It's Not All in Your Head: How Worrying about Your Health Could Be Making You Sick--and What You Can Do about It
212
It's Not All in Your Head: How Worrying about Your Health Could Be Making You Sick--and What You Can Do about It
212eBook
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Overview
Association for Behavioral and Cognitive Therapies (ABCT) Self-Help Book of Merit
Product Details
| ISBN-13: | 9781606238134 |
|---|---|
| Publisher: | Guilford Publications, Inc. |
| Publication date: | 05/05/2005 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 212 |
| File size: | 6 MB |
About the Author
Gordon J. G. Asmundson, PhD, is Professor and Canadian Institutes of Health Research Investigator in Psychology and Kinesiology and Health Studies at the University of Regina, Canada, and Adjunct Professor of Psychiatry at the University of Saskatchewan. Dr. Asmundson is well known for his award-winning research in the areas of anxiety disorders, health anxiety, and acute and chronic pain.
Steven Taylor, PhD, is a clinical psychologist and Professor in the Department of Psychiatry at the University of British Columbia. Dr. Taylor has also received several prestigious research awards. His work focuses on cognitive-behavioral treatments and anxiety disorders.
Together, Drs. Asmundson and Taylor are the authors of a related professional book, Treating Health Anxiety, also published by Guilford.
Read an Excerpt
It's Not All in Your Head
How Worrying about Your Health Could Be Making You Sickâ"and What You Can Do about It
By Gordon J. G. Asmundson, Steven Taylor
The Guilford Press
Copyright © 2005 The Guilford PressAll rights reserved.
ISBN: 978-1-60623-813-4
CHAPTER 1
Do I Worry Too Much about My Health?
Joan: "Do something soon or I'm going to die."
"A few Mondays ago I had a very rough day. It started off bad when a traffic jam on the expressway made me late for the first of several important meetings. My stomach was aching all day, and I had terrible cramping. The stuff I took to relieve my pain didn't work. I tried to convince myself that this was likely just the result of a very stressful day. But for much of the day and through the night I kept thinking that something was seriously wrong—most likely an ulcer but maybe even stomach cancer. My father died of colon cancer when he was in his mid-fifties. For the past few weeks I've been paying close attention to my stomach and I've been worrying a lot. It seems that something untoward is always going on—nausea almost every day, heartburn on some days, irregular bowel movements, and queasiness. I've seen my family doctor probably three or four times in the past three weeks, but she tells me nothing is wrong. She says I just need to watch my diet and take it easy. Two other doctors I went to see last week told me the same thing. But I disagree. My stomach pain can't possibly be from poor diet and stress. I'm pretty sure now that I have stomach cancer and that if something is not done soon I'm going to die."
Jonathan: "What's wrong with me?"
"I've been having heaviness in my legs and feeling sluggish for the past eight months. This doesn't happen every day, but as of late I've felt this way more days than not. Sometimes I also get headaches and feel clumsy. I've seen my family doctor as well as several specialists to try to find out what's wrong with me. At first I thought I might have the flu, but after feeling lousy for three weeks I began to worry that I might have Lou Gehrig's disease. My uncle died from it a few years ago. The neurologist gave me a whole bunch of tests, including an MRI, and assures me that I don't have Lou Gehrig's disease or multiple sclerosis. An internal medicine specialist thought it might be Hodgkin's disease, especially after I told her about my night sweats, but her tests also failed to find anything wrong. Now my family doctor assures me I probably have nothing to worry about. But something's not right with me. I'm not imagining my sluggishness, headaches, clumsiness, or night sweats. I've been reading a lot on the Internet about these symptoms. I think the doctors must have missed something. Maybe it is multiple sclerosis or even a brain tumor!"
Bob: "Dangerous germs are everywhere."
"For as long as I can remember, I've had a healthy habit of staying away from germs. They're everywhere—doorknobs, handrails, telephone receivers, ATM buttons, toilet seats, money—and really must be avoided. Other people have touched these things, and who knows where their hands have been or what diseases they have. I frequently see people who, with good intentions of stopping their germs from spreading, cup their hand over their face when coughing or sneezing. Good for them? No way! These same people take their unwashed, germ-infested hands and use them to operate the photocopier, twist open the lid to add some cream to their java, and greet coworkers with a friendly and germ-laden pat on the back. And that's just the start. What do you think happens when nature calls? The cough germs get spread to the bathroom door, the toilet seat, the flusher, and join the splash and spatter germs of those who've already completed their lavatory business. Most of my coworkers don't wash after flushing, and as a result their hands become a veritable germ party. Bathrooms are the worst for me. I try not to use them in public but, when this can't be avoided, I do most things with my feet—opening the doors, lifting or lowering the toilet seat, and operating the flusher. In the past few weeks I've started carrying latex gloves for those situations where I can't handle things with my foot technique. The gloves have proven useful in other situations, and I have started wearing them regularly. My family and friends tell me I'm too worried about germs and I have a germ phobia. I agree that I might be a little obsessed, but I think it's a healthy obsession."
We all worry about our health from time to time, often because we try to understand the reasons for the sensations our bodies are producing. Could my upset stomach be the result of something I ate, or is it an ulcer? Are my headaches and sore eyes the result of a rough day, or do I have a brain tumor? What is that pain in my chest area? Could it be something wrong with my heart? Why have I been feeling so tired lately? Am I working too much, or could it be early signs of multiple sclerosis? We may worry about catching some sort of disease. For example, during the first few months of the severe acute respiratory syndrome (SARS) outbreak in 2003, many people worried about being exposed to the virus after having encountered somebody with a cough. People who have or have had a serious disease, such as cancer or a heart condition, also may worry a great deal about their health. But some people worry too much. Joan, for example, worried about having colon cancer, even though she had seen three doctors who all told her she didn't. Joan's worries were excessive. It is estimated that about 20 percent of the population—one in every five people—worry too much about being sick.
If you're reading this book, it is a safe bet that your doctor or doctors have been unable to provide a satisfactory explanation for some of the bodily sensations and disease-related questions that are causing you concern, let alone offer you any effective relief. Do you spend some time each day worrying about the causes of your bodily sensations? Are you afraid some sort of malfunction or physical breakdown is happening in your body and that you have an undiagnosed disease? Do friends and family tell you that you worry too much about your health or call you a hypochondriac or germ phobic? Have your doctors told you there is nothing wrong and that you shouldn't worry? Maybe you aren't quite sure and you wonder, "Do I worry too much, or do I really have a serious disease?" If so, this chapter will help you decide.
In the pages that follow, we suggest an alternative way of understanding the sensations that cause you concern. This is a necessary first step in helping you determine whether you worry too much about your health. We also ask you several questions and have you complete a self-assessment regarding your health-related worries. You will probably be skeptical at first of the alternative explanations we suggest. We know this from our experience with the many people we've seen in our research and clinical practice. The cognitive-behavioral approach we use asks you to consider that the bodily sensations that concern you might not be symptoms of disease but rather result from such things as stress and fatigue. Even if considered with the greatest of reluctance at first, our approach can be very effective in helping you identify your health-related worry and, where excessive, improve the many areas of your life that it affects. If other things haven't helped, isn't it worth a try?
What Is Health Anxiety?
Most cognitive-behavioral researchers and practitioners use the term health anxiety to describe the wide range of worry that people can have about their health. Many of the questions you will be asked about have a specific focus on health anxiety. Thus, to help you fully understand how to determine whether you worry too much about your health, we first discuss the terms health and anxiety, as well as their combined use.
Health
Health is sometimes thought to be the absence of disease. If you don't have a virus, tumor, ulcer, or some other pathology in one of the body systems, you must be healthy. We, like many health care professionals, don't care much for this notion of health: It implies that either you have health or you don't. Being healthy involves more than not being sick. An important part of health is physical well-being. Being happy, feeling fulfilled, and having a good social support network are also important. Thus we might think of health as made up of physical, emotional, and social components. We might also think of it as occurring on a continuum that ranges from very poor to very good. The World Health Organization has used this definition of health since the 1940s. Some people don't like this definition because it means you have to be doing well in all three of the physical, emotional, and social areas to have very good health. This may not always be possible, but it's something we can all try to achieve.
Anxiety
Think back to times when you've felt anxious about something other than your health. Did you feel you were in danger? Were you uncertain about what might happen? Did you feel distressed?
Anxiety occurs when you think something bad is going to happen but you are uncertain that it will. For example, in preparing to give a speech, you may begin to feel anxious as you wonder whether it will go over well with the audience. Or, while taking a short cut through an unfamiliar neighborhood, you might begin to worry about whether some shady character is going to pull you into a back lane and mug you. The anticipation of harm, combined with uncertainty about how threatening the situation will actually be, creates feelings of uneasiness and apprehension—those vague feelings that something may be wrong or that something terrible might happen.
But anxiety is not simply a feeling of uneasiness or apprehension. It also involves changes in our physiology and behavior. When we're anxious, our body responds in ways designed to prepare us to take action against potential threats: heart rate quickens, muscles tense, breathing becomes labored, and we might sweat, feel nauseated, and experience other bodily changes. Because the source of the threat isn't clear, the best action to take usually isn't obvious. In other words, it's difficult to know what to do or how best to respond in the anxiety-provoking circumstance. This uncertainty also sometimes carries over into ourdaily lives. In our speech example, the anxiety over doing a good job during the speech may actually prevent good performance. Why? Because you may spend too much time worrying about possible outcomes rather than rehearsing and doing other things that contribute to success.
Anxiety is similar to but not the same as fear. Fear is an emotional response that occurs when you're confronted with a specific threatening situation or object. If a shady character did pull you into a back lane while holding a knife to your throat, you would be feeling fear, not anxiety, because you know exactly what is threatening you! Likewise, if you are hiking and come face-to-face with a grizzly bear, you're not uncertain about the danger.
Anxiety and fear can be important in helping us get by in our environment and perform at our best. Our daily lives are filled with situations in which that extra jolt of adrenaline helps us deal with a challenge. Without some degree of fear, you would be very unlikely to even attempt to escape that grizzly bear! Nor would we perform at our best during a job interview or on a test. Consider our speech example again. A person with a moderate degree of anxiety about speaking to a large audience is likely to be well prepared—knowing her material, taking along a few jokes to break the ice, and having handy a few visual props to keep the audience's attention—whereas a person with little or no anxiety may go in unprepared and have to wing it. But for those in whom anxiety can be excessive, the feelings of uncertainty and apprehension may by very intense, may last for long periods of time, and may go way beyond being a helpful response. A person who is too anxious about giving a speech may freeze up and be unable to speak in front of the audience or, more likely, might not even show up to talk at all. Unfortunately, many people experience so much anxiety that it interferes with their ability to manage their day-to-day living—their relationships suffer, they miss work, they feel depressed, and they don't know how to make it stop. Recent statistics indicate that anxiety disorders have surpassed depression as the most common mental health problem experienced by North Americans.
Health Anxiety
If we put together the individual definitions of health and anxiety, we get the following: Health anxiety is the feeling that your physical well-being, or disease-free state, is threatened and you don't know what the cause or what the outcome will be. Like other forms of anxiety, health anxiety involves changes in thoughts, physiology, and behavior. Also like other forms of anxiety, health anxiety can range from mild to severe. Mild health anxiety can be temporary and can sometimes be a signal to follow up on some bodily change or sensation by seeking advice from a doctor. But it can also be excessive and preoccupying, as in the examples of Joan, Jonathan, and Bob. When health anxiety is out of proportion to the risk of disease and persists even though there is no evidence of disease, mental health professionals often refer to it as a health anxiety disorder. Like the other anxiety disorders, it has an impact on all aspects of health. The trick, of course, lies in figuring out what is out of proportion and inappropriately persistent. That is, how much is too much?
Are Your Bodily Sensations Imagined or Real?
The bodily sensations or concerns you're experiencing are real—very real. Any sane person would worry about a headache that doesn't go away or about waking up with a stomachache every morning. The trouble is that these are not always signals of disease—in fact, they rarely are—and the worry can grow out of proportion to the actual threat.
Where do the bothersome bodily sensations come from? They might arise from changes to your diet, activity levels and preferences, or sleeping habits. For example, if burritos are not something you regularly eat, you may experience some stomach upset after having a few of them (especially if you use extra hot sauce). Also a number of minor physical ailments can have signs and symptoms that may look like a more serious condition. Lumps in the breast may be benign (harmless) fibroids rather than cancerous tumors, clumsiness may be due to fatigue and not multiple sclerosis, and headache may be the result of a stressful day rather than a blood clot in the brain. In many cases, the sensations are part of the body's anxiety response. Anxiety is associated with many bodily changes and sensations, including shortness of breath, pounding or racing heart, chest tightness, muscle tension, fatigue, dizziness, stomach upset (for example, nausea, bloating), diarrhea, flushing or hot flashes, and trembling or shakiness.
These sensations, whether they come from changes in your lifestyle, minor physical ailments, or anxiety, have one thing in common: They are harmless. But if you notice these changes and start to worry about whether they are signaling disease, you are very likely to become more anxious, and the changes will persist and possibly get worse. One of the main goals of this book is to show you how to identify and effectively respond to your health anxiety before it spirals out of proportion to the point where it actually perpetuates the very sensations that cause you concern.
The Health Anxiety Cycle
To successfully deal with excessive health anxiety, you need to learn how to determine whether bothersome bodily sensations and symptoms are harmless. Visiting a doctor is a good (and essential) first step. Some health-related worries may be associated with health issues that your doctor should look at. Bodily sensations such as stomach upset or a pounding heart or feelings such as being off balance and clumsy can happen for any number of reasons. It's important to figure out as soon as possible whether they're related to a disease so that proper medical care can be given. Quite often the doctor is able to figure out the cause of the sensations and make a recommendation that leads to relief. For example, Jeff went to see his doctor after having had a headache for five days for which Tylenol provided no relief. The doctor determined that Jeff had a bacterial sinus infection and prescribed an antibiotic that relieved the headaches within two days. The positive outcome of Jeff's visit to his doctor, though, may not represent your typical experience when visiting your physician.
If the doctor rules out physical disease, then seeking alternate explanations is the next step. Unfortunately, many people with health anxiety get stuck at Step 1, visiting their doctors repeatedly or seeking the opinions of many doctors and specialists. Have you visited your doctor several times in a short period of time about the same health concern? Have you visited several doctors in the hope that one would give you a physical explanation for your health concern? The habit of repeatedly visiting doctors for the same concern can provide reassurance that you're okay. But that feeling of reassurance is short-lived and can prolong rather than help resolve the health anxiety.
(Continues...)
Excerpted from It's Not All in Your Head by Gordon J. G. Asmundson, Steven Taylor. Copyright © 2005 The Guilford Press. Excerpted by permission of The Guilford Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
I. Understanding Health Anxiety1. Do I Worry Too Much about My Health?
2. Body and Brain: It's Not All in Your Head
3. Do I Have Some Other Anxiety Disorder?
4. Sick and Sad: Am I Depressed, Too?
II. Breaking the Health Anxiety Cycle
5. Understanding and Managing Stress
6. Thoughts That Influence Your Anxiety and How to Change Them
7. Behaviors That Influence Your Anxiety and How to Change Them
III. Maintaining Your Gains
8. Dealing with Doctors
9. Helping Friends and Family Help You
10. Living Life and Maintaining Your Gains
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