Health Anxiety: What it is (Part 1)

Episode 29

In this 2-episode mini series on health anxiety we'll discuss what it is and how to overcome it using an evidence based 4-pronged approach. Join me today to learn more about the anxiety response in your brain and body, how this applies to health anxiety, and an exercise to explore your unique experience of health anxiety symptoms, thoughts, and behaviors. Gaining understanding of the basic physiology of anxiety and how you uniquely experience it in a health related ways lays a foundation for working with your mind-body system instead of constantly feeling against it.

Health related anxiety has been steadily on the rise since 2020. It's a topic that’s been requested by many of you for me to cover on this podcast and a recent survey indicated that 1 out of 3 individuals experience heightened anxiety over their health status. Hit play to learn more!

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Transcript

0:00  
Welcome to regulate, and rewire and anxiety and depression podcast where we discuss the things I wish someone would have taught me earlier in my healing journey. I'm your host, Amanda Armstrong. And I'll be sharing my steps, my missteps, client experiences and tangible research based tools to help you regulate your nervous system, rewire your mind and reclaim your life. Thanks for being here. Now let's dive in. 

0:29  
health related anxiety has been steadily on the rise since 2020. This is a topic that has been requested by many, many of you listeners for me to cover on this podcast for a while now. And even a recent survey indicated that one in three individuals one in three, which means you know, many, many people whether you know it or not. And likely, if you've come to a podcast like this, an episode like this, you are one of those one in three, who have experienced heightened levels of anxiety over their health status due to what we've all collectively experienced in these last few years. So that's what I want to cover with you in this two episode mini series on health anxiety, what it is and how to overcome it. 

1:19  
So this is part one of that two part mini series and today we are going to go over primarily first understanding health anxiety. And like you may know now we almost always start our conversations with a little bit of psychoeducation on what is happening in our brain and in our body and our nervous system. So if you're a regular listener, some of this might be review. But I also think it is always really great to continue to go over this because it just continues to normalize and validate these bodily experiences to help you understand what's really going on in your physiology. And the second thing that I am going to offer today is how to gently start to explore your own health anxiety, how to unpack your unique experience of this. 

2:10  
Then next week in part two, we are going to discuss approaches to healing and recovering from health anxiety, I will share a specific four pronged approach of evidence based best practices to approach health anxiety. And it's a combination of things that you might not have seen before. So if you feel like you've been trying to heal your health anxiety and you haven't been able to it might be because you are missing one or a few of these four pieces to this approach. And my hope is that you leave this mini series today and next week with a really clear roadmap on how to approach healing your health anxiety. And then next week, we'll also include really specific tools, strategies, and next steps really practical ways that you can tackle this. 

2:58  
So jumping right in today with what is health anxiety. It is a type of anxiety disorder, in which you become preoccupied with fear of having or developing serious illness. So this looks like you having persistent worries about your health or maybe even the health of a loved one. And what begins as a seemingly small symptom can often become a fear of cancer, heart attack, other serious illness. And this can also be experienced as having these reoccurring physical symptoms, things like headaches, chest pains, nausea, that are often caused by anxiety versus a underlying medical condition. So health anxiety is a feeling of anxiety, fear or worry centered around your health or the health of loved ones. It exceeds, quote normal levels of worry. So what do I mean by exceeding normal levels of worry? Some signs might look like having reoccurring thoughts and worries about developing or having serious illness, bodily sensations, and physical symptoms caused by anxiety rather than underlying medical conditions. I have a particular client that I've worked with who has gone to the ER three times just to be told that what she was so sure was a heart attack or something bigger, was just anxiety symptoms. And we actually see this a lot. I have worked with many, many clients who have had many, many ER visits just to be told that their symptoms are generated by anxiety that can feel really, really frustrating. Sometimes it can feel really invalidating and in some cases it can be the truth and we're going to talk a lot more about that in this series. 

4:49  
Exceeding a normal level of worry could look like your health anxiety or your health concerns. Making it difficult for you to concentrate on other parts of your life. Maybe your continually checking for signs of physical illness or injury. You might often seek reassurance from medical professionals or family members regarding your health, or seeking constant medical care in the form of appointments, extra tests, etc, just going above and beyond, in kind of chasing a diagnosis or a cause for symptoms, even after test results come back normal doctors have reassured you and so on. Essentially, these worries and these health concerns become obsessive intrusive. And this constant belief or fear that something could go wrong or is wrong with you, triggers a constant threat response in your body. 

5:43  
So like I mentioned, I want to spend some time here reviewing the basic physiology of anxiety, because this has a powerful role to play in eventually healing, health anxiety. So when you have this fear that something could go wrong, or is constantly going wrong, it triggers a threat response in your body. And when this happens, you feel in your body, like you are face to face with a tiger. So let's take a minute to understand this response. Because I think that psychoeducation this context really helps to strip away shame, and brings in some compassion and some curiosity for working through your healing journey. So let's talk about our physiology of anxiety in general, to create some context for our deeper conversation around health anxiety. 

6:36  
So in your autonomic nervous system, there are two primary states, your sympathetic state and your parasympathetic state. The sympathetic nervous system state is that activated mobilized fight or flight state, we've referred to this as your yellow zone of activation. And this is really what is switching on in the action of anxiety. Then we have our parasympathetic state, which is most commonly associated with feeling calm, relaxed, we've referred to this as our green regulated zone. This is our rest and digest our social connection state. But based on the polyvagal theory, there are actually two branches of your parasympathetic nervous system. The first is that ventral vagal green zone where you feel calm and connected to people. But then we also have a dorsal vagal branch of our parasympathetic nervous system, which is our most primitive part of our nervous system. And it is most associated with Freeze, shut down, immobilization, dissociation, depression, etc. 

2:58  
So sometimes what this can look like is when we feel really, really stressed, really anxious or overwhelmed. And then it all feels like it gets to be too much. We slip into this dorsal vagal shutdown. So when we're feeling unmotivated, flat, etc, helpless, hopeless. Oftentimes, this can come as a result of us being in that sympathetic activated state. For too long stressors feel like they're getting too big, and we shut down into this immobilized dorsal vagal redzone state. Now, it's important to know that these are not chosen things. In any particular situation, your nervous system chooses the state, that it feels best suits your survival, of whatever that circumstances, whether it's actually happening in your present external life, or if that situation is totally being played out, internally in your sensations, or even in the thoughts in your mind. So when that threat response is activated, your nervous system chooses kind of fight flight or freeze based on biology, evolution, and primarily on your past experiences and the wiring that's been laid down over your lifetime. So what can happen and and I say that, so that, again, we can have some context and really start to strip away some of that shame, blame or guilt for why you respond or react certain ways in certain situations. It's based on this evolutionary hardwiring, and it's based on patterns that have been laid down by your past experience. And you'll hear me say multiple times today. The hopeful message here is that we can always rewire those patterns if they're no longer serving us. So what can happen is that we get stuck in certain patterns of responding. Again, this could be because you been through something traumatic, or because you've just been under a lot of stress. 

9:53  
Maybe worry was modeled for you in early childhood. So your system gets you used to going into a flight mode or a fight mode. And so going forward, your nervous system predicts that it's just going to receive a lot of the same thing that it's always received. And so we become hyper vigilant, we become hypersensitive to threat. And because of these past experiences, your nervous system just begins to reflexively respond from a place of fight flight or shutdown, in certain situations when maybe somebody else would move through that a little bit more regulated or level. 

9:53  
So again, what I'm saying is that it is not your fault. If you have anxiety showing up for you. Your nervous system is just trying to take shortcuts by predicting that it's going to receive more threat in the future. And it's become really sensitive to responding to stimuli to circumstances in that way. And, and, and, and this is a neuro plastic system, meaning it's flexible, and we are able to create change, you are not stuck in health anxiety, or driving flying social, generalized anxiety, your responses to stimuli and to situations are not hardwired, you aren't stuck in responding a certain way forever. 

11:21  
So let's take a quick minute now to talk about what happens in the brain. So we talked about what happens in our nervous system, when we have this threat, this activation, even sometimes activation to the point of shutdown. But let's also take a minute and talk about what happens in our brain when our system gets activated. So there's a part in your brain called your thalamus that is constantly taking in sensory data points, and it filters them and then sends whatever it deems is necessary information to your amygdala. Now your amygdala is involved in emotional regulation, and kind of most popularly known for sending off threat alarms in your body. So the amygdala is where anxiety and this fight or flight response gets turned on in your brain. So your nervous system sends sensory information to your thalamus. And if it's something that could be threatening your amygdala sounds the alarm. So think about the amygdala, like a smoke detector in your house. Most of the time when your smoke detector goes off, it is because you have burnt toast, not because your house is actually on fire. But your smoke alarm is going to go off every single time whether it is a real threat. Or if it just thinks that it could be one. Because the smoke alarm in your house would rather send you 1000 false alarms per day than to take the chance of missing out on warning you about the real fire the real life threat. And the amygdala works the same way. It would rather send you 1000 false alarms per day, then take the chance of missing the real one that could be life threatening. 

13:16  
So your amygdala doesn't care if it's a real threat or a perceived one. It sounds the alarm. Because primitively we needed to be really prepared. And we'll talk a little bit next week on this built in negativity bias. But think about this system, when it was first created when we're living outdoors in a tribal setting. Right, we needed to be prepared because the rustle that we heard or saw in a bush could have been a tiger or a rabbit. And this primitive operating system in our brain really hasn't caught up to modern day life. So with this previous example, you hear rustling, your alarm goes off and your body and your brain and cortisol and adrenaline are released. And then a rabbit pops out of the bush and immediately your prefrontal cortex, right? This is the logical higher thinking part of your brain. contextualize is a situation that there's no real threat. Your body tension releases, you have a big exhale. And your system resets because it's just a rabbit. It's not a tiger. 

14:24  
But today, that rabbit isn't a rabbit. It's an email from your boss, it's somebody cutting you off in traffic. What we're going to talk about today, it is hearing or reading about something that's health related. Maybe it's a sensation in your body that is setting off this alarm. And your system responds as if it's still this unknown. Is it a tiger or is it a rabbit? And the hardest part of this is that our modern day society operates at such a pace that we never get to reset or we rarely have built in Time or conditions to reset the minute we get a stress signal from one thing. We're getting it from another from another from another which is again trained our system towards hyper vigilance towards hypersensitivity towards spiraling out over the tiniest potential thing, never really allowing our system to reset to regulate to bring that logical brain that prefrontal cortex back online to contextualize a situation. 

15:31  
So with this hyper vigilance programmed into our systems, and with the conditions that have been created in your past lives, or globally, since we all went through pandemic, little things can quickly sound an alarm and feel like much bigger things, because your physiology responds accordingly. When this fight flight status activated, your heart rate increases your breath rate, muscle tension, vision changes. And all of that can happen even if there isn't anything very threatening. And then if we don't understand our body's physiology, we can then read each and every one of these very normal bodily reactions to a fight or flight state as symptoms, worsening new symptoms appearing, and so on. So I want to help you understand what is happening in your body to normalize what is happening in your body when your health anxiety is triggered. Because that body awareness, that context is going to be one of the first filters of safety as we talk about what it looks like to recover from health related anxiety. Okay, so let's circle back and just take a quick minute to discuss things that could potentially fuel or cause health anxiety for you. Like I've mentioned, it could be past events or trauma in your life that shaped your beliefs, shaped your worldviews shaped your story, right? things always happen to me, if it can go wrong, it will go wrong. That's always my story, or it's been our family story. The past experiences of dealing with illness yourself or even witnessing that and a loved one, maybe somebody who died from a serious illness, or somebody who had some real symptoms that a doctor didn't catch that led to something even worse. Health anxiety can come from simply not understanding your body sensations. So you misread them. This is something we call faulty interoception. Like we've talked about, for maybe non health related reasons your life experience has created that hypervigilance you consider yourself to be a warrior. And that's just getting funneled and reflected into health issues now, and like I've mentioned a couple times, like the stress of the past few years since 2020, just has really made us hypersensitive to health related things. And so it can be helpful in this process. And we'll talk more about this when we get to the exercise at the end of our conversation today. To identify based on our lived experience some unhelpful beliefs or assumptions that we have around health. 

18:21  
So listen to these and just take note of ones that might feel familiar for you. And again, this will come into play a little bit later in our conversation. I must take every symptom or sensation seriously. I need to be symptom free in order to be healthy. I must report all new bodily sensations to my doctor, I need to have a diagnosis to move forward. My doctor should be able to explain everything going on in my body and changing. Any discomfort or pain in my body is problematic. If my doctor orders tests, something must be wrong. If I don't insist on more testing, then my doctor will miss out on something really important. So again, this is not an exhaustive list your unique thoughts or beliefs around health can sound a million different ways. But being familiar with which of these beliefs or assumptions your brain makes most often, we're going to talk about how you can use that to help you pause and reroute with tools we'll talk about next week. 

19:35  
So here's the thing to understand about your brain. It hates uncertainty. It wants things to be known and it is constantly sourcing for meaning. So any sensation that you feel can lead to that spiral of Why am I feeling this? What does this mean for me? This thought pattern can send you again spiraling out into that health anxiety rabbit hole And eventually, we want to create a mental patterning that can sound instead of why what oh my gosh, oh my gosh, oh my gosh, that can sound more like, Okay, I'm having a sensation, I'm noticing a symptom in my body. These sensations happen all the time in a human body, and it does not necessarily mean that something is wrong. That's our goal. That's where we want to get. 

20:26  
So let's say that you have a signal, a sensation or symptom, whatever you want to call it, even pain, right pain is a signal, it is your body's way of signaling danger. But like a smoke alarm. Pain doesn't always mean that anything is actually wrong. Oftentimes, if you have an area of chronic pain that's been cleared by a doctor, you know, saying that there's nothing wrong with this area. It doesn't mean that you're not actually feeling a symptom, you might very well be feeling pain in a certain area, what we're saying is that it's not because of a medical injury or a medical condition. This could be an alarm system in your body from your nervous system from your brain. That is just sending you a faulty danger signal from an area where there's not an injury. And this could be related to trauma, nervous system dysregulation, faulty interoception. And I can already hear some of your brains spiraling out at me right now like, But Amanda, Amanda, what about that one time that one time I told the doctor that everything was fine. And then I saw another doctor, and it wasn't fine. Or that one time I was watching a show, and this person had symptoms, and they didn't go get them checked out. And it became something way worse, like, yes, sweet friend. Take a deep breath, all of that can happen. Your symptoms, your worries, they're all valid. They all make sense based on your current circumstances, your past lived experience. And the truth can also be that most of the time our symptoms are not life threatening. 

22:05  
So how do we differentiate between valid health concerns and health anxiety? Health anxiety is when our worries about our symptoms are excessive, they're out of proportion. Health anxiety becomes a problem when it is a persistent fear despite negative test results. reassurances from health care providers. It is a problem when it leads to consistently unhelpful behaviors like excessive checking reassurance seeking the internet, rabbit holes you send yourself on. And all of this causes this chronic fight or flight response in our body that often gets in the way of our day to day functioning, we start living less of a life because we're so afraid of all of the what ifs. 

22:58  
So a really common health anxiety cycle can look something like this, it starts with a trigger. This trigger could be an internal bodily sensation, or an external trigger a story something somebody says something you watch on the news starts with it number one a trigger, then your brain pops in with this potentially unhelpful health rule or assumption that this sensation is wrong. Or that something must be bigger than maybe it is. That thought exasperates, this fight or flight response in our body, which exaggerates and create exasperates actual somatic anxiety symptoms in our body. And then we have this hyper vigilance. And so we focus on we have that excessive checking that reassurance that behavior. So we have this trigger, we have this thought we have our physiology that changes with this fight or flight response. And then we all have that drives behaviors, like hyper vigilance, excessive checking, etc. And in the short term, there is often some relief and sense of control in that. But the long term replaying of this cycle over and over and over again, just reinforces and increases patterns of hyper vigilance, hypersensitivity and anxiety. And that constant orient checking intensifies our symptoms via that sympathetic response in our body. And the behaviors this often leads us to shrinks our world and our experiences. 

24:38  
So just a quick summary, before moving on to the last part of our chat. First Health anxiety, really any anxiety is a sympathetic nervous system response. It activates a fight or flight response in the body and those sensations heightened anxiety, and can often be misinterpreted as something being wrong. So some calm I'm in somatic sympathetic responses are faster heart rate, shallow breathing, dizziness, tunnel vision, tingling in our arms, hot flashes and need to pee digestive issues a number of other things. And when we've experienced trauma that is stored in our body, we often have autoimmune pain, chronic pain in different areas of our body. So the first point I want to make here is that understanding more about your body's normal range of functions and knowing about your body's physiology, can help you to clear up a lot of those misinterpretations. The second thing I want to reiterate, is two parts of this anxiety cycle. When that amygdala and your nervous system senses threat, real or imagined, there is a fast and a slow track to processing and responding to that alarm. The Fast Track is that like instant push, a fear that physiological experience adrenaline, cortisol, etc. And then the slow track involves your prefrontal cortex, that logical part of your brain, which will either be focused on fear based thoughts that keep your alarm going, or rational thoughts that help your system returned to safety. And next week, we're going to talk about what it looks like to take your current cognitive hardwiring that feels a sensation, and then logically process it in your brain through fear based thoughts, and how to slowly work on rewiring towards more rational regulated thoughts. And the third thing I want to quickly review is, this word you've heard me say that some of you are more or less familiar with, which is interoception. And interoception, is your ability to sense internal signals from your body. And with health anxiety, people often have what's referred to as faulty interoception, where you might misinterpret your body signals to be more sinister and dangerous than benign or neutral sensations. 

27:02  
So what we'll talk more about in part two are the things that you can do to support rewiring at each of these three points. Now, again, I can hear some of your brain spiraling out. But Amanda, like I have real symptoms. Are you saying that this is all in my head? And no, absolutely not. You very well may have very real symptoms. So when you've been told, even by a doctor, perhaps that it's all in your head, this doesn't mean that you aren't having real sensations or symptoms in your body. what it might mean is that those symptoms are not a result of something being medically or physiologically wrong. But instead it is coming from an exasperated by these alarm signals, and the way that we're processing them in our brain. So as a misinterpretation, it might be hyper vigilance, that's blowing up over estimating or over fixating a sensation or symptom. And a lot of these sensations are created by the state of our nervous system. So maybe it's not something medically wrong. It's just a faulty, dangerous signal from our brain. And there is a lot a lot a lot of research that shows that for chronic pain or autoimmune symptoms, that when we work on regulating the nervous system, we can significantly help ourselves with those chronic pain or autoimmune symptoms. And when we work on creating this felt sense of safety, when we rewire patterns of regulation into our system, our health anxiety spirals are going to untangle as well. And this is absolutely something we can do. 

28:55  
So the last thing I want to offer you today is an exercise that you can do to look at your own health anxiety. So what you'll do is to look at your health anxiety cycle is on a paper have three columns, somatic sensations, thoughts and fears and behaviors. In that somatic sensations column, you are going to look at what are some of the common sensations or symptoms that you experience? What is that like whoosh of alarm? Feel like in your body? Where do you experience some chronic pain, breath, any general sensations that typically trigger an anxiety spiral for you? When you have those somatic sensations, so maybe you draw an arrow from sensations to the fear column, what are your thoughts or fears that come up? What are your beliefs? What do your what ifs sound like your worries, your intrusive thoughts, and then maybe draw an arrow from that column to the behaviors with that fear those what ifs, that story spiraling? What do you do behaviorally, the checking the scanning, the avoiding the reassurance seeking, etc. So again, those three columns, sensations, this may even be just a triggers column because they might not be internal, they may be external thoughts and behaviors. 

30:22  
And I'll give three quick examples. So in that sensations, this is an example from a client, they came in, they get a tight chest, heart palpitations, their thoughts are I'm having a heart attack and I'm dying. Their behaviors in the past were that they've gone to the ER three times they've had all the tests run, everything has come back fine. Now, since we've been working with them on nervous system regulation, and anxiety in general, she still sometimes feels her chest get tight. But she has the tools to intervene, to know. And she also has the context, she understands her body's physiology that okay, this is likely not a heart attack. This is likely anxiety. 

31:11  
And here are my tangible tools to manage this. And I'm hoping that sharing this as a message of hope that in working with clients through various parts of the four four pronged approach that we're going to talk about next week. The same clients experience of the symptoms plays out so differently now, she notices his body sensations and instead of letting them fast track her to the ER, letting that push alarm take over, she has the ability to pause and regulate to bring her prefrontal cortex online to logically and somatically calm and reset her nervous system and her body. So when example number two is a personal example, so I've never struggled with personal health anxiety, but I have had really bad dental anxiety for a while, which could be like a subcategory of this. So for me, a reoccurring sensation would be that my teeth would be sensitive to cold. And my thoughts would immediately be, I have another cavity, what if it's a root canal, I hate going to the dentist, I'm gonna go and it's not just going to be one tooth, there's going to be more bad news, there's always bad news. And I would spiral out. And my behavior was that I would avoid, I just wouldn't make the appointment and I wouldn't go. And the other third example, is oftentimes health anxiety that gets projected on people that we love. And so for me, I would change that first category instead of sensation, it's trigger. So when this trigger would be, for me, something that my kid says, for example, he went for a while of saying, like, Mom, my back hurts my back hurts. Turns out it was growing pains. But even this week at church, he came up to me and he said, Mommy, My body hurts on the inside. And the first time I was just like, oh, okay, and then he came back a couple minutes later, mom, my body hurts on the inside. And my brain immediately goes like, what if he has cancer, but it could also be growing pains. So I have both an unreasonable and a reasonable voice in my head. And my behavior from an old me would have been to immediately just play 1000 questions with my three year old to schedule an immediate appointment, maybe taken to urgent care demand that there were scans. But because I live in a more regulated nervous system, I have a lot more checks and balances internally, tools that I can pull from. Instead, I asked another question. I said, Can you tell me where and I made a mental note to pay attention to energy levels or anything else that might be going on for the next couple days. And if he still is telling me in two to three days, or if it becomes very obvious, he's in more pain that his body hurts inside will go to the doctor. Here's how this actually played out with my son. About four minutes later. He's like, I need to go potty. I was like, alright, Dad, go take him. He came back. And he goes, Hey, Mommy, my body doesn't hurt from inside anymore because I got out a lot of pee. It wasn't childhood cancer. It was simply a three year old boy who had held his pee for too long. It wasn't a cavity. In fact, it was just receding gums because I was brushing my teeth too hard. Something that I could have learned much sooner if I hadn't let my anxiety make me avoid it. And for my client, it was never a heart attack. What she has come to learn is that the symptoms were normal, sympathetic, activation happening in her body. For someone who just didn't yet understand her physiology. 

34:51  
If you are somebody who struggles with health anxiety, I want to invite you sometime this week to gain a little bit more awareness or perspective around on certain aspects of your health anxiety cycle. So again, what are the sensations or triggers internal or external, the thoughts that follow and the behaviors that follow those thoughts. And next week in part two of this health anxiety mini series, I am going to walk you through a four pronged approach to help you overcome your health anxiety. This is the same model that can be even more broadly applied to other types of predictable anxiety, things like driving or flying, social, etc. So if health anxiety doesn't specifically apply to you, I want to invite you to filter today and next week's conversation through your own situational anxiety lens. 

35:43  
So in summary, three tangible takeaways from today. Health anxiety is a persistent or frequent set of interfering thoughts that something is or could go very wrong, health related for you or a loved one, and this persistent worry causes you to take excessive measures or gets in the way of you living life the way that you want to. You've heard me before on this podcast defined anxiety as an overestimation of threat paired with an underestimation of your ability to manage the threat. Health anxiety is an overestimation of health threat paired with an underestimation of your ability to manage that health related threat. And we're going to go a little bit more into that next week. 

36:28  
Takeaway number two, understanding more about your body's normal range of functions and physiology can help you clear up those interoceptive signals and help with misinterpretation of symptoms. Becoming familiar with your most frequently experienced triggers, thoughts and behaviors can give you leverage to reclaiming control if you've entered into an anxiety spiral. 

36:53  
And number three is that anxiety spiral exercise. If you choose, take some time to reflect on and explore your unique health anxiety cycle. What are your most commonly experienced sensations or triggers again, internal or external, your thoughts your fears or beliefs that these sensations bring on, and behaviors, the actions you take or the avoidance and next time we are going to dive into part two that will offer specific guidance and tools to help you navigate and heal health anxiety. And in the meantime, I am sending so much hope and healing your way. 

37:34  
Thanks for listening to another episode of The regulate and rewire podcast. If you enjoyed what you heard today, please subscribe and leave a five star review to help us get these powerful tools out to even more people who need them. And if you yourself are looking for more personalized support and applying what you've learned today, consider joining me inside Rhys, my monthly mental health membership and nervous system healing space or apply for our one on one anxiety and depression coaching program restore. I've shared a link for more information to both in the show notes. Again, thanks so much for being here. And I'll see you next time.

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