- People with health anxiety hold maladaptive beliefs about health and illness.
- Core beliefs influence how we interpret and react to symptoms and bodily sensations. Core beliefs aren't permanent; they can be changed.
- Cognitive restructuring is a CBT technique that can be helpful in reshaping maladaptive beliefs about health into adaptive beliefs.
People with health anxiety have dysfunctional beliefs about health and illness. One common belief among health-anxious people is that they are weak and particularly vulnerable to sickness or disease. They might have the sense that their health is ‘barely hanging on by a thread.’ They are convinced that, because of their presumed weakness, any illness or disease that happens to come along will be what puts them in the grave.
Now, I want to recognize that in some cases, people are actually dealing with serious or debilitating diseases and have compromised immune systems. And in those cases, of course, one may be particularly vulnerable to illness and the appropriate steps need to be taken to protect their health, as advised by their doctors.
That said, many people who experience health anxiety and live with this assumption are not weak or vulnerable to disease to the extent they are assuming. And this belief causes them to live in fear of any and all diseases, naturally. Why? Because if they believe that any disease they get will be the end of their life, it is only natural to live in fear of it! Of course they are going to be startled by and concerned about any bodily sensation or symptom that pops up because they are convinced it could be the beginning of the end.
The whole process can look a little like this:
- They hold the core belief that they are weak and vulnerable to disease, and therefore live in fear of disease because they believe they won’t stand a chance against it.
- This belief leads them to be hypervigilant and on high alert for any potential ‘threats’ (i.e. symptoms or bodily sensations).
- Any time they have a symptom or bodily sensation (even when it is neutral or benign such as due to normal body noise or anxiety), they fear it may be due to a serious disease.
- They then make biased interpretations of the symptoms or bodily sensations (i.e. engage in thinking errors).
- Their misinterpretations make them feel very unsafe and, therefore, they begin to do a bunch of things to feel safer (i.e. engage in safety behaviors like going to the doctor frequently, asking loved ones about symptoms, googling symptoms, incessantly pinching, poking or checking body parts or symptoms).
It is a miserable cycle! See the diagram below for a visual illustration of this process.
So, how does one change this cycle?
The goal is to recognize one's own physical strength, resilience and capability of coping with, treating or overcoming the vast majority of illnesses and diseases. This is where cognitive restructuring techniques can be helpful. Cognitive restructuring is a CBT technique that helps one to examine and challenge their thoughts and beliefs. In this case, one needs to examine the evidence of their belief, that they are weak, vulnerable and prone to sickness. This process allows them to pull out all of their assumptions (i.e. write them down) and evaluate the validity of each one.
We often don’t question our beliefs but just assume they are valid. This is problematic because our beliefs are the lens through which we see the world around us. If one has illogical or faulty beliefs, they may be interpreting symptoms in a distorted and biased way without even realizing it.
Challenging core beliefs
When it becomes evident that a client carries this belief of being weak and vulnerable to disease, I suggest we take a few minutes to challenge it.
Step 1: We write the maladaptive core belief at the top of the worksheet (I am weak, vulnerable and prone to sickness).
Step 2: We then come up with a new, more adaptive belief (the goal is for them to learn to believe this more and more over time).
Step 3: We assess the degree to which they believe both beliefs (0-100, with 100 being the strongest).
Step 4: We make two columns, one to gather evidence for the old core belief and one to gather evidence for the new core belief.
Step 5: We begin collecting evidence for the old, maladaptive core belief.
Step 6: After we are finished, we go through the list of evidence and look for any potential thinking errors or inaccuracies. We write out the reframes next to each piece of evidence.
Step 7: We then move to the right side to list out all the evidence that contradicts the old core belief and supports the new core belief.
Step 8: As a final step, we look through all of the evidence on both sides and then assess the extent to which they believe the old core belief as well as the extent to which they believe the new one. If they believe the new core belief even a little bit more (and the old core belief a little less), even if it is only a 10-point difference, I would conclude the intervention was helpful.
See the table below for a detailed example of the results of this activity.
It’s important to keep a few things in mind when completing the core belief worksheet.
1. When you are identifying evidence for the old/maladaptive core belief, make sure you are including everything. Even if you know the piece of evidence is silly, you still want to write it down. You need to give yourself the opportunity to really challenge this and see how illogical it is. If you don’t, you still may carry it around in your mind as a truth, to some extent.
2. Make sure you document the extent to which you have both beliefs, before and after the intervention. This will help you to evaluate whether it was helpful. Importantly, don’t discount small changes in your belief after you do this. Even just 10 points can make a difference and mean the intervention was at least somewhat helpful.
3. You will not change your beliefs entirely during this one activity. Beliefs take time to change. Use this worksheet as a starting point. You will then work to build from there, slowly collecting evidence in your environment to support your new, healthy belief. In addition, you will want to continue to challenge any assumptions you make in your daily life that support your old belief.
A few final comments
There you have it! Try this activity out for yourself and see what you come up with. Cognitive restructuring can take time at first. But, as you continue to use these skills, it will take less and less time for you to come to these same conclusions. Remember this: Your thoughts and beliefs about health and illness are not facts! Evaluate their validity and try to come up with new conclusions. It takes work at first but is well worth the effort.