How to Manage Health Anxiety

Hint: Don't call Dr. Google ☎️

Nov 06, 2023

ICYMI 👉

I recently saw a generally healthy middle-aged patient for fatigue and a gnawing sense that she had a hidden cancer. She reported staying up late scrolling through images of war on her phone, and then waking up to an endless loop of worry about her health. Her physical exam and laboratory testing were normal except for a slight increase in her lymphocyte count. Before I could explain what this meant (a normal response to her recent bout of COVID), she asked me, “Do you think I have cancer?”

a red fire extinguisher on a red wall — Photo by Josephina Kolpachnikof on Unsplash

A few days later, a newsletter reader named Lindsey wrote to me about her own health worries:

I have times when I feel an uncharacteristic level of health anxiety- for me, for my loved ones- where I blow a symptom out of proportion and think the worst case scenario or when I become just effing freaked out. It almost feels like a trauma trigger- the sense of helplessness and fear just washes back over me. Are you seeing this in others? And if so, could you perhaps post something for us that lets us know we aren’t alone?

My message to my patient and to Lindsey: You are not alone—and there are some good reasons why.

The residual loss, grief and heightened sense of vulnerability left over from the pandemic—combined with the existential crisis of war and human devastation we have witnessed—are nothing short of trauma. Of course, no two people will react the same way to having life upended or the tragic stories from overseas, but I think it’s fair to say we’re all experiencing some sort of emotional distress.

Living in a state of hyper-vigilance takes a toll on our physical and mental health. As trauma specialist Dr. Gabor Mate says, “Trauma is not what happens to you, it's what happens inside you.”

Of course, it’s entirely normal to feel on edge or have trouble sleeping, for example, during traumatic events. It’s also important to recognize that stress not only affects us emotionally; it has physical, behavioral, and cognitive ramifications, too. Hearts race and palms sweat. We gravitate toward comfort foods and drinks. Our thinking becomes distorted. We marinate in “What ifs” and “Oh my God”s.

We also seek to rationalize unbridled anxiety, sometimes attaching it to a body part or unnamed physical ailment. For those prone to health-related anxiety, our primitive brains would rather let Dr. Google identify a deadly diagnosis than experience the uncontrollable swirl of anxiety and uncertainty itself.

Of course no one actually wants a diagnosis of cancer or ALS, but there’s certainty in knowing what we’re fighting, in the singular focus on a nameable entity. It makes sense. Anxiety hates the absence of control; the internet diagnosis promises us a specific kind of certainty.

However, the antidote for health-related anxiety isn’t a date with WebMD. It’s to recognize the anxiety is the first place and to bring the boiling pot of anxiety back to a simmer.

So, here is my advice for my patient, Lindsey, and anyone else dealing with health-related anxiety:

Normalize the cognitive distortions of anxiety. Our rational brain can't always compete with our subconscious drive to protect ourselves from harm, sometimes at the expense of our well-being. And even once an existential threat is managed, diminished, or gone, it takes time for our nervous system to re-equilibrate. If Dr. Google is your go-to “drug” when you’re feeling out of control, don’t be surprised when you turn to it for every ache, pain, or tingling body part! By acknowledging the biochemical nature of trauma and its effects on our thinking, we can bring our rational brains back online.

Check the facts with your doctor. People who worry about their health can also get sick! Checking out your symptoms with a medical professional can give you peace of mind. Dismissing health-related anxiety (whether it’s your own or someone else’s) not only is inappropriate; it adds fuel to the fire of anxiety. Of course, reassurance isn’t the “cure” for health-related anxiety, however fact-finding is the first step toward addressing fear itself.

Recognize that there is a tsunami of online health misinformation. Junk science is popular because it preys on people’s vulnerabilities. It capitalizes on the fact that most people don’t have a doctor—and, if they do, they have 10 minutes with them. The churn of misinformation does serious harm to people who are naturally predisposed to worry about their health. Simply getting offline is the first step to getting back in the driver’s seat of your health.

Accept that uncertainty isn’t going away. Acceptance isn’t about giving up. It’s not about giving in to our anxiety. It’s about ceding control over the things we cannot control and redirecting our (limited) energy and brain space toward the things we can change. For example, we may not be able to control the current political and social unrest—or the pain of witnessing overt antisemitism—but we can self-soothe by limiting our time online, reaching out to loved ones and to those who are suffering, and spending time in nature. An honest reckoning with our medical facts—including a propensity toward anxiety—can improve our sense of agency and calm.

Address anxiety head-on. I often remind my patients with health-related anxiety that anxiety is the cancer. And while, of course, some anxiety is normal, anxiety that takes on a life of its own—i.e., worry that causes physical, emotional and cognitive problems—should be treated like any other health issue. From mindfulness techniques and a structured exercise routine to psychotherapy and medication as appropriate, we treat anxiety not by telling people, “Don’t worry!” but as the bio-psycho-social problem that it is.

I recently discussed the issue of health anxiety with the amazing Anne Borden King whose career has centered on fighting against health misinformation online. As the mother of an autistic child, she has witnessed the scourge of junk science first-hand. She has said, “You can’t get rid of the impetus for pseudoscience, but you can stop a lot of vulnerable people from being exploited.”

Her podcast, Noncompliant, is helping people separate fact from fiction. On this episode of her podcast, we talked about how the pandemic set us up for ongoing fears about health (not just COVID). I hope you give it a listen!

As always, I welcome your comments!

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