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What Keeps Health Anxiety Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concise, they provide an easy way for clients to understand at a glance why their disorders persist, and how they might be interrupted. What Keeps Health Anxiety Going? is designed to help clients experiencing health anxiety understand more about their condition.

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A PDF of the resource, theoretical background, suggested therapist questions and prompts.

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Languages this resource is available in

  • Chinese (Simplified)
  • English (GB)
  • English (US)
  • Italian
  • Polish
  • Romanian
  • Spanish (International)
  • Vietnamese

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Introduction & Theoretical Background

A little bit of concern about your health is normal, and even healthy! If you have health anxiety, worries about your health can take over your life and cause you a lot of distress. If you have health anxiety you might find yourself:

  • Worried about having or getting a serious illness.
  • Excessively anxious.
  • Not feeling reassured by negative test results.
  • Repeatedly checking your body for signs of illness.

Research studies have shown that Cognitive Behavioral Therapy (CBT) is one of the most effective treatments for health anxiety (Cooper et al, 2017). CBT therapists work a bit like firefighters: while the fire is burning they aren’t very interested in what caused it, but are more focused on what is keeping it going. This is because if they can work out what keeps the problem going, they can treat it by ‘removing the fuel’ and interrupting its maintaining cycle. 


Psychologists including Paul Salkovskis, Stanley Rachman, Gordon Asmundson, Adrian Wells and Ann Hackman have identified key components that are thought to explain why some people keep suffering from health anxiety. The What Keeps Health Anxiety Going? information handout describes some of these key factors, which act to maintain health anxiety. It illustrates these maintaining factors in a vicious flower format in which each ‘petal’ represents a separate maintenance cycle. Helping clients to understand more about the cognitive model is an essential part of cognitive therapy for health anxiety. Therapists can use this handout as a focus for discussion, or as a template from which to formulate an idiosyncratic model of a client’s experiences of health anxiety.

Therapist Guidance

“One interesting way of thinking about health anxiety is to look at why, for some people, it does not get better by itself. This handout shows some of the most common reasons why some people’s health anxiety persists. I wonder if we could look at it together and think about whether it describes what is happening for you?”

References And Further Reading

  • Cooper, K., Gregory, J. D., Walker, I., Lambe, S., & Salkovskis, P. M. (2017). Cognitive behaviour therapy for health anxiety: a systematic review and meta-analysis. Behavioural and Cognitive Psychotherapy, 45(2), 110-123.
  • Rachman, S. (2012). Health anxiety disorders: A cognitive construal. Behaviour Research and Therapy50(7-8), 502-512.
  • Salkovskis, P. M., Warwick, H. M., & Deale, A. C. (2003). Cognitive-Behavioral Treatment for Severe and Persistent Health Anxiety (Hypochondriasis). Brief Treatment & Crisis Intervention3(3).
  • Taylor, S., Asmundson, G. J. G. (2004). Treating health anxiety: a cognitive behavioral approach. New York: The Guilford Press.
  • Wells, A., & Hackmann, A. (1993). Imagery and core beliefs in health anxiety: Content and origins. Behavioural and Cognitive Psychotherapy21(3), 265-273.