Introduction

• Define health anxiety and medical trauma as related but distinct clinical presentations
• Understand health-related concern on a continuum from adaptive vigilance to anxiety-driven preoccupation
• Recognize the emotional “aftershock” that can persist after frightening, painful, invasive, or invalidating medical experiences
• Differentiate appropriate medical vigilance from anxiety-maintaining checking, reassurance seeking, and avoidance
• Understand that health anxiety can coexist with genuine medical illness or chronic health conditions

Objective 1: Identify cognitive distortions and behavioral patterns associated with health anxiety and medical trauma

• Common cognitive patterns in health anxiety, including catastrophizing, probability overestimation, selective attention, emotional reasoning, and certainty-based thinking
• The health anxiety maintenance cycle: trigger → threat interpretation → anxiety/arousal → safety behavior → short-term relief → increased vigilance
• Approach-based safety behaviors, including body checking, symptom searching, repeated reassurance seeking, and excessive monitoring
• Avoidance-based safety behaviors, including avoidance of appointments, procedures, medications, exercise, medical information, or being away from perceived sources of safety
• Understand how reassurance can reduce distress in the short term while unintentionally reinforcing future reassurance seeking
• Recognize physical sensations associated with anxiety without automatically attributing medically unexplained symptoms to anxiety
• Identify common manifestations of medical traumatic stress, including intrusions, avoidance, hyperarousal, mistrust, and changes in beliefs about the body or healthcare
• Differentiate future-oriented health anxiety from trauma-related activation in response to reminders of prior medical experiences
• Use functional analysis to identify triggers, interpretations, responses, short-term consequences, and longer-term patterns

Objective 2: Use trauma-informed, therapeutic approaches to reduce avoidance and build resilience

• Apply trauma-informed principles of safety, transparency, collaboration, voice, choice, and empowerment
• Validate health-related fear without confirming catastrophic interpretations or providing excessive reassurance
• Support clients with histories of medical dismissal, mistreatment, or loss of bodily autonomy
• Distinguish informed medical advocacy from anxiety-driven attempts to obtain absolute certainty
• Use CBT strategies to move from catastrophic certainty toward balanced and flexible interpretations
• Identify medically appropriate care that should remain in place while gradually reducing anxiety-driven “extra” safety behaviors
• Use collaborative exposure and response prevention when clinically appropriate without overriding legitimate medical guidance
• Incorporate narrative approaches to explore how medical experiences have affected identity, safety, trust, control, and the client’s relationship with their body
• Restore agency when medical cues activate past experiences through present-moment orientation, choice, communication planning, and portable regulation strategies

Objective 3: Guide clients in tolerating uncertainty and developing balanced health-related thinking

• Understand intolerance of uncertainty as a maintaining process in health anxiety
• Shift the therapeutic goal from eliminating uncertainty to increasing the client’s ability to function while uncertainty remains
• Develop individualized uncertainty ladders that gradually reduce reassurance seeking, checking, avoidance, and other safety behaviors
• Help clients distinguish possibility from probability while avoiding unrealistic promises of safety
• Support valued-life re-engagement even when health-related uncertainty cannot be fully resolved
• Coach partners and family members to provide emotional support without repeatedly participating in reassurance cycles
• Adapt interventions for clients with chronic illness or genuine medical vulnerability
• Prepare clients for feared medical procedures using predictability, choice, communication, regulation, future rehearsal, and aftercare
• Develop plans for future symptoms, appointments, test results, procedures, and other health-related triggers

Summary and Q&A