Health Anxiety and Physical Symptoms
When physical symptoms begin to dominate your life.
Physical symptoms can be frightening, frustrating and exhausting.
You may be experiencing persistent concerns about your health, digestive difficulties, unexplained physical sensations or symptoms that continue despite medical investigations and reassurance.
You may have a diagnosed physical condition but notice that stress, anxiety or emotional states significantly affect your symptoms.
In each of these situations, the relationship between physical and psychological health can become complex.
Psychological therapy does not begin with the assumption that your symptoms are "all in the mind". It begins by taking your experience seriously and understanding what may be happening across the body, brain, emotions and behaviour.
Health anxiety
Health anxiety is more than simply worrying about your health.
A physical sensation, change in your body or piece of medical information can trigger a powerful sense that something may be seriously wrong.
You may find yourself repeatedly checking your body, researching symptoms, seeking medical reassurance or asking other people for reassurance.
Alternatively, you may avoid doctors, medical information or anything that could confirm what you fear.
Reassurance can help temporarily. However the relief often doesn't last.
Another sensation appears. Another possibility occurs to you. The uncertainty returns.
Over time, increasing amounts of attention can become focused on the body and the possibility of illness.
When physical symptoms are real but difficult to explain.
Sometimes people experience persistent physical symptoms for which medical investigations have not identified a sufficient explanation.
These are sometimes described as medically unexplained symptoms or persistent physical symptoms.
The absence of a clear medical explanation does not mean that the symptoms are imagined.
Pain, gastrointestinal symptoms, dizziness, fatigue, heart palpitations and other physical sensations can be very real, even when it is difficult to identify a single underlying cause.
For some people, the search for an explanation can itself become exhausting.
You may move between medical appointments, investigations and periods of reassurance while continuing to experience symptoms that significantly affect your quality of life.
Psychological therapy can provide another way of understanding what is happening without dismissing the physical reality of your experience.
Digestive disorders and the brain–gut relationship.
The digestive system and the brain are in constant communication.
Stress, anxiety and changes in physiological arousal can influence digestive functioning, while gastrointestinal symptoms can themselves activate anxiety and threat responses.
For some people, this creates a particularly difficult cycle.
A digestive symptom creates concern. Concern increases physiological arousal and attention to the body. This can intensify the experience of symptoms, which then creates further concern.
Over time, eating, travelling, commuting, meetings, social situations or simply being away from a bathroom can become associated with anxiety.
Therapy can help identify and change the psychological and behavioural processes that may be interacting with digestive symptoms while recognising that appropriate medical care remains important.
When the body becomes a source of threat.
Our brains constantly receive and interpret information coming from inside the body.
People differ in how strongly they notice these signals. Differences in interoception, sensory processing and attentional style mean that some people are particularly aware of subtle changes in digestion, heart rate, pain or other bodily sensations. This can also be relevant for some neurodivergent people.
Also, when you have experienced frightening symptoms, illness, a medical scare or prolonged uncertainty about your health, the brain can become increasingly alert to these physical sensations.
Once a sensation is interpreted as potentially dangerous, the body's threat system responds. Heart rate, breathing, muscle tension, digestion and other physiological processes can change.
Those changes create further sensations.
The difficulty is therefore not necessarily the original sensation alone, but the cycle that develops around it.
Understanding this cycle can be an important part of treatment.
You may understand that anxiety is involved and still experience the symptoms.
One of the most frustrating aspects of health anxiety and stress-related physical symptoms is that insight does not necessarily switch off the response.
You may know rationally that previous investigations have been reassuring.
You may recognise that symptoms become worse during periods of stress.
You may understand exactly what your doctor or specialist has told you.
And yet your body continues to react.
This is because physiological threat responses are not controlled by rational thinking alone.
My therapeutic approach therefore goes beyond simply challenging worrying thoughts. We look at the wider system maintaining the difficulty: attention, interpretation, reassurance, avoidance, behaviour, emotional learning and physiological responses.
How psychological therapy can help?
Treatment depends upon what appears to be maintaining your particular difficulty.
My work integrates evidence-based psychological approaches including Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT), EMDR and evidence from interpersonal neurobiology.
CBT can be particularly helpful for understanding cycles involving physical sensations, catastrophic interpretations, checking, reassurance and avoidance.
ACT can help develop a different relationship with uncertainty, uncomfortable sensations and difficult thoughts rather than organising life around trying to eliminate them.
Where previous frightening health experiences, medical procedures or other experiences continue to trigger a strong emotional or physiological response, EMDR may also form part of the therapeutic work.
The aim is not to persuade you that nothing is wrong.
It is to help you understand what is happening, reduce unnecessary threat responses and enable physical symptoms and concerns about health to occupy less psychological space.
Psychological therapy alongside appropriate medical care.
Psychological therapy should not be used as a substitute for appropriate medical investigation or treatment.
If you are experiencing new or unexplained physical symptoms, these should be appropriately medically assessed.
For many people, however, medical and psychological care are not competing explanations.
A physical condition can have psychological consequences. Anxiety can influence physiological processes. Persistent symptoms can sensitise the threat system. Previous medical experiences can affect how future sensations are interpreted.
Understanding these interactions can create additional opportunities for treatment and recovery.
Is this the right therapy for you?
You may benefit from an initial assessment if concerns about your health or physical symptoms are taking up increasing amounts of your attention, affecting your work or relationships, restricting what you do or leaving you caught in repeated cycles of fear and reassurance.
You may also be seeking help because physical symptoms appear to worsen with stress or because you have been left with persistent symptoms despite appropriate medical investigation.
You don't need to know whether the problem is "physical or psychological" before coming to therapy.
The initial assessment allows us to explore what is happening, what has already been investigated and treated, and whether psychological therapy could be a useful part of your care.
