- A variety of popular therapeutic modalities can be helpful for clients with illness anxiety.
- Clinicians need to understand the most effective therapeutic approaches for helping illness anxious clients.
Illness anxiety, while sometimes overwhelming and frightening, can be coped with. Some popular commonly-used therapeutic modalities may be effective in assisting clients who are struggling with intrusive and obsessive thoughts about their physical health status. Following are 7 therapeutic interventions and how they can be implemented to help these clients.
CBT is perhaps the first-line treatment of anxiety disorders, including Illness Anxiety Disorder (IAD.) Because it teaches clients to question and challenge their anxiety-driven conclusions, it allows for building evidence to discredit the anxious thought. In simple practice, it may look like this:
Event: Client experiences chest pain.
Automatic Thought: “I am having a heart attack and I need to call 9-1-1.”
Challenge to Automatic Thought: “I am not experiencing any other physical symptoms. I am also prone to heartburn, and I ate something spicy at lunch.”
New, adaptive thought: “I am most likely not experiencing a heart attack and this physical discomfort I feel is likely unrelated to a heart attack. It is more likely that I am experiencing indigestion. At this moment, I probably do not need emergency services.”
This type of “thought-stopping” and challenging, cornerstones of CBT, can help a client slow the rush and flood of thoughts that occur following an unexpected and uncomfortable physical symptom.
Rational Emotive Behavioral Therapy (REBT)
An offshoot of CBT, REBT focuses on the “unconditional acceptance” of ourselves, our lives, and our situations through a rational, rather than an emotional, lens. REBT teaches clients to “dispute” irrational thoughts in the service of arriving at a more sensible, logical view of a situation. Because anxious cognitive patterns often lack logic, REBT is helpful in restoring and promoting a healthier, alternative way of looking at a situation.
Dialectical Behavioral Therapy (DBT)
DBT helps patients find a cognitive “middle ground” between the emotion-driven mind and the logic-oriented mind. Because anxiety is most often emotion-based, it tends to ignore logic and rational thinking. This single-mindedness can result in unhealthy behavioral responses. Learning and implementing DBT skills can assist clients in tolerating feelings of discomfort rather than having to react emotionally to them. In the case of IAD, if a client learns to slow their cognition following an uncomfortable feeling, they have a greater opportunity to utilize logic to arrive at an appropriate behavioral response. For the IAD patient, this may mean the difference between seeking unnecessary emergency care and having a more reasonable response, such as scheduling a doctor’s visit in the near future. DBT teaches clients to work and respond from their “Wise Mind,” the healthy overlap of the emotional mind and the rational mind.2
The word somatic, from the Latin for “of or pertaining to the body,” refers to anything body-related. Somatic therapy is an umbrella concept which includes a number of body-based interventions such as meditation, yoga, physical exercise, dance or movement therapy, breathing exercises, and massage. Somatic therapy highlights the importance of the brain-body connection and should be considered as an option to help those struggling with IAD. Generally, somatic therapy skills can be taught to a client by a therapist or counselor.
Mindfulness-Based Cognitive Therapy (MBCT)
It is a Buddhist belief that anxiety “lives in the future,” and the importance of mindfulness and presence in the moment cannot be overstated in the treatment of IAD. Mindfulness teaches clients to replace “what if” with “what is.” In the case example given above, “what if” sounds like “My chest feels tight and that means I’m going to have a heart attack,” whereas “what is” sounds like “My chest feels tight right now in this moment.” The “what is” thought is simply an acknowledgment of what is happening, without an attached assumption or conclusion. Through acknowledgment of our feeling in the moment, we are able to “be with” our feelings rather than respond emotionally or behaviorally to them.
Narrative Therapy (NT)
Narrative therapy teaches us to view our lives as a story but cautions us against focusing on only one part of the story. Often, we become singularly focused on the “problem story,” the part of the larger narrative influenced by our challenges and problems. NT urges us to take a broader, more inclusive view of our life story, noticing and honoring both the problematic and challenging parts as well as the more comfortable and victorious sections. Through this approach, we begin to see our personal narratives as nuanced rather than one-dimensional. For an anxious person, anxiety loosens its grip and becomes only a portion of the story, not all of it.
Imaginal Exposure Therapy
Visualizing and imagining the situations that frighten us can be helpful in beginning to feel safe again and can promote a gradual return to activities and situations that have caused anxiety or avoidance. For example, a therapist may guide a care-avoidant client through an imagined scenario in which they have a medical visit at a doctor’s office. Because the visualization is done within the safe confines of the therapy office, the exercise may begin to rebuild safety and comfort within the anxious client’s mind regarding the situation, promoting an eventual return to the actual situation. Once the client can visualize safely returning to a previously feared situation, they often can return to the situation in real life.
Ellis, A., & Ellis, D. (2019). Rational emotive behavioral therapy. American Psychological Association.
Lane, Phil. (2024). Understanding and Coping with Illness Anxiety. Routledge.
White, M., & Epston, D. (1990). Narrative means to therapeutic ends. W.W. Norton & Company, Ltd.