When I had been trying to “treat” my hypochondriac anxieties on my own, prior to seeking therapy, I had read in many different places that something called “Cognitive Behavioral Therapy” (CBT) was shown to be effective at treating hypochondriacs. (And anxiety in general).
There was just one problem. I really couldn’t find out any information about what CBT was or what it involved. I wanted to try some “at home” version of CBT to see if it would even work, or whether it was just some granola bullshit worthy of major eye-rolling.
My Understanding of CBT Prior to Therapy
So, after some digging, I read that CBT involved a lot of “exposure” therapy. Basically, if you have a fear of germs, for example, working yourself up to walking close to a garbage dumpster. And then touching the garbage dumpster for a second. Then for 30 seconds. Then not washing your hands for at least a minute afterwards, etc.
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Well, that’s all fine and good. But I can’t exactly expose myself to a blood clot or heart attack. I don’t want to give myself a broken ankle just to prove to myself that I’d likely survive a subsequent operation. So, I was never quite able to see the applicability of CBT to hypochondria and health anxiety.
Umm, well, that’s vague.
Challenging faulty beliefs? I KNOW my beliefs are faulty, motherf*cker! So, how exactly will CBT help me realize something I already know? And re-wiring my brain? Sounds lovely and like something that could be helpful, but what exactly does that involve? Can I try it on my own?
Cognitive Behavioral Therapy for Health Anxiety in Real Life
After much deliberation, I finally decided to seek therapy after I couldn’t find any good “DIY” approaches to helping my health anxiety. And, it was an amazing decision, because all that weird, vague, seemingly non-applicable stuff finally started to make sense when I talked it over with an actual professional.
So, back to that exposure therapy part of CBT for health anxiety. How exactly do I get exposure therapy for hypochondria when I don’t exactly want to expose myself to things like a stroke? Well, it’s not quite as straightforward as some anxiety disorders or phobias, but it was still relatively simple, albeit fairly time consuming.
One of the methods of exposure therapy for health anxiety that was recommended to me was through “imagined exposure.” But, imagined exposure didn’t really work all that well on me. (More on that later). Instead, it was recommended that I try a variation of imagined exposure, where I actually record my voice narrating scenarios that are scary to me. I’d start with less scary scenarios, working my way up to truly terrifying scenarios. While listening to the recording of the scenarios, I would take deep, relaxing breaths. And then, I’d listen to the scenario over and over and over and over again.
My therapist explained this as “habituation.” I was making a scary scenario seem habitual. Boring. Then, as I’d habituate to the “less scary” scenarios, I’d start listening to the increasingly distressing scenarios, doing the same thing. Deep breathing while hearing the scenario over and over and over again.
The deep breathing (which I initially thought was totally useless) is part of a long-term process of “training my brain” to react more calmly to scary scenarios. The deep breathing was not necessarily intended to help me in that given moment.
Like I mentioned, audio “imagined exposure” was actually a very time consuming part of my self-directed therapy (meaning outside my one hour weekly sessions with Dr. Lindo). I’d draft each scenario in a text document on my computer, then read it out loud into a digital voice recorder / dictaphone thing. Although my smartphone has the capability to record things, I was being kind of paranoid. Some of my scenarios just seem so fucked up (“now imagine you start unexpectedly coughing up blood uncontrollably while home alone and start to pass out before you can get to the phone to dial 911”), that I really didn’t want any of those “voice memos” to be on my phone or associated with any “cloud” account. That was just me. You certainly don’t need your own digital voice recorder!
I followed guidance from my therapist, as well as guidance in the OCD Workbook for creating each of my scenarios. Specifically, the OCD workbook said that my imagined exposure scenarios should include the following elements:
- The triggering situation (such as a sharp, sudden pain in my abdomen)
- Initial fearful thoughts
- Emotional reactions and physical symptoms
- Additional fearful and doubting thoughts.
- Urges to ritualize (engage in my compulsions), without following through.
- What this would say about me if the worst happened
- Core fear or worst case scenario.
The OCD workbook also had different worksheets for me to complete for each imaginal exposure session. It asks you to record your “SUDS level” after each recording. SUDS is “Subjective Unit of Stress.” Basically after each recording, I ask myself to rate how distressed I’m feeling on a scale of 1-10. Recording my SUDS level after each imaginal exposure would help me track whether my distress was decreasing for each scenario.
There’s actually a second part of CBT that I learned about from my therapist and in my OCD Workbook, and that is Response Prevention. Response prevention is just another word for controlling my compulsions, which I’ve talked about at length in a prior post.
Simply controlling my compulsions (practicing “Response Prevention”) led to a dramatic improvement in my Health Anxiety OCD within the first two months. Part of my response prevention therapy included a complete halt of Googling my symptoms. I did that cold turkey and it was easier than I expected. I have not Googled a single symptom in nearly 18 months now!
Challenging Overestimation of the Likelihood of Harm
One of topics I found most insightful in my OCD workbook was the topic of challenging your beliefs. And specifically, challenging how much we overestimate harm.
The example in the book deals with a type of OCD in which people are overly afraid of causing something terrible (like a car accident) by something they did wrong. The scenario talks about how the person rolls up their window in their car because if a sheet of paper flies out of the window, it could cause another driver to lose control and crash the car. So, it explains how the person should break down each and every step of that scenario and to assign a probability percentage to each element in the chain of events. Then, calculating the final probability of the awful, ending event.
This one is kind of complicated for a layperson like myself to explain, but the OCD Workbook had some great worksheets to guide how your own estimations.
In short, in one of my own scenarios, I challenged how much I overestimate the harm of breaking an ankle while hiking. And catastrophize those thoughts all the way to the point of imagining myself dying. Yes, from a broken ankle.
I learned that there are many, many different techniques that make up CBT. Much beyond the few I’ve mentioned here. Some techniques might work great for some folks, but not for others. That’s why it was important for me to try as many of the techniques that I could, to help prioritize the techniques that I was finding most helpful, and weeding out the techniques I did not find useful. However, I made myself commit to each technique for six weeks.