2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines | Circulatio

Chronic Illness And Health Anxiety

Source: Katie Willard Virant

If you live with chronic illness, it's likely that you've experienced health anxiety. It's a normal response to illness to fear disease progression or recurrence. Will our medications continue working? If not, will new treatments come along that will help us live well? What will it look like if our illness recurs or worsens? Will we suffer greatly? Will our lives be upended? Will we die?

Fear is a natural response to a real threat (Lebel et al., 2016). For a significant number of people, though, health anxiety becomes problematic. At what point does fear of illness progression become disabling? How do we manage our health anxiety so that we can enjoy a good quality of life?

Problematic health anxiety

Fear is a signal emotion, as it alerts us to the possibility of danger. When we use fear productively, we respond to it by using our cognition (including our memories, experiences, and knowledge) to ascertain whether we actually are in danger.

Living with chronic illness can cause our fear alarm to be very sensitive—and with good reason. When we've experienced suffering due to illness, our bodies remember this. Anything that reminds us of this suffering—an ache or pain, a medical test, even driving past the hospital—can cause our fear alarm to go off.

Evaluating the fear and, if warranted, turning off the alarm (more on this below) is a positive way to manage health anxiety. For many people, though, it is difficult or even impossible to turn off the fear alarm. For these people, health anxiety becomes its own torture.

While normal health anxiety may cause unpleasant moments, problematic health anxiety causes long-lasting, intense distress that is linked to depression, anxiety, and diminishment of quality of life (Loughan et al., 2021). Problematic health anxiety often includes death-related thoughts, intrusive thoughts and feelings, and isolation (Mutsaers et al., 2016). Many people experiencing problematic health anxiety ruminate over disease progression and recurrence so strongly that it is as if they are actually experiencing the events that they fear.

People experiencing problematic health anxiety sometimes use maladaptive coping skills in an attempt to manage it (Almeida et al., 2019). Some people avoid medical treatment in an attempt to "forget" about their illness. Others seek reassurance in the form of unnecessary medical appointments and scans to ease their minds that the illness is quiescent. Still others withdraw from family and friends, not revealing how much health anxiety is affecting their lives for fear of being judged and ridiculed.

Treating problematic health anxiety

Problematic health anxiety is a highly individual experience, meaning that psychotherapy to treat it must attend to each person's unique needs (Almeida et al, 2019). Nevertheless, standard treatment protocols do exist, including cognitive behavioral skills, relaxation training, meditation skills, and psychodynamic/existential therapy (Hall et al., 2018).

Cognitive behavioral skills include learning how to identify thoughts, emotions, and behaviors feeding the anxiety. For example, recognizing which triggers increase anxiety and which stimuli soothe anxiety is very useful. Developing self-coaching strategies is an important part of this work. Using self-talk like "I can't know the future" and "I am safe in this moment" is another valuable cognitive tool.

Relaxation training, self-compassion training, and meditation skills are strategies designed to calm an anxious nervous system. As anxiety is a mind/body experience, calming the body is a key piece in treatment. Practicing these techniques is fruitful.

Psychodynamic and existential work are additional components of treatment. In psychodynamic work, you explore how patterns of thinking and feeling were developed. In this context, you piece together what you learned about anxiety from your early relationships and how those early lessons have affected your relationships and experiences throughout life. In existential work, you think about suffering, death, and the meaning of life—issues that are activated by illness and health anxiety. Importantly, you'll work to come to terms with what you cannot change, grieving losses and finding a way to live meaningfully.

Conclusion

Problematic health anxiety in chronic illness is underdiagnosed and undertreated (Loughan et al., 2021). If you see yourself in this post, please know that you are not alone and that help is available. Working with a therapist to understand and alleviate health anxiety can greatly improve your quality of life.

Chronic Illness Essential Reads

To find a therapist, please visit the Psychology Today Therapy Directory.

Fix It Or Face It: The Real Work Of Psychotherapy

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Psychotherapy is often misunderstood as merely a tool for curing mental illness. In reality, therapy serves two equally important functions: helping individuals cope with problems they cannot fix and guiding them toward resolution. Consequently, they no longer have to endure these issues. Through these roles, psychotherapy provides symptom relief, adaptive coping strategies, and meaningful improvements in life, even when challenges are chronic or unresolved. This article explores the multifaceted functions of therapy, underscoring its value through empirical studies and showcasing its relevance in both acute and long-term mental health care.

Therapy as a Path to Problem Resolution

Psychotherapy aims to reduce or eliminate symptoms in its most concentrated form, enabling individuals to function more effectively. One common approach, cognitive behavioral therapy (CBT), has proven effective in treating depression and anxiety by changing negative thought patterns and behaviors. Evidence for this comes from a meta-analysis that showed significant reductions in depressive symptoms among individuals with chronic illnesses who received telephone-delivered CBT, thereby highlighting its therapeutic value even when delivered remotely (Altieri, Sergi, & Tommasi, 2024).

Structured psychodynamic therapy also shows strong results in achieving lasting changes in personality traits and emotional patterns. Research indicating that psychodynamic interventions led to meaningful and sustained psychological change over time was demonstrated in long-term improvements, especially for those with complex mental disorders (Leichsenring & Rabung, 2011).

These studies affirm that when mental health conditions are treatable, psychotherapy serves as a powerful solution-focused tool. It empowers individuals to regain clarity and control over their emotional well-being and mental health challenges.

Living Well With the Unchangeable

Despite its transformative potential, psychotherapy does not solely focus on resolution. Some issues—such as chronic medical conditions, long-standing grief, or deeply ingrained personality traits—may persist. In these cases, the role of therapy shifts from fixing to helping individuals live more effectively alongside the challenges by promoting acceptance and reducing psychological distress.

Clinical evidence supports this adaptive function. One study found that psychotherapy enhances the quality of life for patients with chronic illnesses by helping them reframe their experiences and develop healthier cognitive and emotional coping strategies (Iyer, 2024). For individuals navigating life with autoimmune disorders or neurodegenerative diseases, therapy provides a nonjudgmental space to grieve losses, express frustration, and cultivate resilience.

The effectiveness of process-based approaches also supports this model of care. By helping individuals focus on life values and develop psychological flexibility, such therapies have significantly improved emotional functioning, even when symptoms persist (Gloster, Haller, Villanueva, & Block, 2023). Rather than aiming to eliminate obstacles, these interventions shift the client's relationship with the challenge, enabling the pursuit of a meaningful life despite ongoing difficulties.

Bridging the Divide: Adaptive and Curative Roles Together

In practice, psychotherapy often blends curative and adaptive elements. Clients rarely enter therapy knowing whether their concerns can be fully resolved, and therapists frequently navigate between promoting change and encouraging acceptance. Therapy evolves into a dynamic process where clients alternate between alleviating distress and adapting to what persists.

Research supports this dual role. A large-scale study examining outcomes for patients with long-term medical conditions revealed that psychotherapy reduced anxiety and depression while also enhancing patients' confidence in managing their daily lives. Although physical conditions remained unchanged, the therapeutic impact on emotional well-being was evident (Delgadillo, Dawson, & Gilbody, 2017). This ability to embrace realism and hope makes psychotherapy adaptable and individual-focused. Clients gain symptom relief, validation, and support that enable them to navigate their challenges more effectively.

Finding Strength in Change—Or in the Courage to Accept What Stays

Psychotherapy isn't just about curing what hurts; it's also about learning how to live with what lingers. Whether you aim to address a challenge or find peace alongside it, therapy provides tools for clarity, courage, and connection. It adapts to your needs, assisting you in taking steps toward healing or resilience. No matter the path, you don't have to walk it alone.

References

Altieri, M., Sergi, M. R., & Tommasi, M. (2024). The efficacy of telephone‐delivered cognitive behavioral therapy in people with chronic illnesses and mental diseases: A meta‐analysis. Journal of Clinical Psychology, 80(2), 115–132.

Delgadillo, J., Dawson, A., & Gilbody, S. (2017). Impact of long-term medical conditions on the outcomes of psychological therapy for depression and anxiety. The British Journal of Psychiatry, 210(1), 47–53.

Gloster, A. T., Haller, E., Villanueva, J., & Block, V. (2023). Psychotherapy for chronic in-and outpatients with common mental disorders: The "Choose Change" effectiveness trial. Psychopathology, 56(3), 142–153.

Iyer, S. (2024). The role of psychotherapy in managing chronic illness. Shodh Sagar Journal of Interdisciplinary Psychology, 2(1), 12–21.

Leichsenring, F., & Rabung, S. (2011). Long-term psychodynamic psychotherapy in complex mental disorders: Update of a meta-analysis. The British Journal of Psychiatry, 199(1), 15–22.

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