Freedom From Health Anxiety by Karen Lynn Cassiday uses a primarily cognitive behavioural therapy approach to support people dealing with illness anxiety disorder (formerly known as hypochondriasis) and other forms of health anxiety.
The book begins with a checklist to assess the negative impact of health anxiety in the areas of negative reactions of others, feedback from others about anxiety being a problem, negative effects of anxiety in daily life, checking behaviours, avoidance behaviours, and financial cost. There’s also an exercise to identify the ways in which illness anxiety leads to avoidance behaviours.
The author explains what health anxiety is (intolerance of uncertainty is a big part of it) and what it is not (secondary gain or Munchausen’s syndrome, for example). Concepts throughout the book are illustrated with example scenarios based on clients that the author has worked with in her therapy practice. Also scattered throughout the book are exercises aimed at helping you raise your resilience.
Exposure therapy is emphasized as an intervention, and the author explains that rather than constructing a hierarchy of exposures, it’s more effective to tackle exposures in random order. Guidance is provided on how to set up effective exposures in order to develop habituation (getting used to feared stimuli) and inhibitory learning (suppressing thoughts/behaviours like reassurance-seeking and avoidance).
There’s a chapter devoted to giving up reassurance-seeking. The author writes, “Trying to get reassurance is like trying to walk across an interpersonal minefield in which the other person has no map.” She explains, “if you give your worry the cookie of reassurance, then you can expect only one outcome: more illness anxiety.” Exposure and response prevention (which is commonly used in the treatment of OCD) is presented as a way to cut down on reassurance-seeking.
The author helps readers to distinguish between what constitutes a helpful conversation with health professionals and what constitutes harmful reassurance-seeking, which I thought was a useful distinction to make. Sometimes there are reality-based health concerns that need to be dealt with, and the book offers tips on how to take reasonable precautions without overdoing it.
There’s a chapter devoted to increasing tolerance of uncertainty, which can free up a lot of cognitive resources that would get sucked into attempts to eliminate uncertainty in making decisions. There’s also a chapter on enhancing your recovery, which offers suggestions for interoceptive exposures, i.e. creating feared physical sensations. Gratitude is explored as a way to build greater joy and resilience. The final chapter explores additional treatment options, including eye movement desensitization and reprocessing (EMDR), acceptance and commitment therapy (ACT), medications, and complementary and alternative therapies like acupuncture, Ayurveda, tai chi, and qigong. I’m definitely a fan of a multi-pronged approach to mental health issues.
The author comes across as someone who has significant clinical knowledge and experience specifically related to illness anxiety. Her tone is optimistic, but without that false overconfidence that sometimes bugs me about CBT-based books. She acknowledges that this will be a difficult journey, but seems to have hope that readers will be able to find the strength inside themselves to push through with treatment and make progress. The book felt very balanced and realistic, and the author has quite a comforting written presence.
Illness anxiety isn’t something I deal with personally, but I wouldn’t hesitate for a second to recommend this book to anyone who is dealing with this disorder, or with health anxiety more generally.
Freedom from Health Anxiety is available on Amazon (affiliate link).
I received a reviewer copy from the publisher through Netgalley.