We’re living in a time when every little cough, sniffle, olfactory or circulatory problem can elicit a knee-jerk bout of worry: Is this the beginning of covid-19? For some people, however, it’s more than a fleeting concern: Experts say and research shows that the pandemic has triggered a surge in health anxiety. In fact, health anxiety related to the coronavirus has been given its own name: coronaphobia.
“People are very concerned and anxious about getting covid,” says Lynn Bufka, a senior director at the American Psychological Association and a practicing licensed clinical psychologist in Maryland. “We should all have some kind of heightened vigilance about protecting ourselves, but for some people, [the anxiety] is out of proportion to the actual risk and generally disrupts life.”
Health anxiety is defined as worries and anxiety that relate to a perceived threat to your health. It exists on a continuum and can be a facet of several psychiatric illnesses, including hypochondriasis (now called illness anxiety disorder).
“Health anxiety relates to the belief that bodily sensations or changes are due to some disease process,” says Gordon Asmundson, a professor of psychology at the University of Regina in Canada and co-author with Steven Taylor of “It’s Not All in Your Head: How Worrying about Your Health Could Be Making You Sick — and What You Can Do About It.” During such viral outbreaks as the coronavirus, for example, people with high health anxiety may misinterpret post-exercise muscle aches or a bout of coughing as telltale signs that they’re infected, which in turn increases anxiety and can bring on stress-related symptoms.
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Although having some anxiety about your health is beneficial, because it can motivate you to take smart steps to protect it — such as wearing a mask, maintaining social distance and frequently washing your hands — too much can tilt the balance into troublesome territory. “People with excessive levels of health anxiety engage in lots of checking behaviors, such as taking their pulse or temperature, or they engage in reassurance-seeking and often go from doctor to doctor seeking reassurance,” explains Taylor, a professor and clinical psychologist at the University of British Columbia. “Reassurance can be like a drug of addiction. It can perpetuate the problem.”
Health anxiety also can lead people to frequently search the Internet to see if their symptoms match whatever illness they’re afraid they might have. “That’s a real problem, because Dr. Google will pop up with scary diagnoses or things that could be wrong,” Taylor says. “It’s going down a rabbit hole: You check one thing, and that can lead you to another, and you can end up scaring yourself even more.” Research has found that people have a tendency to engage in disease-related “query escalation” during Internet searches, which can cause health anxiety to build.
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In addition, health anxiety can interfere with sleep, especially if an endless loop of what-if scenarios plays in your mind. It can trigger physical symptoms, such as a rapid heart rate, shallow breathing, headaches and stomach distress. And it can interfere with your daytime quality of life, impairing your mood, concentration and ability to enjoy normally pleasant activities. “It becomes a concern when the worry and preoccupation are out of proportion to the actual risk, or if it interferes with your ability to do other things — such as work, school or being a parent — in life,” Bufka says. At this point, you should definitely take steps to quell your health anxiety.
People who are susceptible to health anxiety may have grown up with general feelings of anxiety or vulnerability, relatives with the condition, or exposure to certain behaviors, Asmundson says. If your parents constantly fretted about their digestion or excessively fussed over you when you had a cold, for example, you may be more likely to perceive yourself as fragile or to closely monitor your body for changes and develop health anxiety.
Research has found that adults who have a greater intolerance for uncertainty tend to have higher health anxiety during a pandemic (such as the 2009 H1N1 pandemic). And a December study found that people prone to feeling pre-pandemic disgust and those who have high perceived stress levels are especially susceptible to coronavirus anxiety.
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Although you might think that the availability of coronavirus vaccines would ease health anxiety, that’s not necessarily true. People with health anxiety may worry about the vaccines’ safety, Taylor says, or about the possibility of having an adverse reaction to being vaccinated. Those eager to get a vaccine may experience anxiety as they wait until they become eligible or can secure an appointment for it. Adding to these worries, Bufka says, is the fact that questions about the vaccines remain unanswered, such as “how soon people will need to be vaccinated again, and how much the vaccines will lead to immunity in the community.”
The good news is that you can get a grip on health anxiety on your own or with professional help. Here’s how:
Stick with a healthy lifestyle
Consume a healthy diet, get enough sleep, stay connected to others (even if it’s from afar) and exercise regularly. Although people with severe levels of health anxiety may avoid exercise because it makes them physically uncomfortable, Taylor says, that only compounds the problem. “Physical deconditioning kicks in very quickly,” he says, which can bring on other worrisome symptoms, such as an elevated heart rate or shortness of breath after climbing stairs. By contrast, research shows that aerobic exercise, especially high-intensity exercise, such as jogging, can have a significant and rapid effect in lowering anxiety.
Practice mindful acceptance
When you feel worry flaring up, “sit with your health anxiety, accept that it’s there and put it in a mental box, so you can proceed with your life,” Bufka says. Or, try writing your health worries in a notebook, then closing the notebook and consciously switching your attention to something else. With practice, you can train yourself to set aside your concerns.
Calm your nervous system
“If you learn how to control your autonomic nervous system activation — the flight-or-flight response — it puts you in more of a business-as-usual mode, rather than a danger mode, which can help with health anxiety,” Asmundson says. You can do this with paced diaphragmatic breathing (slowly inhaling through your nose for two counts, pausing for one or two counts, then exhaling for two counts; your belly should rise and fall with each breath), progressive muscle relaxation (systematically tensing then relaxing specific muscle groups) or meditation.
Refrain from excessive checking behaviors
Repeatedly monitoring your temperature or sense of smell for covid-19, or searching your skin for signs of cancer, isn’t going to do you any favors. If you become so vigilant about checking a raised mole or a swollen lymph node, for instance, you could irritate it with all your poking and prodding — and become more convinced that it’s a sign of a serious illness, warns Jonathan Abramowitz, a professor of psychology and director of the Anxiety and Stress Disorders Clinic at the University of North Carolina at Chapel Hill. If you have truly worrisome symptoms, such as dizziness, fainting or a persistent lump in your breast or groin, by all means, see a trusted doctor and follow their advice. But don’t hop from one doctor to another seeking reassurance, and don’t spend hours searching health information online. To avoid these checking behaviors, stay off the Internet when you’re not working and/or keep your hands and mind busy with activities such as coloring, knitting or reading in your free time.
Change your mind-set
The way you think about bodily sensations and your overall health can provoke anxiety or dial it down, experts say. For example, focusing on negative symptoms or jumping to catastrophic conclusions can increase health anxiety. You can break these patterns with cognitive reframing: questioning your anxious thoughts and trying to create a more realistic assessment of your health, Bufka says. To do this, take a particular thought (I’ve been exhausted this week, so I must be getting sick) and consider other ways of looking at the situation (I’ve been working hard and skimping on sleep, so that’s why I’m wiped out).
Seek professional help
If you can’t reframe anxious thoughts on your own, cognitive behavioral therapy (CBT) can help, Abramowitz says. And don’t fret about having to physically meet with a practitioner: A September study that compared online with face-to-face CBT treatment for health anxiety found that the Internet version was as effective as in-person sessions, and cost less. (To find a reputable CBT professional, Abramowitz suggests turning to the Association for Behavioral and Cognitive Therapies or the Anxiety and Depression Association of America.) If a therapist can’t help, consult a psychiatrist; experts say that some people with intense health anxiety can benefit from taking an SSRI antidepressant.
If you think you might have coronaphobia, and one of your worries is that this problem is destined to be with you for life, keep this in mind: “Health anxiety can be transient,” Taylor says. “Just because you’re experiencing health anxiety during the pandemic doesn’t mean it’s going to become a long-term problem.” The key is to take steps now to manage it and prevent it from becoming entrenched.
Stacey Colino is a writer in Chevy Chase, Md., specializing in health and psychology and is the co-author of “Emotional Inflammation: Discover Your Triggers and Reclaim Your Equilibrium During Anxious Times.”
Illustrations by Asia Pietrzyk. Edited by Elizabeth Chang. Copy edited by Rachael Bolek. Designed by Victoria Adams Fogg.