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There’s a pain in my chest: health anxiety, CBT, and difficult self-care

Audio: Read by the author.

Cognitive Behavioural Therapy (CBT) has been vital in helping me deal with anxiety. 

It is a form of therapy that unravels the way you think, the way you approach your thoughts, fears and worries. In unfolding the way fearful thoughts form themselves, it challenges them and sometimes, on a good day, it can snuff them out altogether. 

Practicing CBT is emotionally taxing. The key to it culminating in a peaceful, relieving outcome is to approach fearful thoughts with a steadfast, clinical rationality. You have to step outside of yourself, in order to decide whether your fear is something worth losing sleep over, or whether you should forget about it, drink a glass of squash, and move on with your life. 

As an example, let’s imagine a little hamster living in a roomy cage in her human’s 10th floor flat. Let’s imagine this hamster has a fear of being eaten by a cat in her sleep. She sits down at her little hamster desk, with a little hamster notebook and pencil, and in a shaky hand she begins to write out her hamster CBT. It would look something like this:

THOUGHT: a cat is going to eat me in my sleep.

HOW THIS THOUGHT MAKES ME FEEL: I can’t sleep at night. I struggle to eat. Nausea, pain in my chest, upset, fear, lots of bad dreams. Worried all the time. 

HOW MUCH DO I BELIEVE THIS WILL HAPPEN: 80%

Then, the hamster weighs up the evidence for and against her potential cat-based demise. 

Thought is rational/true:

Cats like to eat small rodents. I am a small rodent.

If a cat broke into my cage to eat me, I would be powerless to stop it. 

My cage may not be secure enough – it feels a bit shaky and I’m worried a cat would be able to break in. 

The human likes to keep the window open at night. 

She stops, and stares at the page under her little hamster light. Writing all this down was neither easy nor pleasant: in fact, she thinks she feels worse now that she’s started to question the structural integrity of her cage. But she takes a deep breath, and writes down the following:

Thought is irrational/false:

The human lives high up in this building, and there are no balconies, so it would be almost impossible for a cat to get in through the window. 

The cage entrance is too small for a cat to get in, even if it breaks.

The worry has made me feel ill and is taking over my ability to sleep and be well-rested, which shows it isn’t a healthy fear. 

No other hamsters worry about this like I do, which shows it isn’t a normal fear. 

So, after writing this out, the hamster will have eventually reassured herself, even if only enough to get a good night’s rest, that her fear is unfounded. It’s extremely unlikely that a cat will eat her in her sleep, and obsessing over the thought is only making her life difficult. She may even have realised the origin of her fear: she now remembers that the pet shop she came from was full of cats. She can now work to move on from this, knowing she is living in a safe cage in a quiet house. 

Before she puts down her hamster pencil and goes to sleep, she writes down this conclusion: ‘HOW MUCH I NOW BELIEVE THIS WILL HAPPEN: 35%.’ Her fear hasn’t completely gone, but she has dissected it enough that she can find some peace. She has a lie-in and wakes up feeling better. 

CBT has helped me many times to deal with similar frightening thoughts. It stops them in their tracks, after they lumber and trundle towards you as a runaway train, like this: 

I feel…

I feel like something bad is going to happen to me. 

I have a pain in my chest, I feel nauseous, I feel tearful. 

If I keep feeling like this, I will lose my job.

When I lose my job, I will become depressed.

I will be so depressed I will lose all my friends. 

When I lose all of my friends, I will be so miserable that I will never make friends or get a job ever again. 

Because of this I will become a shut-in and never leave the house. 

This will make me even more depressed…

And so on. CBT processes these thoughts to this:

I feel…

I feel like something bad is going to happen to me – 

What bad thing? 

I do not know if this is true. 

I have no reason to believe this. 

I have felt these scary feelings before, and nothing came of it. 

This is anxiety, and it will pass with nothing awful coming of it. 

It has passed before, and it always will. 

CBT stops the brakes. Importantly, it can eventually stop the brakes on the physical symptoms that so often occur with anxiety: the pain in my chest. The nausea. The dizziness. 

But, this isn’t always the case. CBT is particularly difficult, for instance, when it comes to hypochondria: the fears that something terrible will happen not just to me, but specifically to my physical health. 

Most of the time, the physical sensations I feel are a by-product of the fears I am experiencing. But with hypochondria, more often than not the physical sensations are the cause of the fear. Even when they’re not the cause, they still get dragged in, like a bucket and spade being ripped from the shore into the ocean. It’s an almost comical self-fulfilling prophecy. 

I feel…

I feel a pain in my chest. 

There is something wrong with my body that is as of yet undiagnosed and is very dangerous. 

I now feel nauseous. 

This nausea is a part of my as of yet undiagnosed, very dangerous affliction!

I feel nauseous and dizzy!

My as of yet undiagnosed, very dangerous affliction is getting worse as we speak! 

In hindsight, I can laugh at the fears I’ve had in the past. I imagine myself as some pallid and hysterical Victorian woman, stretched over a chaise-longue with the vapours (even though all she is experiencing is a slight sniffle), solemnly dictating my will to one of my seven sons. Looking back, I know now that these health anxieties are disproportionate. Despite this, at the time they can feel overwhelmingly real. 

They can’t be backtracked on like other worries. I can listen to the anxious thought – something wrong, undiagnosed, very dangerous – and question it. Have I felt these sensations before? Did they go away? How do I know that there is something seriously physically wrong? Yet the original factor – the physical sensation that is causing the fear in the first place – doesn’t go away like thoughts do. 

I feel…

I feel a pain in my chest. 

Have I felt this before?

Did it go away?

How do I know there’s something seriously wrong?

But… I still feel a pain in my chest.

There’s a pain in my chest. 

There’s a pain in my chest…

In these situations, CBT is not a cure-all. Other methods must be wrenched forth and put to use. Something can still be taken from my CBT practice though: the military dedication that goes into writing down the frightening thoughts, and the reasoning my brain uses to justify them. Discipline is key in handling hypochondria. 

The common-sense rules for hypochondriacs are as follows:

  1. Don’t google your symptoms.
  2. Give your symptoms two or three days, and if they don’t diminish, then do something about it. 
  3. Do NOT google your symptoms. 

Rule One is key here. Logging into ‘hypochondria.com’, as my mum says, is the worst possible thing a hypochondriac can do. The internet may be good for many things, but it is also a catalogue of every terrible thing imaginable: you will be three clicks away from diagnosing yourself with radioactive brain worm. You certainly will not get radioactive brain worm. In a perfect world, you wouldn’t even be able to read the symptoms of radioactive brain worm and cross-examine it with your slight dizziness and vaguely aching upper thigh in the first place. But there you are, on DoIHaveRadioactiveBrainWorm.com, and a stranger’s comment from March 2009 is dire but conclusive: your symptoms mean you have The Worm, and boy have you got it bad.   

The kicker is, not googling symptoms is an extremely difficult act. The anxious impulse to know things, know something, anything, can outweigh our understanding that the information we end up with might actually be from an outdated medical forum full of people who do not know what they’re talking about. When you’re in an anxious thrall, logical conclusions like this no longer matter. What matters is that your brain has found the evidence to justify its beliefs, no matter how helpful or rational this belief proves to be. This is why I have to be extremely strict with myself when it comes to these sorts of fears: hypochondriacs simply cannot afford to scratch that itch. Curiosity kills the cat, especially when the cat is scratching at the door. 

Rule Two, meanwhile, has its own set of difficulties. During particularly bad health anxiety spikes, there are two conflicting voices in my head: one telling me that I’m panicking, and that I shouldn’t waste a professional’s time on symptoms that are barely there; and another that’s begging me to call the doctor, 111, a priest, or else I’ll surely get worse and something terrible will happen. I’m not suggesting one should avoid getting help if something feels wrong, but this is where discipline comes in: you have to ask yourself what is genuinely, legitimately the most useful thing to do in this situation. You have to look inside yourself and ask whether what you’re experiencing is a physical health concern, or the rising waters of panic. This isn’t an easy question to answer: it takes practice, it takes thought, and it takes bags – heavy, cumbersome bags – of self-restraint. 

Pencilling in and challenging your biggest fears through CBT is as easy as convincing yourself you’re not going to die in your sleep from an undiagnosed illness. It is hard, and it can be unpleasant. ‘Self-care isn’t easy’ is a saying I’ve seen many times on Instagram, but I don’t think it can be overstated. Sometimes, to look after yourself properly, you have to do the difficult thing and face feelings that you’d much rather avoid. The problem with anxiety is that no one can see how hard you’re trying to cope. But, knowing that effort is being put in is something to be proud of in itself. 

Don’t google your symptoms.


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About Author

Josephine Dowswell (she/her) is a writer from Wolverhampton. She has a background in English Literature and hopes to one day be lowered from a high ceiling inside a giant pearly shell. You can find her poetry on Instagram @ceilingdreams_ and her zine @hope.xzine.

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