Helping Health Anxiety
Helping Health Anxiety

Helping Health Anxiety
Module 9
Healthy Living &Self-Management PlanningIntroduction

2

The Health Anxiety Model Revisited

2

A New Way of Operating

3

Preventing Set-backs

5

Self Management Plan

6

Healthy Living

7

Module Summary

9

About the Modules

10

The information provided in the document is for information purposes only. Please refer tothe full disclaimer and copyright statements available at www.cci.health.gov.au regarding theinformation on this website before making use of such information.
forCentrelinicalC Interventions• Psychotherapy • Research • Training

Module 9: Healthy Living and Self-Management Planning

Page 1Helping Health Anxiety
Introduction
Congratulations on making it to the end of this information package! In this final module, you will find asummary of all of the important concepts and strategies introduced to you in the previous modules. Youwill also find a self-management plan designed to help you stay on track in the future.

The Health Anxiety Model Revisited
Remember the model of how health anxiety is maintained from Module 3? It showed how certain internalor external triggers can activate your health rules or assumptions. Once activated, these rules andassumptions can negatively affect the way you think about your health and interpret health relatedinformation. The more you think in this negative manner, the more anxious you feel, and the stronger yourdesire is to focus on your symptoms, check and seek reassurance, and avoid things that remind you of yourhealth related concerns. Engaging in these behaviours may provide some short term sense of relief orcontrol. However, in the long term, the vicious cycle remains unchallenged and continues each time you
are confronted with a trigger. Below is a simplified model to refresh your memory.

Internal or External Triggers

Activates unhelpful health rules / assumptions

Unhelpful health related thoughts

Anxiety symptoms

Focussing onsymptoms

Checking &Reassurance Seeking

Avoidance &Safety Behaviours

Short term consequences

Sense of relief or control over symptoms

Long term consequences

Focusing on symptoms can increase intensity of symptoms
Checking behaviours may bring on or intensify symptoms
Avoidance limits opportunities to learn new things and challenge fears
Unhelpful health related thoughts, rules and assumptions continue unchallenged
Anxiety continues
Increased desire to focus on symptoms, check and seek reassurance, and to avoid
or use safety behaviours

forCentrelinical
C Interventions• Psychotherapy • Research • Training

Module 9: Healthy Living and Self-Management Planning

Page 2

Helping Health Anxiety
A New Way of Operating
The old health anxiety model represents a vicious cycle, where the things that you think and do actually
increase the amount you worry about your health, and the frequency and intensity of physical sensations
you experience. The good thing about a cycle is that you can reverse it from a negative cycle to a morepositive cycle. It is like a wheel moving in one direction that has some momentum behind it. By making
some changes and putting some force against the old motion, you can usually get it to spin in the opposite
direction. Initially, trying to change the direction of the wheel can be a real effort and may not be smooth at
first. However, with some persistence it starts to get easier and the wheel eventually gathers its own
momentum in the new direction.
We hope that by now you have been able to start loosening up the old health anxiety cycle. So let’s take amoment to review the key strategies introduced throughout these modules, and see how they might fit
together in a new model (see page 4).
Notice in the new model, that internal or external triggers can still activate your old unhelpful health rules
and assumptions. This is because those unhelpful rules and assumptions have generally been around for along time, so you can’t expect them to disappear overnight. The key thing is that instead of allowing theseunhelpful rules and assumptions to then guide your thoughts, feelings and behaviours, you choose to do
things differently. Over time these old rules and assumptions may then fade out and not be so easily
activated.
So, when your old health rules and assumption are activated you instead:• Adjust your health rules and assumptions by challenging them, devising new helpful healthrules and assumptions, and putting them into practice;• Let go of your focus on health symptoms and worries by practicing your attention exercises(mundane task focussing, meditation), and using your postponement strategy to delay any further
focussing on these to a later time and place;• Re-evaluate any unhelpful health related thoughts by using a thought diary during your“worry period” to address any thoughts that keep popping back up;• Reduce any unhelpful checking or reassurance seeking behaviours by evaluating how
helpful the old behaviour really is, generating a new more helpful behaviour, and then testing it out;
• Reduce any avoidance or safety behaviours by gradually confronting
feared thoughts, people, places and activities.
Doing each of these things, although sometimes hard in the short term, can lead to arange of long term benefits. The key thing is to keep going, because the more of theabove strategies you use, the more likely you are to reverse that old cycle of healthanxiety.

forCentrelinicalC Interventions• Psychotherapy • Research • Training

Module 9: Healthy Living and Self-Management Planning

Page 3

Helping Health Anxiety
My New Way of Operating
Internal or External Triggers

Activates unhelpful health rules / assumptions
INSTEADINSTEAD

Adjust unhelpful health rules / assumptions
Ask myself:
Where did it come from? Why is it still here?
What impact does it have on my life?
How is it unreasonable, unrealistic or unhelpful?
What is an alternative rule / assumption?
How can I put this into practice?

Let go of my focus on health symptoms
and worries
Practice my attention exercises(i.e., mundane task focussing and meditation)

Re-evaluate unhelpful health related thoughts
If I am still worrying when I get to my worry
period, use a thought diary to directly challenge
the worry and develop more realistic predictions

Use postponement to delay any further focussing
on these until a specific later time and place

Reduce Checking & Reassurance Seeking

Reduce Avoidance & Safety Behaviours

Ask myself:
How helpful is my checking/reassurance seeking?
What are the advantages / disadvantages?
Should I decrease, postpone or eliminate this?
What specifically will I do instead? Why?

Gradually start to confront feared thoughts,
people, places and activities
Be aware of and try to gradually decrease any
safety behaviours I am using

Test out this new behaviour

Initial increase in anxiety, discomfort and uncertainty••••

Less worry and concern about symptoms and general well-being
Less chance of bringing on physical symptoms of anxietyLess chance of creating new symptoms due to checking behaviours
More opportunities and confidence to be able to respond appropriately to healthproblems that arise
Less time spent checking, reassurance seeking, or avoiding
Improved relationships with friends, family, and health professionals
More time for other important or enjoyable activities•••

forCentrelinicalC Interventions• Psychotherapy • Research • Training

Short term consequences•Long term consequences

Module 9: Healthy Living and Self-Management Planning

Page 4

Helping Health Anxiety
Preventing Set-backs
Now that you have made it to the end of this information package, the most important thing is to keep
going! It is important to recognise though, that even if you are trying your hardest to put all of thestrategies in place, you can expect some set-backs to happen along the way. Change is never a straightforward process.
Think about the idea of trying to learn a new sport. It will take some time for the skills to feel more naturaland to learn all the new rules. You will need to persist and practice to make it easier on yourself. At times,
you may come up against some tough competition, but that doesn’t mean that you should give up! It justmeans that you might need some more practice.
Try not to focus too much on any set-backs that you experience. Instead, focus yourattention on what you will do next to get back on track, such as practicing the strategies
summarised by the “My New Way of Operating” model. You can even use any set-backs
you experience as a way of learning something new about yourself, to help avoid similar
problems in the future.
It may be helpful to create a personalised self-management plan to recognise the signs of a set-back and to
put things in place as soon as possible. This way you can prevent a small set-back from turning into a largeone.
On the next page is a self-management plan worksheet for you to identify:• Early warning signs of a set-back. These are clues you can keep watch for that indicate you
might be starting to worry about your health again.
• Potential problem situations. These are the things that could potentially trigger off anotherepisode of health anxiety in the future.
By being aware of these early signs and potential triggers, you will be in a better position to “spot” theonset of health anxiety, and then take early action to prevent it from becoming worse.
There is also room for you to record helpful:• Strategies or techniques. These are the things you have learnt that are helpful for reducing yourhealth anxiety.
• Coping statements or phrases. These could include your new health rules or assumptions,
ideas you have developed from your thought diaries, or any other things you have found helpful toremind yourself of from these modules.

forCentrelinicalC Interventions• Psychotherapy • Research • Training

Module 9: Healthy Living and Self-Management Planning

Page 5Helping Health Anxiety
Self-Management Plan
What are the early warning signs that tell me I might be heading for a set-back and need to dosomething about it myself? (e.g. particular thoughts, behaviours such as checking or avoidance, thingsothers say to me, anxiety symptoms)

What situations are potential problems for me? (e.g. times of increased stress, medical checkups, receiving a diagnosis)

What strategies/techniques have I learned that I could apply when I notice some early warning signs?

What are some of the coping statements or helpful phrases that I can use to help myself cope
when I am feeling anxious or worried, or have had a set back?

forCentrelinicalC Interventions• Psychotherapy • Research • Training

Module 9: Healthy Living and Self-Management Planning

Page 6

Helping Health Anxiety
Healthy Living
You might recall that right back at the start of Module 1, we discussed the idea that ‘health’ does not justrefer to the absence of disease, injury or illness. Rather, ‘health’ often refers to a person’s state of physical,
mental and social functioning. The final step to overcoming health anxiety is therefore to think about how
you might improve those areas. After all, if you are taking real steps to improve your overall health, it gives
you less to worry about!
On the next page, you will see that there is room to write in your ideas about a variety of ways you might
improve your overall health. We recommend that rather than setting an overall goal, that you are specificwith what you will actually do. For example, you might look at the “diet” box and think that you would liketo eat more healthily. To get this started you could write “I will buy fresh fruit and vegetables with myshopping”.
Below are some questions that might help you identify whether you need to do something to improve eacharea on the Healthy Living Worksheet. We have also provided an example of how to set a specific goal forthat area.
••••••••

Social activities and support: Do you need to catch up with old friends? Do you need to initiate
some new friendships? “I will call Jane this week to catch up for coffee”
Stress management: Is there too much stress in your life at the moment? How could you reduce it?
“I will join a Tuesday yoga class and leave work on time to get there”
Diet: Are you eating a nutritional and balanced diet? Are there any problem areas with your diet?
“I will cut back to one coffee per day this week”
Exercise: How often do you exercise? Do you need to do more or less exercise?
“I will walk the dog two mornings per week instead of letting my partner do it”
Pleasant or fun activities: Do you have enough fun in your life? Are there things you used to enjoy
that you have cut back on or stopped doing? Do you put ‘fun’ last on the priority list?
“I am going to buy and start a jigsaw this Thursday”
Sleep: Are you getting enough rest? Do you find it hard to get to sleep or stay asleep? Do you putoff going to sleep because you are doing other things? Do you have good sleep habits?
“I will take the TV out of the bedroom because I keep staying up later than I ought to”
Personal goals: Is there anything you would like to achieve that you need to start working on?
What are your short, medium and long term goals? What is on your ‘to do’ list? Of all the things on
your ‘to do’ list, which would you most like to achieve? What clear step could you take towards
this goal?
“I will visit my relatives more often, starting with a visit to my Aunt this Saturday”Other: Is there anything else that you could do that would improve your overall health? Do you
need to reduce you alcohol intake? Are you due for a check up with your dentist or doctor? If you
have been recommended a medication or other treatment programme, are you maintaining it? If
not, how will you maintain it?
“I will call my dentist to book a check up”
You may find that you have identified quite a few changes that you would like to make.
You may want to get a diary so that you can schedule in each of these activities and keep
track of how you are going with meeting your new goals.

forCentrelinical
C Interventions• Psychotherapy • Research • Training

Module 9: Healthy Living and Self-Management Planning

Page 7

Helping Health Anxiety

Social Activities & Support

Stress Management

Diet

Exercise

Healthy

Pleasant or Fun Activities

Sleep

LivingPersonal Goals

forCentrelinical
C Interventions• Psychotherapy • Research • Training

Other

Module 9: Healthy Living and Self-Management Planning

Page 8Helping Health Anxiety
Module Summary•

To reverse the vicious cycle of health anxiety you need to:•••••

Adjust your health rules and assumptions
Let go of your focus on worrisome symptoms
Re-evaluate any unhelpful health related thoughts
Reduce any unhelpful checking or reassurance seeking behaviours
Reduce any avoidance or safety behaviours•Changing your health related rules, thoughts and behaviours takes time and lots of practice•

Expect set-backs, but rather than focussing on them use your self-management plan to recognise themearly, prevent them from getting worse, and get back on track.

•Engage in behaviours that promote your overall health, such as accessing social support, managing yourstress levels, having a healthy and balanced diet, exercising regularly, having fun, getting enough sleep,
setting and achieving personal goals, limiting your alcohol intake, attending regular check-ups, andmanaging any health issues you have.

To finish up …

Congratulations! You have made it to
the end of the modules. We hope you
have found them to be beneficial andthat you will maintain the gains you
have made. Do keep using thestrategies and review the modules
from time to time. Good luck!

forCentrelinicalC Interventions• Psychotherapy • Research • TrainingModule 9: Healthy Living and Self-Management Planning

Page 9Helping Health Anxiety
About The Modules
CONTRIBUTORSDr Rebecca Anderson (MPsych1; PhD2)Centre for Clinical Interventions

Paula Nathan (MPsych1)
Centre for Clinical Interventions

Dr Lisa Saulsman (MPsych1; PhD2)Centre for Clinical Interventions
1

Masters of Psychology (Clinical Psychology)2

Doctor of Philosophy (Clinical Psychology)

BACKGROUND
The concepts and strategies in these modules have been developed from evidence based psychologicalpractice, primarily Cognitive-Behaviour Therapy (CBT). CBT for health anxiety is based on the approachthat health anxiety is a result of problematic cognitions (thoughts) and behaviours.

REFERENCES
These are some of the professional references used to create the modules in this information package.
Abramowitz, J., Taylor, S., & McKay, D. (2010). Hypochondriasis and severe health anxiety. In McKay, D.,
Abramowitz, J., S., & Taylor, S. (Eds.). Cognitive -behavior therapy: Turning failure into success (pp. 327-346).
Washington, DC: American Psychological Association.
Asmundson, G., & Taylor, S. (2005). It’s not all in your head: How worrying about your health could be making
you sick – and what you can do about it. New York: The Guilford Press.
Furer, P., & Walker, J. (2006). Health anxiety treatment manual. University of Manitoba: Manitoba.
Furer, P., Walker, J., & Stein, M. (2007). Treating health anxiety and fear of death. New York: Springer.
Papageorgiou, C., & Wells., A. (1998). Effects of attention training on hypochondriasis: A brief case series.
Psychological Medicine, 28, 193-200.
Salkovskis, P., Warwick, H., & Deale., A. (2003). Cognitive-behavioural treatment for severe and persistent
health anxiety (Hypochondriasis). Brief Treatment and Crisis Intervention, 3, 353-367.
Willson, R., & Veale, D. (2009). Overcoming health anxiety: A self-help guide using cognitive behavioural
techniques. London: Robinson.

“HELPING HEALTH ANXIETY”
This module forms part of:Anderson, R., Saulsman, L., & Nathan, P. (2011). Helping Health Anxiety. Perth, Western Australia: Centrefor Clinical Interventions.
ISBN: 0 9757995 6 8forCentrelinicalC Interventions• Psychotherapy • Research • Training

Created: August 2011

Module 9: Healthy Living and Self-Management Planning

Page 10