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A formulation based on the cognitive-behavioural model of health anxiety — mapping the vicious cycle of misinterpretation, anxiety, checking, and temporary reassurance.
This formulation shows how health anxiety is maintained by a cycle: you notice a body sensation or health information, interpret it as meaning something is seriously wrong, become anxious (which produces more sensations), and then engage in checking, reassurance-seeking, or avoidance — which temporarily reduces anxiety but reinforces the belief that you were right to worry. Work through it with your therapist.
Use at the formulation stage with clients presenting with health anxiety. Based on Salkovskis and Warwick's cognitive-behavioural model, this maps the maintaining cycles of misinterpretation of bodily sensations, safety-seeking behaviours, and attentional bias toward health threat information.
Build collaboratively using a recent health anxiety episode as the anchor. Start with the triggering stimulus (body sensation, health information, or medical encounter) and map the client's interpretation, emotional response, safety behaviours, and how these feed back to maintain preoccupation.
For clients with longstanding health anxiety across multiple health concerns, develop the formulation around the process rather than any single feared illness. For clients with comorbid medical conditions, carefully distinguish between appropriate health vigilance and anxiety-driven checking.
Ensure appropriate medical investigations have been completed before formulating the presentation as health anxiety. The formulation should acknowledge genuine medical uncertainty where it exists rather than dismissing all health concerns. Avoid if the client feels their concerns are being invalidated.
The formulation should highlight how safety behaviours (checking, reassurance-seeking, Googling symptoms, body scanning) provide short-term relief but maintain the problem long-term. The client's reaction to this formulation is diagnostically useful: resistance may indicate the therapeutic relationship needs strengthening before intervention.
Suitable for clients working with health anxiety, formulation, salkovskis, warwick, cbt, hypochondriasis, maintenance cycle. This tool can be used as a standalone worksheet or as part of a structured homework plan.
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Track health anxiety episodes — the trigger, misinterpretation, anxiety level, safety behaviour used, and the actual outcome.
Track gradual reduction in body checking behaviours — setting targets, monitoring frequency, and recording what happens when you check less.
Test how attention to the body creates and amplifies sensations — demonstrating that body scanning is part of the problem, not the solution.
Track urges to seek reassurance, whether you resisted, and what happened — building evidence that you can tolerate uncertainty without reassurance.