Health anxiety treatment, online across New Zealand

What is health anxiety?

Health anxiety is a persistent preoccupation with having or developing a serious illness, often driven by misreading ordinary bodily sensations as signs of danger. Diagnostic manuals call it illness anxiety disorder or somatic symptom disorder (DSM-5-TR), or hypochondriasis (ICD-11). It is kept going by checking, reassurance seeking and searching symptoms online. Cognitive behavioural therapy adapted for health anxiety is the recommended psychological treatment, with large improvements in controlled trials.

Caring about your health, or health anxiety?

Paying attention to your body is sensible. Noticing a new mole, getting a persistent cough checked, going for the smear or the prostate check: none of that is health anxiety. Health anxiety is what happens when the checking never produces lasting relief, when every normal result is followed by a new concern, and when thinking about illness takes up more of your day than living does.

It often looks like this. A headache that lasts two days becomes a brain tumour by the second evening. A skipped heartbeat on the couch becomes a heart problem the GP must have missed. A tingling hand gets searched online at midnight and three hours later you have read about motor neurone disease and cannot sleep. The GP says everything is fine, and for a day or two it is. Then the attention shifts to a different part of the body.

People with health anxiety are not making it up and are not weak. They are stuck in a loop that makes complete sense from the inside, and the loop is what therapy targets.

The behaviours that keep it going

The cognitive behavioural model of health anxiety, developed by Paul Salkovskis and Hilary Warwick, describes how the things you do to feel safer end up feeding the fear. The main ones are:

• Body checking. Pressing a lump, photographing a mole every day, taking your pulse, swallowing repeatedly to test a sore throat. Checking creates new sensations (prodding a gland makes it tender), and it keeps your attention locked on the body.
• Seeking reassurance. Asking your partner "does this look normal to you?", booking a third GP appointment, requesting another blood test. Reassurance works for a few hours. Then doubt returns, often stronger, because the relief taught your brain that the danger was worth checking.
• Searching online. Symptom websites are built to list every possibility, including rare ones. Searching almost always finds something alarming, and health anxiety reads "rarely" as "possibly me".
• Avoidance. Some people do the opposite: skipping check-ups, refusing to see the doctor, switching off the news story about cancer. Avoidance keeps the fear intact by never letting it be tested.
• Scanning. Repeatedly turning attention inward to see how the body feels. The more you look, the more you find, because bodies are noisy.

Each of these behaviours makes sense in the moment and each makes the problem worse over time. Changing them, carefully and with support, is the heart of treatment.

Why normal sensations start to feel dangerous

Bodies produce odd sensations all day: twinges, pins and needles, a flutter in the chest after coffee, floaters in your vision, a muscle that twitches when you are tired. Most people notice these for a second and move on. In health anxiety, the sensation gets interpreted as a possible sign of catastrophe, and that interpretation triggers anxiety.

Anxiety itself then produces more sensations: a racing heart, dizziness, tight chest, nausea, tingling, lightheadedness. These feel like evidence that something is physically wrong, which produces more anxiety. The loop can run for hours.

Health anxiety often starts, or gets worse, after something real. A friend the same age gets a serious diagnosis. A parent dies young. A doctor once missed something. A difficult pregnancy. These experiences teach the mind that bodies can betray you without warning, and the mind responds by trying to catch the betrayal early. The intention is protective. The result is a life spent on alert.

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Is it health anxiety or OCD?

The two overlap, and a psychologist will want to understand which you are dealing with because the emphasis of treatment differs. In health anxiety the fear centres on already having, or developing, a serious illness, and the checking and reassurance seeking are aimed at finding out. In OCD, intrusive thoughts about illness or contamination are met with rituals designed to prevent harm or neutralise the thought, and the rituals often feel senseless even to the person doing them.

Questions a psychologist might explore include: Are you mainly afraid of a disease you might already have, or of catching or causing one? Does the checking follow rules (a set number of times, a particular order)? Are there other intrusive thoughts outside the health theme? Is there a sense that the thought itself is dangerous or must be cancelled out?

Both respond to cognitive behavioural approaches, and the skills overlap. If OCD is the better fit, the treatment is exposure and response prevention; see our pages on OCD vs anxiety and contamination OCD.

CBT for health anxiety, step by step

A systematic review of 14 studies found CBT for health anxiety produced large improvements compared with control conditions, with gains maintained at 6 and 12 months. It is not generic relaxation or "positive thinking". It is a specific set of steps, and most people recognise themselves in the model within the first session or two:

1. Building your own map. You and your psychologist trace a recent episode: the sensation, the thought, the fear, what you did, and what happened next. This becomes the shared model you return to throughout.
2. Two explanations. A core part of this treatment is holding two theories side by side. Theory A: "I have a serious undetected illness and must find it." Theory B: "I have a problem with worry about health, and the checking is keeping it alive." You are not asked to believe Theory B. You are asked to test it, as an experiment, for a defined period.
3. Experiments with attention. Spending two minutes focusing hard on your left hand and noticing what sensations appear teaches, in a way no explanation can, that attention creates symptoms. Learning to redirect attention outward is a skill you will practise daily.
4. Reducing checking and reassurance. This is done gradually and collaboratively. You might agree to check a mole weekly rather than daily, or to delay searching online by an hour and notice what the urge does. Family members are often brought into the plan so they know how to respond.
5. Facing the fear directly. Later sessions often involve deliberately approaching what has been avoided: writing out the feared scenario in detail, reading about the illness without searching for reassurance, or sitting with an unexplained sensation without acting on it.
6. A plan for the future. Including agreed guidelines for when a symptom does warrant a GP visit, so that stopping the checking does not mean ignoring your health.

Doing this treatment online

Health anxiety is one of the conditions where online CBT has been tested head-to-head against in-person therapy. In a randomised trial of 204 adults published in JAMA Psychiatry, a 12-week internet-delivered CBT programme for health anxiety produced outcomes no worse than face-to-face CBT. Live video sessions with a psychologist, as Mindwell offers, add real-time discussion to that structure.

Video also fits the practical work. Attention experiments can be run in the room you actually worry in. The mole you check or the mirror you scan is right there, so experiments about reducing checking can be planned around your real routine rather than described in the abstract. And for people who have come to dread medical settings, not having to sit in a clinic waiting room for a psychology appointment is a small but welcome difference.

Working alongside your GP, not instead of them

Psychological treatment for health anxiety does not mean deciding you are never physically unwell. A reasonable medical check of any new, persistent or changing symptom is part of good care, and your psychologist will encourage it. What changes is what happens after the check: learning to accept a clear result rather than seeking a second, third and fourth opinion.

Many people find it useful to agree a plan with their GP as part of therapy, for example scheduled appointments at sensible intervals rather than appointments driven by anxiety. Your psychologist can write to your GP with your consent if that helps. Health anxiety can also exist alongside a genuine long-term condition, and the same approach helps people with chronic illness or chronic pain worry less about it.

Medication is sometimes used for health anxiety, usually antidepressants, and that is a decision for you and your GP or psychiatrist. Our psychologists do not prescribe or advise on medication changes.

What to expect at Mindwell

Mindwell is a telehealth practice: all sessions are 50-minute video appointments through Carepatron, which runs in your browser. You book online, choosing a psychologist or taking the first available slot, and first appointments are typically within 7 days. No referral is needed. After booking you will get a confirmation with your video link and a short intake form.

In the first session your psychologist will want to hear the history: when the worry about health began, what it has attached to, what checking and reassurance look like for you, and what medical investigations you have had. Together you will agree what to work on and how often to meet; weekly is common at the start.

Sessions cost $199 + GST ($228.85 including GST), paid at booking, with a receipt for health insurance claims. Sandy Laurenson and Candice van der Merwe work with anxiety and OCD, and Katherine Lee with anxiety and emotional regulation, so the overlap between health anxiety and OCD is familiar territory. Mindwell works with adults 18 and over in New Zealand, and is not an ACC provider. There is also a free self-guided health anxiety course at Just a Thought, which some people use before or alongside therapy.

Related support: Anxiety therapy · OCD vs anxiety · Panic attacks · OCD treatment