Health Anxiety: the Overly Sensitive Smoke Alarm

Over my working life, I have learnt both how convincing health anxiety is and how well it keeps up with the news. I say the latter because I’ve witnessed the shifting tides of health anxiety, reflecting change in media coverage of certain illnesses. So, years ago, when Creutzfeldt-Jakob Disease (CJD) was frequently in the headlines, I saw clients whose primary concern was that they might have this rare and devastating illness. When HIV was a dominant health fear, I saw clients who were convinced that they were infected, despite multiple negative tests. I don’t see either of these now. Today, the focus has shifted to cancer, neurological conditions, and other current illnesses. Health anxiety is a true shape-shifter - adapting itself to current news or personal events and stressors. The specific fears may change, but the underlying pattern remains consistent.

The False Alarm: Health Anxiety Explained 

Many clients have found it helpful to acknowledge that their health anxiety is like an overly sensitive smoke alarm. A smoke alarm should signal real danger—a fire that needs immediate attention. Unfortunately,  an overly sensitive alarm goes off for burnt toast - a false alarm. Health anxiety operates much the same way. A headache signals a brain tumour. Pins and needles signal a stroke. Muscle twitches signal MND. The alarm in your brain bellows at the slightest hint of physical symptoms, leaving you feeling anxious and in need of reassurance – from medics, hospitals, friends, family, the internet – assurances that don’t work in the long-term. 

Health anxiety is one of the many “what ifs” that anxiety can latch onto, just like obsessive-compulsive disorder (OCD) or generalized anxiety disorder (GAD). With health anxiety, it might feel like these worries are protecting you from danger—that by remaining hyper-aware, you can catch an illness early and prevent disaster. But the truth is, health anxiety is not protective – it simply traps you in a cycle of hyper-vigilance, self-checking, reassurance seeking and relentless worry - a loop of doubt and dread.

The Endless Loop

One of my longstanding clients illustrates this loop of health anxiety perfectly. I originally saw her 15 years ago, when she was convinced she had sustained a brain injury from breathing in smoke fumes, despite reassurance from her GP – she kept thinking “what if the GP’s wrong” and googling repeatedly, her anxiety causing headaches that further confirmed to her a potential brain injury.

Through sessions, her control over health anxiety improved, googling stopped, headaches reduced, and I didn’t see her again for a couple of years. In response to a major stressor in her life she returned, fearful that a minor bump to her head had caused a brain injury - concerned that this time it was real. The cycle of health anxiety is incredibly powerful, convincing even the most rational minds that a false alarm reflects an urgent crisis.

This client intermittently returns every few years for a session or two – generally when there’s major uncertainty in her life, such as promotion or relationship issues – the theme repeating: “I’m worried I’ve got a brain injury”. Yet, over these years, she has not only completed a university degree and advanced training but has also succeeded in a demanding career - all without any sign of the brain injury she was so convinced she had sustained. Fortunately, now it only takes a session to be reminded of the strategies she needs to use – most definitely not googling.

The Dangers of Googling

Unhelpfully, one of the most common behaviours I see among clients with health anxiety is the urge to search online for information about their symptoms. Googling symptoms may feel like it offers relief - like a gambler chasing the next win, hoping for that reassuring result that confirms nothing is wrong. But, just like gambling, it often results in a loss – only escalating fear and discovering new worries to ruminate over. A single search can turn an innocuous symptom into a myriad of catastrophic possibilities. Why? Because health anxiety, like OCD, attaches to uncertainty and capitalises on it. Our brains are wired to seek certainty, especially when it comes to our health. The problem is, no amount of checking or seeking reassurance can provide 100% certainty. This is where the cycle tightens its grip.

Effective Treatment Strategies 

So, how do we step out of this cycle? In treating health anxiety, I find that strategies used for OCD can be highly effective. One particularly powerful approach is the 4 Rs, described by Jeffrey Schwartz in his book Brain Lock.  It’s simple, but is generally very effective - if practised daily:

1. Relabel: Identify that what you’re experiencing is health anxiety – the same worry repeating over, despite reassurance that the symptoms are not a sign of serious illness. You need to relabel the thought: “This isn’t a genuine symptom; this is my health anxiety speaking.”

2. Reattribute: Understand that this thought is a false alarm—just like a smoke detector going off for burnt toast. Realise that it’s not protecting you; it’s just causing distress.

3. Refocus: Shift your attention away from the health concern and engage in another activity for at least 15 minutes. This could be walking, talking to a friend, or working on a hobby. The goal here is to disrupt the loop of thoughts.

4. Revalue: Over time, learn to see the intrusive thoughts as insignificant background noise. They lose their power when you stop reacting to them as though they are meaningful.

These steps don’t eliminate health anxiety overnight, but with practice, they teach the brain to respond differently. When clients learn to apply these steps, they often report feeling free from the cycle of worry. And it doesn’t mean you never to go a doctor with health worries – it just means you stop returning for the same worry repeatedly.

Dealing with Setbacks

Progress takes time and setbacks do happen. But by applying the 4 Rs, you can gradually shift the focus away from anxiety. Just like my client who has intermittently feared brain injury for 15 years, reality often stands in stark contrast to the health anxiety. 

Most importantly, try to reduce “Googling” your symptoms. As any medic will say “don’t confuse your Google search with my 6 years at medical school”. Remind yourself that searching for reassurance may provide a fleeting sense of control, but it almost always results in heightened anxiety. Treat it like an addiction—resist the urge and find healthier ways to soothe yourself.

Conclusion 

In my years as a psychologist, I’ve seen many clients escape the grip of health anxiety. By learning to identify the false alarms of health anxiety and respond differently, you can break free from the cycle of fear and repeated checking. Your goal isn’t to ignore your health, but to recognise when your health anxiety is tricking you into living in a state of perpetual vigilance that does more harm than good. It’s about learning to tolerate uncertainty and live with the reality that absolute certainty isn’t possible. Through strategies like the 4 Rs, we can teach ourselves that not every smoke alarm signals danger and move through our days without being held hostage by fear.