Introduction
Hey, beautiful soul! Today we are going to continue talking about health anxiety.
But first, let me ask you, do you ever find yourself:
- Worrying constantly about your lichen sclerosus getting worse?
- Spending hours on Google looking up different symptoms and conditions?
- Obsessively check your vulva for signs of disease progression?
- Feeling like your symptoms are a sign of a serious health issue, such as having vulvar cancer?
If you found yourself saying ‘Yes!' to any of the above, you may be living with health anxiety. This is something I struggled with early in my lichen sclerosus journey. In fact, it took almost a year for it to really start to settle. Even now, it will still creep up on me from time to time. However, over the last year, I've learned some tips and tricks to help deal with health anxiety. Today, I'm going to share them with you.
In this post, you will learn about meditation, psychoeducation, Google search, exposure therapy, behavioral stress management, cognitive behavioral therapy, and medication for health anxiety. I speak both from lived experience and from evidence-based information from psychology papers.
Before you read on, be sure to check out my last post where I described what health anxiety is and what the research says about it.
How Meditation Can Help with Health Anxiety
I know, I know; not another person telling you to meditate for anxiety. I get it, I do. As someone who has had anxiety ever since I was a little girl, I know the knee-jerk, eye roll reaction to this suggestion.
But hear me out!
Meditation alone will probably not do much for health anxiety. At least, not in the moment when the anxiety has peaked. But, if you practice consistently and do so along with some of the other tips I recommend, you can reap huge benefits!
In a current perspectives review paper by Asmundson (2010), the author mentions psychoeducation as one treatment option for health anxiety. Psychoeducation involves components such as meditation and relaxation techniques to help manage health anxiety.
What the Research Says about Psychoeducation for Health Anxiety
Psychoeducation is more than just meditation and relaxation techniques. It also involves:
providing the individual with information about the nature of his or her presenting concerns and potential strategies for addressing these concerns.
Amundson et al, 2010, 309.
Psychoeducation is available either as individual or group therapy. Studies have shown psychoeducation to be superior to wait-list control in reducing health anxiety. Wait-list control is essentially a control group of folks who do not receive the intervention – in this case, psychoeducation – but are put on a wait-list to get the intervention once the study ends. These studies showed that folks who received psychoeducation saw a reduction in hospital/doctor visits. They also saw an overall reduction in their health anxiety, which was maintained at a one year follow-up. For folks who do psychoeducation in a group setting, many report the benefits of sharing with others and feeling less alone.
My Experience with Psychoeducation
I participated in six months of psychoeducation at my local hospital. Since it kicked off during the onset of Covid-19, the program was held virtually. We met two times a week. One session was a shorter meditation led by a psychologist. The second session was longer and included education, meditation, relaxation techniques, and group sharing/discussion. It was incredibly healing for me to be in a safe space with others who understood what I was going through. I made friends in that program with whom I stay in touch to this day. I continue to practice many of the relaxation techniques I learned.
Nip That Google Habit in the Bud
Yup, I know. It's a tough one. Google is so readily available these days, and for many of us with health anxiety, it's a knee-jerk reaction to open Google on our phones when we find ourselves preoccupied with a symptom or sensation.
But these Google rabbit holes we go down are seldom beneficial for our mental health. The amount of times I have diagnosed myself with different diseases and genuinely thought I was dying is very high. And I'm not saying that lightly. There have been searches that left me convinced I had vulvar cancer and it was going to be too late for me since the waitlist to see a specialist where I live was more than one year.
9 out of 10 times, Google search is awful for my mental health. I had to actively work very hard to break this habit, similar to breaking my habit of compulsive vulva checks, which you can read about here. You may try to stop abruptly, or you may try to phase out of this habit slowly. Stopping completely and abruptly might feel too overwhelming for you. Instead, consider setting a timer to limit your time on Google. There are also mobile apps that keep track of the time you spend and will remind you when you’ve met your limit.
Exposure Therapy and Response Prevention
Exposure therapy involves exposing the patient to the cause of their fears. Examples include exposing patients to hospitals, patients vocally calling out diseases they're afraid of, patients imagining they have a disease, or patients exercising to induce rapid heart rate (Amundson, 2010). Please note, this type of therapy is not for the faint of heart. It absolutely requires supervision and guidance from a trained psychologist. A study by Visser and Bouman (1992) found exposure therapy was superior to wait-list controls, with a notable reduction in health anxiety reported at seven months.
Response prevention is often:
…combined with exposure to encourage the patient to delay or refrain from behaviors that maintain health anxiety (i.e., bodily checking, seeking reassurance).
Amundson et al, 2010, 309
For example, a therapist may have the patient describe their symptoms and then hand them a smartphone but have them delay opening Google to do a symptom search. It's about getting the patient comfortable in their discomfort and staying present with the therapist instead of acting immediately on their urges.
Behavioral Stress Management
Behavioral stress management focuses heavily on the role stress plays in producing harmless but unpleasant bodily sensations, such as a tight chest, rapid heart rate, and dizziness. It teaches patients key stress reduction techniques and encourages patients to do pleasurable, stress-reducing activities such as walking or dancing.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) combines both psychoeducation and exposure therapy. With CBT, the therapist will work with the patient to restructure their thoughts and feelings about bodily sensations and illness. Behavioral exercises, such as exposure and prevention responses, are also included to help the patient come to understand the effects of their health anxiety and how it exacerbates their symptoms and perpetuates an anxious cycle.
A number of controlled studies have shown CBT to be superior to wait-list controls, medical treatment, and other interventions (Clark et al, 1998; Barsky and Ahern, 2004; Warwick et al, 1996).
The Fire Alarm Analogy: My Greatest Tool in Combatting Health Anxiety
Perhaps one of the greatest pieces of information I learned that helped with my health anxiety was the fire alarm analogy.
I learned about this during a pain education program I went through at Sinai Hospital in Toronto.
Pain is our alarm system for danger; it lets us know when we need to take action in order to prevent harm to our bodies. For example, if you touch a hot stove, the pain you feel triggers you to quickly remove your hand to prevent a severe burn. And this can be incredibly useful. Similarly, a fire alarm alerts us that there is danger and action needs to be taken (e.g., evacuate the building and call the fire department). However, fire alarms don't always sound when there is a real threat. Sometimes, the alarm gets jammed, malfunctions, or is pulled by accident. I'm sure we all know someone in elementary school that pulled the alarm to get out of class. In this case, there was no fire and no danger present.
Chronic pain and distressing symptoms like chronic itch can be like the fire alarm that gets jammed or pulled accidentally. Not every unpleasant sensation is a sign that real danger is present. Sometimes there may not be a fire to put out.
I'm going to make a YouTube video on this analogy in relation to lichen sclerosus, so make sure you are subscribed to my channel so you don't miss that in-depth explanation.
How This Analogy Helped My Health Anxiety
This analogy really resonated with me. I wrote it down and taped reminder notes to the walls above my bed and workstation. Any time I felt a new sensation that would send me into an immediate panic, I would repeat out loud, “Not all unpleasant bodily sensations are a sign of danger; there may not be a fire to put out”. I practiced staying with the discomfort and the worried thoughts instead of reaching for my phone or calling my doctor to insist on more tests.
There isn't always a fire to put out. This analogy was pivotal in my journey with health anxiety for chronic pain and illness. In time, I was able to sit with and listen to the paper-cut lichen sclerosus sensations or itch and know that my life wasn't in danger and that this would eventually pass. With that, I was able to put the tools I acquired in psychotherapy and CBT to work on the feelings of uncertainty and anxiousness, and, in time, they slowly started to fade.
Medication
I use CBT and psychoeducation to manage my health anxiety. But, full disclosure, I also take medication for my anxiety. Specifically, I use escitalopram. I have generalized anxiety disorder, panic attack disorder, PTSD, and health anxiety, so it's fair to say I'm a big basket of anxiety. For me, I need medication in addition to other types of therapy.
Please know if you use medication for your mental health, there is zero shame in doing this.
Small case studies and trials have shown medication to be effective in reducing symptoms of health anxiety (Asmundson et al, 2010, 310).
Conclusion
In sum, there are a number of options for managing health anxiety. You do not have to do all of them. Explore options that feel safe and right for you and your needs. How I manage my health anxiety may not be how you manage yours, and that is OK.
Be sure to subscribe to my YouTube channel as I will be talking more in-depth about my experience with health anxiety and what helped (and didn't) over there.
Reach out to Me
If you want to chat with me about health anxiety or Lichen Sclerosus, I can be reached at:
Instagram: @thelostlabiachronicles
Facebook: @TheLostLabiaChronicles
Email: lostlabiachronicles@gmail.com
Virtual Meetups
Do you want more support in your journey with Lichen Sclerosus? Consider joining our Lichen Sclerosus Support Virtual Meetups. We meet every other Saturday from 2-4 and 7-9 pm ET. These meetups are a safe space for you to share your story, cry, celebrate, vent, ask questions, and be a part of a community of support. Click the button below to sign up!
