief (before activity): 75/100

EVIDENCE IN SUPPORT OF THE THOUGHT:

• While telling a story, I forgot the woman's name (and I have met her multiple times)

• My grandmother had dementia 

EVIDENCE AGAINST THE THOUGHT: 

• I have actually had a fairly good month overall, in terms of productiveness and organization- which probably wouldn't be the case if I really was in the beginning stages of dementia 

• I remembered the name a few minutes later so it was just a momentary lapse in memory 

• I have met the woman a few times but don't interact with her regularly, making it easier to forget her name

• I don’t have any other symptoms of dementia (e.g. memory loss that disrupts daily life, difficulty planning or problem-solving, difficulty completing tasks that I know well, confusion about the time, day and place, social withdrawal, drastic changes in mood).

• I am 43 and my doctor told me that to develop dementia before the age 65 is extremely rare 

After evaluating the evidence, I want you to re-rate your degree of belief. You might find that after this activity the number has changed a bit. Let's say your degree of belief went down to 55. Thus, you reduced your belief in this thought by 20 points. This is a quick way to determine whether this technique had any impact. Even if we only noticed a 10 point difference before and after the activity, I would conclude that it was a success. After all, even a 10 point change would likely make you feel a little better. Also, you shouldn't expect yourself to make drastic changes after 1 time of trying an activity like this. Changing thinking patterns takes time and persistence. Imagine... if you did exercises like this on a regular basis, over time you would believe these types of thoughts less and less. And that is the goal! 

Alternative Explanations

Next, I would ask you: Is there an alternative way of looking at things? What is a more accurate, non-catastrophic explanation for forgetting someone's name? Collaboratively, we would explore other non-catastrophic explanations.

Perhaps, (a) you were nervous during the conversation with your colleague, which can make it harder to think clearly; (b) you haven't been sleeping as well this week; (c) you are stressed about everything you have to do for the holidays; (d) you live with anxiety on a daily basis, which can contribute to forgetfulness; (e) it may be a side effect of a medication you are taking. And the list could go on.

There are often numerous potential non-catastrophic causes for your symptoms. However, in an anxious state, we often don’t even consider the non-catastrophic explanations. A great new habit to develop is to consider as many potential non-catastrophic explanations as you can think of and even try to conjure up evidence for them.

Lastly, when you do this exercise, remind yourself of something. If the symptom you are worried about persists or new, additional symptoms emerge, you will do what you need to do: you will go to the doctor, get it all checked out and deal with it. This exercise is just to help you not automatically "jump to conclusions" and "catastrophize" in the first moment that you discover a new symptom. Doing this exercise does not mean you won't take the necessary next steps in the event that the symptom does warrant action.

My goal is for you to be your own CBT therapist, in which you become a master at using techniques like these so that you can implement them on your own throughout life.

If you want to take the first step toward improving your health anxiety, grab my free guide!