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1. [From 10$/Pg] Tyrers Found Tailored Cbt
[From 10$/Pg] Tyrers Found Tailored Cbt For some people, the act of just testing whether
they have an illness can make them feel worse. Covid may have made it worse.round a year
ago, while having my morning shower, I felt a small, round lump under my armpit. It felt
hard, like muscle, but shifted position when I pressed down – a bit like cold butter under
turkey skin.I couldn’t help but google the appearance of lumps – and, thanks to its location,
became fixated on the idea that I might have the first stages of leukaemia. It was then that I
started having other symptoms: I found that my whoale body was aching and tired, and I
started to inexplicably lose weight.My GP recommended that I get an ultrasound scan, and
by the time I found out the results, I was certain that I was about to hear the worst news. So
you can imagine my relief when the technician told me that it was merely a lipoma – a
benign tumour, made of fat cells, that posed no serious threat to my health. Almost as soon
as I found out, all those aches and pains vanished, and I soon started returning to my
previous weight.The episode was my first – and so far, my only – experience of illness (or
health) anxiety. According to the latest research, at least 6% of people will experience the
condition during their lifetime.Although we don’t yet have updated statistics, that number
may have increased rapidly over the pandemic. With a continuous news cycle emphasising
the symptoms and dangers of the virus, it is natural to feel a certain level of preoccupation
about a possible infection. But for some people the fear of the virus will have been all-
consuming, peaking as they await the results of a lateral flow or PCR test.The pandemic
could have also exacerbated anxieties about other conditions. “I suspect that health anxiety
has increased quite considerably during the pandemic, not least because people have had
more time to ruminate and reflect on their symptoms,” says Peter Tyrer, a professor in
community psychiatry at Imperial College London.It may be no coincidence that my own
episode occurred during a lockdown, when I was unable to visit friends who might have
distracted me, and when I knew that I’d have restricted access to medical treatment, if it
were needed.The last two years has shown there has never been a greater need for
awareness about illness anxiety and its management.HypochondriasisOur understanding of
illness anxiety marks a vast departure from the historical view of the condition, which was
once known as “hypochondriasis”.The people suffering from this disorder were called
hypochondriacs, and they were often belittled and ridiculed as time wasters. Many
commentators argued that the “worried well” simply wanted to add a little drama to their
lives. “It was regarded as a bit of joke,” Tyrer says. “The assumption was that these people
just loved talking about their complaints.”People’s fear of catching Covid may be at its most

2. acute when they are waiting for the results of a test (Credit: Carol Yepes/Getty Images)It
was only in 2013 that the American Psychiatric Association formally adopted the term
“illness anxiety disorder” to describe people with disproportionate and debilitating
concerns about their health. (In the medical literature “health anxiety” is often used as an
alternative name.) Although hard data is lacking, the wider availability of information online
may have increased the prevalence of illness anxiety in the past three decades, compared to
the pre-Internet era.Contrary to the idea that “hypochondriacs” are simply looking for
attention, the origins of someone’s illness anxiety are often highly specific. “There’s often a
trigger,” says Helen Tyrer, a senior clinical research fellow at Imperial College London and
author of the book Tackling Health Anxiety. (Helen and Peter Tyrer are a married couple
who both research illness anxiety.) “It could be that somebody in the family has been ill. Or
that they’ve heard about somebody their own age dying from a disease.” In other cases,
patients may develop excessive and continued worries about a previous illness such as
cancer or heart attack returning, or a current condition – such as diabetes – worsening.The
condition is characterised by an obsessive checking of symptoms. Many of those afflicted
spend hours each day researching potential illnesses online. “Every minute of the day,
they’re checking whether they’ve got this disease or not,” Helen Tyrer says. “It really is on a
completely different scale to most people’s worries about their health.” The continual worry
results in many more visits to doctors’ surgeries and hospitals“The repetitive thoughts are
persistent and create a lot of distress,” agrees Sophie Lebel, a clinical psychologist at the
University of Ottawa, Canada, who specialises in the ways that people cope with cancer
diagnoses.As you may expect, the continual worry results in many more visits to doctors’
surgeries and hospitals. One study of Danish patients found that people with severe illness
anxiety used between 41% and 78% more health care, over a five-year period, than those
with low illness anxiety.Clearly, this comes at a financial cost, and the repeated medical
visits may not bring much benefit to the patient, as they become convinced that the analysis
was flawed. “The patient might think that it was too early to show up on a test, or that the
results were muddled in the lab,” says Helen Tyrer. Similarly, if you are suffering from high
anxiety of Covid-19, a negative LFT or PRC result may not be enough to convince you that
you are not infected. (Of course, this is justified to an extent – though positive LFT results
are 99.97% accurate, the false negative rate is 28% on average for symptomatic
individuals.)The nocebo effectIn many situations, anxieties about our health can create the
appearance of symptoms – a self-fulfilling prophecy that might seem to confirm our
fears.This phenomenon is evident in cases of “white coat syndrome” – in which the stress of
visiting a doctor can raise people’s blood pressure, so that it appears they are experiencing
hypertension. For this reason, some medical providers may provide you with a blood
pressure monitor to take measurements at home when you are relaxed.Simply going to a
doctor’s surgery to get your blood pressure tested can make it higher than it would be
normally (Credit: Kali9/Getty Images)But there are many other ways our fears can create
the appearance of illness. Our expectations can shape our attention and sensory processing,
for example. If you suspect you may have been infected by Covid-19, for example, you may
be extra conscious of a tickle in your throat, an ache in your chest or a feeling of
breathlessness – and the more you think about it, the worse it will seem. This may be

3. especially likely if someone close to you has had the disease, so you know exactly what
symptoms to expect – and a negative LFT or PCR test may not be enough to assuage your
fears.Our expectations can even bring about physiological change, such as the release of
vasodilating molecules that cause headaches. Scientists call these reactions “nocebo
effects” (a direct contrast to the beneficial “placebo effects”). And the discomfort can be just
as unpleasant as a symptom with a purely biological cause. This will only increase the
anxiety – setting about a vicious cycle.People with severe illness anxiety may feel so
paralysed by their stress, that they struggle to take positive actionIf left untreated, chronic
illness anxiety can take its toll on the body. Peter Tyrer points to one 12-year study of 7,000
participants in Norway. After accounting for other potential risk factors, the researchers
found that high levels of illness anxiety increased the risk of coronary heart disease by
70%.This is particularly problematic for people who have existing heart disease, Tyrer says
– with some evidence that illness anxiety has an effect on overall mortality rate. “If you
worry excessively after you have had a cardiac event, you may die earlier than if you don’t
worry about it,” Peter Tyrer says.You might at least hope that excessive health concerns
would encourage someone to take better care of their body such as exercising or eating
well. Yet Lebel says that people with severe illness anxiety may feel so paralysed by their
stress, that they struggle to take positive action.Gaining perspectiveAs interest in illness
anxiety has risen, so has the research into potential interventions. One of the most well-
tested interventions is an adapted form of cognitive behavioural therapy (CBT), which helps
to break negative thought cycles.According to Peter and Helen Tyrer, one of the biggest
challenges is to get the patient to recognise that their anxiety is a problem, rather than a
rational appraisal of the perceived risk. During each session, the therapist then works with
the patient to identify the triggers of their concerns and to question the thoughts that
automatically come to mind, so that they can see their situation a bit more objectively and
put the risks in perspective. This might involve taking a more analytical look at the
presumed symptoms and the times that they appear.Some commentators have argued the
“worried well” simply want to add drama to their lives, but illness anxiety can be serious
(Credit: PhotoAlto/Odilon Dimier/Getty Images)The therapist will also encourage the
patient to break the habit of relentlessly testing themselves for the symptoms. If the fear is
cancer, they might ask the patient to go a whole day or week without looking for lumps, for
example – and to then note whether their recurrent thoughts of the illness had dropped as a
result. The patient will also learn strategies like mindfulness and relaxation techniques to
cope proactively with the fears when they do come to mind.Clearly, these steps will need to
be tailored to the patients’ particular situation. Someone who has heightened anxiety of a
relapse from a previous illness will need to check on their health, for example, but they can
be taught what signs are significant and what can be ignored – rather than panicking over
every potential change. “Many people just don’t know what symptoms to look for,” says
Lebel.It’s important to emphasise that untreated health anxiety is not only bad for your
mental health but your physical health too – Peter TyrerThe evidence to date suggests that
cognitive behavioural therapy can be effective. In one study of 444 subjects, the Tyrers
found tailored CBT significantly reduced patients’ illness anxiety over the course of three
months. Importantly, the benefits could still be seen five years later.It’s worth noting that

4. the programme only involved six sessions with a therapist – making it very cost-effective.
“We’re not talking about a tonne of time,” says Lebel.The sessions can even be completed
online, with one recent trial from a team at the University of New South Wales revealing
significant improvements in patients’ illness anxiety during the early stages of the Covid-19
pandemic. “In general, face-to-face contact is slightly better,” Peter Tyrer concedes.
“Because you can pick up the more subtle changes – but by and large internet treatment is
pretty good.”One of the biggest challenges is to get the patient to recognise that their
anxiety is a problem; therapy may help (Credit: Microgen Images/SPL/Getty
Images)Ultimately, the researchers contacted would like to see much greater awareness of
illness anxiety, and the ways to treat it. Peter Tyrer sees some signs of positive change, but
he would like more people to understand the long-term consequences of such behaviour.
“It’s important to emphasise that untreated health anxiety is not only bad for your mental
health but your physical health too,” he says. “The evidence is increasing that it’s going to
shorten their lifespan.”We may have come a long way from dismissing the “hypochondriac”
as a sad malingerer – but many are still facing their anxieties alone without receiving the
help they really need.