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It’s Not All in Your Head

Joan S. Zofnass, D.S.W.

It’s Not All in Your Head is written for those who "worry too much about being sick," despite having no underlying "physical" illness. Noting that the readers have most likely already tried unsuccessfully to find a medical explanation for their distress (and, if not, they are advised to see a physician to rule out any underlying physical cause), the authors suggest that the readers can, with this book, begin to explore alternative explanations for their health-anxiety and learn how to overcome it. Asmundson and Taylor, both psychologists in Western Canada, provide multiple case examples of individuals struggling to work through destructive health-anxieties that impair enjoyment of life. Using a cognitive-behavioral approach, the authors introduce readers to the possibility that what they fear most is being ill, which leads them to misinterpret minor symptoms as disease rather than recognizing them as symptoms of anxiety.

The book is divided into three sections: Part 1 familiarizes the reader with the concept of health-anxiety. Through a series of questionnaires, the reader participates in the process of identifying health-related worries and is then introduced to the possibility that these symptoms are not reality-based, but rather are due to anxieties that are perpetuating and magnifying minor or even normal bodily sensations. The goal of this section is to teach the reader "where your bodily sensations come from, how they can be misinterpreted as signs and symptoms of disease, and how the vicious cycle of health-anxiety feeds itself."

"Part II: Breaking the Health-Anxiety Cycle," moves readers toward changing thinking and behavior underlying their health-anxiety, challenging their assumption of having a specific disease or diseases, and focusing instead on the symptom(s) of anxiety. The authors present the idea that the health-anxiety cycle can be broken by better management of stress and anxiety. Realizing that not everything can be "resolved," the authors encourage their readers to learn to cope with uncertainty without panic and to put what might otherwise be experienced as catastrophic into a perspective that they can cope with more adaptively.

By answering questions at the end of each chapter, the readers can review the salient points presented. The authors’ underlying premise is that anyone reading this book has not yet found permanent relief from his or her anxiety, but has resorted to a number of temporary "fixes" that did not suffice to resolve the underlying symptomatology. Through understanding the process of coping with fears and stresses, their anxiety can be brought under control. The process, however, requires constant review of maladaptive behaviors and an acceptance that these behaviors are ineffective in reducing stress, while learning cognitive methods to address those anxieties in a healthier manner. Again, through a series of worksheets, the readers participate in identifying areas of stress and then learn to cope more adaptively, through a process of learned cognitive-behavioral techniques. Through a number of concrete daily exercises, the readers learn how to systematically review what they are feeling and, after identifying the maladaptive responses to those feelings, to begin to implement a healthier, more adaptive approach to coping with stress and anxiety.

In "Part III: Maintaining Your Gains," the final chapters review some of the common problem areas: dealing with doctors; dealing with family members; and handling flare-ups of health-anxiety. A series of exercises are provided to help readers prepare to be "on the offensive" in these situations. The final 25 pages provide a number of readings for both adults and children, a list of cognitive-behavioral therapists throughout the United States with expertise in treating health-anxiety, and some additional behavioral worksheets.

Asmundson and Taylor’s goal is to help individuals who sense that there is something wrong in their bodies despite there being no medical explanation for their symptoms. Their approach is certainly in line with those suggesting that "Hypochondriasis" should be moved firmly into the Anxiety Disorders section in DSM-V. As the authors observe, living with the specter of unresolved health issues isn’t just painful, but isolating and life-limiting. Today, the availability of Internet searches for assistance in self-diagnosis can increase anxiety and result in the spread of "cyberchondria," a phrase coined to describe those who read about a myriad of diseases or ailments on the Internet and subsequently believe that they are afflicted (Carrns A: "Cyberchondriacs Get What Goes Around on the Internet Now." Wall Street Journal, October 5, 1999, p A1). Such behaviors can readily disrupt and even replace most aspects of the sufferer’s life. Although the authors provide ample case examples and worksheets for self-treatment and a somewhat ironic approach (seeing that the patients suffer from faulty self-diagnosis to begin with), the book would still be most effective when used with the assistance or guidance of a therapist, who could help tailor a particular exercise to the individual’s anxieties, as well as monitor progress and patients’ backsliding. The many tools offered in the book certainly could be helpful in assessment of the hypochondriacal patient and in the differentiation of anxiety stemming from hypochondriasis from other forms of anxiety, while the structured exercises provided make this a potentially useful book for anyone working with this population.

FOOTNOTES

 
Joan S. Zofnass, D.S.W., is a psychotherapist working in New York City who has worked extensively with medically ill patients.

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