Health Anxiety Formulation
Health anxiety is characterized by a preoccupation with having or acquiring a serious illness, and a high level of anxiety about health. People with health anxiety will engage in excessive health-related behaviors, such as checking their body for signs of illness, or will avoid situations or stimuli that are perceived as anxiety-provoking. The Health Anxiety Formulation describes maintaining factors which prolong distress in health-anxious clients. The formulation is presented as in a ‘vicious flower’ format with ‘preoccupation with health or illness’ as the central feature.
Health anxiety is characterized by a preoccupation with having or acquiring a serious illness, and a high level of anxiety about health. People with health anxiety will engage in excessive health-related behaviors, such as checking their body for signs of illness, or will avoid situations or stimuli that are perceived as anxiety-provoking.
The cognitive behavioral model of health anxiety describes which factors play an important role in the development and maintenence of health anxiety. Cognitive factors include the overestimation of the probability of having or developing a serious illness, overestimation of the seriousness of an illness, and misinterpretations of body sensations / functions / appearance as indications of serious illness. Safety seeking behaviors are also important in health anxiety and include avoidance (of hospitals, sick people, blood, reminders of illness, thought suppression, distraction), checking (of one’s body & bodily functions, of one’s memory), information seeking (via repeated medical consultations and tests, searches for information), and reassurance seeking (from professionals, through searches for information).
This model of health anxiety uses a ‘vicious flower’ format with ‘preoccupation with health or illness’ as the central feature. Maintaining ‘petals’ include cognitive factors (such as appraisals of symptoms, or worry), and behavioral factors including avoidance, checking, and reassurance-seeking. This pack comprises two versions of the model: one describing the main features, and another demonstrating a case example.
This is a Psychology Tools information handout. Suggested uses include:
- Client handout – use as a psychoeducation resource
- Discussion point – use to provoke a discussion and explore client beliefs
- Therapist learning tool – improve your familiarity with a psychological construct
- Teaching resource – use as a learning tool during training
- Furer, P., Walker, J. R., Stein, M. B. (2007). Treating health anxiety and fear of death. New York: Springer Publishers.
- Rachman, S. (2012). Health anxiety disorders: A cognitive construal. Behaviour Research and Therapy, 50(7-8), 502-512.
- Salkovskis, P. M., & Warwick, H. (2001). Making sense of hypochondriasis: A cognitive theory of health anxiety. In Health anxiety: Clinical and research perspectives on hypochondriasis and related conditions (pp. 46-64). Wiley.
- Salkovskis, P. M., Warwick, H. M. C., Deale, A. C. (2003). Cognitive-Behavioral Treatment for Severe and Persistent Health Anxiety (Hypochondriasis). Brief Treatment and Crisis Intervention, 3, 353-367.
- Stern, R., Drummond, L. (1991). Behavioural and cognitive psychotherapy. Cambridge: Cambridge University Press.