Monthly Spotlight

Health Anxiety: an Integrative Perspective.

Health anxiety – sometimes called hypochondria in the past –

is something many people experience, though often quietly. It is that

persistent worry about symptoms, illnesses, or the possibility of something

being seriously wrong with the body. For some, it comes and goes with stressful

times. For others, it can feel like a constant presence, shaping daily

routines, relationships, and even identity.

What makes health anxiety particularly hard is how real it

feels in the body. The racing heart, the tight chest, the dizziness – these are

physical sensations, not imagined ones. And when they appear, the mind quite

understandably goes looking for an explanation. Unfortunately, for someone

caught up in health anxiety, the explanation is almost always the worst-case

scenario. A headache becomes a brain tumour; a cough feels like lung cancer;

fatigue is feared to be MS. The body becomes a battleground of symptoms, tests,

and endless scanning for signs of illness.

From an integrative therapy perspective, there isn’t just one

way to make sense of this. Therapy draws on different strands – psychodynamic,

person-centred, cognitive, behavioural, transactional, and relational – weaving

them together depending on what the person needs. This is important because

health anxiety is rarely about just one thing. It can have roots in past

experiences, current stressors, family patterns, and the way we cope with uncertainty.

A psychodynamic lens

A psychodynamic approach means paying attention to the

unconscious stories beneath the surface. Health fears often carry a deeper

meaning – grief, anger, or guilt that can’t easily be spoken. The body then

becomes the stage where those feelings play out. Someone may obsess over a lump

in their throat, but the real “lump” might be unexpressed grief sitting there.

Therapy involves listening carefully to this symbolic language of symptoms and

connecting current fears with earlier experiences of loss, abandonment, or helplessness.

Many people with health anxiety grew up in families where

illness was either minimised or exaggerated. A parent’s illness might have left

them terrified of death, or perhaps their own pain was brushed aside, leaving

them anxious and hyper-alert as adults. Exploring these histories often helps

make sense of why current worries feel so overwhelming.

A cognitive and behavioural lens

Health anxiety also has clear patterns in thought and

behaviour. A sensation sparks a catastrophic thought, which raises anxiety,

which then makes the sensation worse. Breaking this cycle can involve gentle

cognitive work – noticing automatic thoughts, weighing up evidence more

realistically, and learning to sit with uncertainty.

On a behavioural level, it may mean experimenting with

reducing checking behaviours. Constantly Googling symptoms or asking others for

reassurance brings short relief, but it fuels anxiety in the long run.

Practising alternatives, such as delaying checking or focusing on something

grounding, helps the nervous system learn that uncertainty can be tolerated.

A relational and person-centred lens

The therapeutic relationship itself is just as important.

Health anxiety often carries shame. People worry that their fears are

irrational or that others are tired of hearing them. In therapy, being received

without judgement, with real empathy, can itself be healing. Simply having a

space where fears aren’t dismissed but taken seriously makes a huge difference.

In an integrative frame, the relationship is part of the

treatment. Health anxiety often involves a deep longing for reassurance – for

someone to say “you’re safe, you’re okay.” A therapist can’t provide medical

guarantees, but they can offer containment: a steady presence that helps the

client hold their fears rather than be engulfed by them.

A transactional analysis lens

Transactional Analysis (TA) offers another angle. TA looks at

how people relate to themselves and others through three internal “ego states”:

Parent, Adult, and Child. In health anxiety, the inner Parent voice is often

loud, critical, fearful, warning that something is terribly wrong. The Child

part feels small and terrified, desperate for comfort. What is often missing is

the Adult state, which can pause, weigh evidence, and make balanced decisions.

A client might say: “My chest hurts – it must be a heart

attack.” Here, the Parent voice shouts doom, the Child panics, and reassurance

is urgently sought. Therapy can strengthen the Adult voice: “Yes, my chest is

tight, but I’ve noticed this happens when I’m anxious. I can monitor it without assuming catastrophe.”

TA also highlights relational dynamics. Many with health

anxiety repeatedly seek reassurance from loved ones. The Child asks, “Am I

going to be okay?” while the partner replies from a Parent stance. This cycle

soothes briefly but doesn’t resolve the anxiety. In therapy, exploring these

patterns helps the client see what they are really longing for – not endless

reassurance, but a deeper sense of safety and trust in themselves.

Acceptance, mortality, and meaning

At its heart, health anxiety is about our struggle with

uncertainty and mortality. None of us can know the future, and none of us are

immune to illness or death. For someone with health anxiety, this universal

truth feels unbearable. The thought of mortality lurks just beneath the surface

of every symptom. A stomach ache is not only discomfort – it is a reminder that

the body is fragile, that life has an end.

Many people find it easier to manage everyday stress than to

face the reality of death. Health anxiety can become a way of circling around

that truth without looking at it directly. The mind focuses on symptoms,

medical checks, and “what ifs,” but underneath lies the deeper fear: “One day,

I will die. People I love will die.” This is profoundly human, and therapy

gives permission to bring it into the open.

An integrative approach might gently help clients face

mortality, not as an enemy to be defeated, but as part of life that can shape

how we live. This does not mean minimising fear, but creating space to talk

about it honestly. Often, when the unspeakable is spoken, it loses some of its

grip. Clients may find relief in realising that death anxiety is something all

humans carry, not a private flaw or madness.

Acceptance-based approaches can support this process:

learning to sit with the reality that we are finite, while also noticing that

life continues in the present moment. Mortality awareness can even become a

guide. Rather than paralysing us, it can remind us to live more fully, to spend

time with people we love, to invest in what matters, and to loosen the grip of obsessive checking.

Exploring mortality can also connect to spiritual or

existential questions. Clients may want to talk about what gives life meaning,

how they want to be remembered, or how to live more authentically. These

conversations are often avoided in everyday life, yet in therapy they can be

deeply freeing. Health anxiety then shifts from being purely about fear to

being about a search for meaning, belonging, and acceptance of the human condition.

Humanising the struggle

Most of all, it’s important to humanise health anxiety. It

isn’t “silly” or “attention-seeking.” It usually has roots in genuine

suffering: early experiences of illness, fears of loss, or a longing not to be

left alone. Health anxiety is the mind and body’s way of protecting us, even if it overshoots.

In therapy, the aim isn’t to remove all worry – no one can do

that – but to help people build a kinder relationship with their fears and

their bodies. This might mean fewer hours spent scanning for symptoms, more

tolerance of uncertainty, and more space for relationships, passions, and ordinary life.

Final thoughts and observations

Health anxiety is complex, layered, and deeply human. An

integrative approach doesn’t rely on one method, but brings together many:

exploring unconscious patterns, reshaping unhelpful thoughts, easing compulsive

behaviours, deepening the therapeutic relationship, working with ego states

through TA, and engaging directly with mortality.

Ultimately, the work is about helping people reclaim their

lives from anxiety, to live with uncertainty while still engaging with what

matters most. Therapy attends not just to symptoms, but to the whole person –

their history, relationships, and hopes – and in doing so, opens the door to a

steadier and more embodied way of living.

Please do feel free to reach out if you are ready to take some steps....