Strategies for coping with health anxiety
Health anxiety is such a common mental health problem that the term ‘hypochondria’ is both a clinical and a colloquial word. Although no one wishes to be called a hypochondriac, with its rather uncompassionate associations of being subject to macabre fancifulness, probably most of us, if we were being rigorously honest with ourselves, would admit to having health anxieties at least some of the time. Indeed, health anxieties often exist at the liminal areas of our consciousness, as a vague, yet persistent unease that may be connected to diverse fears that seem to doggedly resist further articulation. Such fears, for example, could be dread about our own mortality, trepidation about being left helpless and terror of being abandoned in our hour of greatest need. These powerful and primal fears fuel our health anxieties, and it, therefore, can be so unfortunately easy, even for the most grounded person, to move from reasonable vigilance about their health to pervasive worry.
Of course, the situation we now face with the coronavirus pandemic is more than prone to exacerbate the prevalence of health anxiety. From a mental health perspective, one of the most pernicious aspects of this pandemic is that it can blur even further the line between legitimate worry and over-concern, which means that when we are stressed by the barrage of news programmes and newspaper articles devoted to COVID-19’s destructive consequences, it can be most challenging to maintain some perspective and not start to panic.
In this article, I shall not try to attempt to detail how to tell who has or has not had the coronavirus, as I leave such matters for the specialists, who have written about this matter on the NHS website and on government pages. What I wish to focus on here are three strategies for those informed readers (and ‘informed’ means, in this context, those who are already acquainted with the symptoms of the virus and are also conversant with the current Government guidelines; getting informed about symptoms is one of the simplest, if not foolproof, ways of potentially alleviating some anxiety). My aim is to help those who are struggling to cope with their (coronavirus) health anxiety, but who are not, as far as it can be possibly discerned, at great risk of serious illness as a consequence of the virus.
Limit your daily news consumption
While it is essential, as I’ve mentioned before, to stay up-to-date about symptomology and current government guidelines, for the sake of your mental health, it’s important to draw, as much as it is possible in these difficult times, a distinction between staying informed and becoming obsessed.
Consequently, if you find yourself glued to the screen, watching the news for many hours a day, then one straightforward way to reduce your anxiety is to limit your daily consumption of coronavirus-focused media. This advice is not, however, a suggestion to avoid the matter altogether or to leave it for a number of days. Rather, from a health and civic duty perspective, I still very much recommend that you give yourself a daily update on the changing situation, but that you don’t fixate on it beyond getting reasonably informed.
As a general rule of thumb, if you find yourself thinking of little else but the virus and/or you are going over, again and again, the same information on the news or on the internet, then it’s no doubt time to stop checking about the coronavirus situation and to move onto other things. To make such a shift is not dysfunctional distraction, but positive coping.
Take a worry break
The ‘worry break’ technique is a staple of cognitive and paradoxical approaches to the treatment of anxiety, as it often proves to be effective, even if it seems counterintuitive at first. When we usually think of addressing our worry, whether it be over our health or some other concern, we typically believe that the best approach is to try and immediately reduce it to the point of eradicating it. Such a head-on approach can sometimes work, but it often shows itself to be confoundingly inept.
In contrast, the worry break approach does not counsel an all-or-nothing strategy; instead, what this tactic suggests is that you do worry, but on schedule. More specifically, each day you are to worry at a time set by you (any time but ideally not too near bedtime) and you are to worry for a time allocated by you (up to twenty minutes is probably long enough). The hardest part to follow is this: once you have finished your worry time, you are not to worry about anything between worry breaks; if a worrisome thought enters your mind, you say to yourself, ‘I’ll address this during my worry break’ and you move onto thinking about something else.
So, in terms of coronavirus anxiety, you may, for example, decide to worry at 8 pm about the situation and when you finish at 8.20 pm, you make a determined effort, as much as possible, to not worry about the matter until the following evening. Avoiding worry during the interim will be challenging, particularly with news coverage being so pervasive, but if you can manage to mitigate the frequency and intensity of your worry, then you are managing your anxiety better.
Why does this strategy often work? There are a number of reasons:
1. If previously you were worrying for an extended period of time, and you now entirely (or at least mainly) restrict your worry to the allotted time, then your period of worrying is drastically reduced; you are indeed giving yourself a break from anxiety and have a better chance of seeing things in perspective
2. As you practice deferring your worry to your allotted time, you are gradually gaining more control over how you direct your attention and it becomes easier to redirect your focus
3. since the worry break gives you permission to fret about what is on our mind as much as you want, repeated exposure to this kind of worst-case scenarios becomes a form of desensitization, and those scenarios often lose their grim power over you as they become more familiar.
Becoming more mindful and deconstructing your thinking
The fact that we think, and we are not always aware that we are thinking, may appear to be one of those banal facts of our inner life. Yet the obvious does not necessarily preclude the profoundly significant. This is the case here: as cognitive therapies emphasise, again and again, our thoughts and our feelings are interconnected, such that our thinking - especially our most automatic, dimly-aware thinking - influences our feelings. If we, therefore, observe in ourselves a sudden, and seemingly inexplicable change in mood, chances are we have had disturbing thoughts that have so far eluded our notice.
One of the most effective responses to this unawareness of our thoughts, with its consequent capitulation to our moods, is to become more mindful, more aware that we are thinking and to recognise what we are thinking. The former involves a recognition - or perhaps more accurately, a continual reminder - that we are thinking. In other words, although our feelings seem to emerge directly from what happens, we should remind ourselves that very often there is a crucial intermediary step: events don’t simply happen to us, they are also interpreted by us, which involves us having certain thoughts about them.
Recognising this intermediary step is vital if you are to consistently respond, rather than uncritically react, to circumstances. Indeed, appreciating the fact that your feelings might be more a reaction to your thoughts than the actual circumstances, can, in of itself, help you cope with difficult feelings like anxiety.
The second aspect is trying to articulate what specific thoughts crossed your mind when you started, for example; to feel panicky. Asking yourself, ‘what passed through my mind when I started to feel anxious?’ usually helps you to put into words, and render conscious, the interpretive thinking that played a significant role in how you feel.
There are various strategies, culled from different therapies, that can build upon the therapeutic effect of becoming more mindful of your thinking. I’ll detail two of main ones here.
Acceptance and commitment therapy (ACT), a form of third-wave cognitive behavioural therapy (CBT), adopts perhaps the simplest or most direct approach. It counsels that when we are anxious, what’s important is to become mindful of how we think, and then reorient our attention to what is most constructively important in our lives. ACT argues that people tend to handle emotional distress in an understandable, yet ultimately self-defeating way: when we get upset, we assume that it’s best to try and rid ourselves of the distressing feelings, in a similar manner to trying to overcome some external problem.
In contrast, ACT proposes instead, that our emotional distress, as part of inner life, cannot be simply removed; yes, negative emotions can be constructively coped with, and their pernicious effects reduced, but they are part of our inner landscape. For this reason, ACT recommends not trying to eliminate negative feelings like anxiety, but rather to cultivate an explicit awareness of our thinking that allows a consequent disengagement from it.
The fundamental orientating move in ACT relies upon an inner stance known as ‘cognitive defusion’. When we are unaware, or at least less aware, of our thinking, we tend, according to ACT, to ‘fuse’ with our thinking, so that we forget that we are cogitating. We become, so to speak, the thoughts, and those thoughts then become unreflectively the ‘truth’ of the situation.
To put it another way, we forget we are wearing cognitive lenses to view an event and instead believe we are seeing things ‘as they are’. The remedy to this perspective is to become defused with your thinking, and therefore to recognise that you are ‘having’ these thoughts. This has two immediate beneficial consequences:
1. Becoming aware of those thoughts - that you are ‘having’ them - puts some internal distance between you and them, which is likely to decrease the intensity of the negative feelings
2. After noticing that you are ‘having’ these thoughts, you can reorient your thinking to more constructive matters as you’ve been able to pinpoint what to disidentify from.
A concrete example of this could be you are reading some article on the coronavirus, and suddenly, seemingly inexplicably, you feel panicky. You can ask yourself, ‘what passed through my mind just there?’. Say, for the sake of simplicity, you discover your thought was, ‘I’m going to get seriously ill and end up in hospital’. Assuming there is little current evidence for this prediction, you can now frame it in the following way: ‘I’m only having the thought that I’m seriously ill with the virus and will end up in hospital’. You can then reorient your attention, as much as possible, to constructive activities that you enjoy and find fulfilling. Should these troublesome thoughts emerge again in your mind - and it’s likely they will, some of the time at least - you can simply label them as ‘not helpful’ and refocus on your constructive activities.
Another cognitive therapy response to your thinking, once you’ve become aware of your negative automatic thoughts, is to interrogate them and subject them to critical scrutiny. To use the previous example, once you are aware that you are having the thought that you’re seriously ill and about to end up in hospital, CBT encourages you to ask several questions, such as: where’s the evidence [that I’m seriously ill]?; are there alternative, credible explanations for why I’m feeling anxious, instead of actually being in danger?; what might be counter-evidence to what I’m thinking?
Such questions deconstruct our thinking and determine, as much as is feasible, how substantial our thinking is on the theme that worries us. They often, although not inevitably, help us to distinguish fact from fancy, or, at least, likelihoods from worst-case scenarios.
If, after trying out these approaches or other recommended coping strategies, you still feel anxious during this pandemic, then it may be wise to reach out to a qualified counsellor for extra support. A trained counsellor can work with you via Skype or telephone to articulate your concerns and help you put things into perspective, which can be vital during these difficult, distressing times.
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