One day, while out with friends, Mark feels his chest tighten. It seems to come out of the blue and takes him by surprise. Now nervous, he begins to pay closer attention to the physiological sensations around his chest for the rest of the day. As he does, he notices even more twinges throughout the day. What is going on? Is he having a heart attack? Does he have a heart arrhythmia? Is his heart failing? Perhaps he has some very rare heart disease. Scared, Mark goes to the hospital and undergoes several tests to get his heart checked. The result? Mark's heart is perfectly healthy. However, days later he cannot shake the fear that something is wrong with his heart and that his doctors have missed something. As he becomes more anxious, he feels the urge to go back to the hospital for more testing.

For folks with health anxiety, Mark's situation is not uncommon. Health anxiety, formerly known as hypochondriasis, is characterized by attention to physical and physiological sensations paired with the belief that those sensations indicate a serious illness.1 Health anxiety is maintained or exacerbated because individuals tend to interpret temporary, physiological sensations as symptoms of a serious illness, resulting in anxiety about their health. This increased anxiety leads to greater attention to the symptom, as well as greater physiological arousal and even more anxiety, creating a cycle of fear and close attention to physical symptoms.2

Treatment Most Effective

Several studies indicate that selective serotonin reuptake inhibitor (SSRI) medications, relaxation techniques, and talk therapy can be effective in treating health anxiety.3,4 According to a recent meta-analysis, however, the most effective method to treat health anxiety is cognitive behavior therapy, often referred to as CBT.5

CBT Works With Health Anxiety

The primary principle behind CBT is that our thoughts, behaviors, and emotions interact to create a maladaptive cycle that maintains or exacerbates symptoms of a disorder. To break the cycle, therapists employ CBT to change maladaptive thoughts and behaviors with the goal of helping clients learn new ways to cope with their anxiety.

In Mark's case, his thoughts about his chest tightening as an indication of a serious illness, his behavior of paying closer attention to the sensations, and his fear or anxiety that he might have a serious illness all interact to create a cycle in which he continues to feel health anxiety. To break his health anxiety cycle, a therapist using CBT will help him explore other causes of his chest tightening.2 For example, did he have too much caffeine? Has he been smoking cigarettes or drinking more alcohol? Is he exercising more than usual? Is he stressed out? All of these are potential, and more likely, reasons that Mark may feel his chest tighten. In challenging Mark's original thoughts that he has a serious heart disease, CBT allows Mark to explore other nonthreatening options that ultimately reduce his anxiety.

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1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association.

2. Abramowitz, J. S. & Braddock, A. E. (2006). Hypochondriasis: Conceptualization, treatment, and relationship to obsessive-compulsive disorder. Psychiatr Clin N Am, 29, 503–519.

3. Bouman, T. (2014). Psychological Treatments for Hypochondriasis: A Narrative Review. Current Psychiatry Reviews, 10(1), 58-69.

4. Greeven, A., van Balkom, A. J., Visser, S., Merkelbach, J. W., van Rood, Y. R., van Dyck, R., . . . Spinhoven, P. (2007). Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a randomized controlled trial. Am J Psychiatry, 164(1), 91-99. doi: 10.1176/appi.ajp.164.1.91

5. Cooper, K., Gregory, J. D., Walker, I., Lambe, S., & Salkovskis, P. M. (2017). Cognitive behavior therapy for health anxiety: A systematic review and meta-analysis. Behav Cogn Psychother, 45(2), 110-123.

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