As we begin to relax rules around the COVID-19 precautions that have helped keep us safe for two years now, it's understandable to be at least a little anxious. But when that anxiety becomes especially time-consuming or distressing, experts say it may qualify as a mental health condition.
What is health anxiety?
“If people weren’t already thinking about communicable disease threats, COVID certainly put it at the forefront,” Michael Wheaton, an assistant professor of psychology at Barnard College who specializes in treating OCD and OCD-related disorders, told TODAY. But for those with health anxiety, that tends to take up a much bigger part of their life.
"Generally speaking, health anxiety is characterized by a preoccupation with the possibility of having or acquiring serious illness or disease," Samantha Farris, assistant professor of psychology and director of the Rutgers Emotion, Health and Behavior Laboratory, told TODAY. (People who have a health condition may have anxiety or concerns about managing their illness, which is a different situation.)
“If I were to get the sniffles one day because of a change in the weather or allergies, someone with elevated health anxiety would likely interpret that as a sign of infection, which would then increase anxiety and increase preoccupation with those symptoms,” Matthew Tull, professor in the department of psychology at the University of Toledo, told TODAY.
All of us likely have some level of health anxiety now and then, and many of us certainly experienced "transient health anxiety" during the pandemic, Farris said. But at the extreme end, what we refer to as health anxiety can be related to a few different mental health conditions that can have a very real impact on someone's life.
One of those conditions is illness anxiety disorder (formerly called hypochondriasis). This tends to manifest as excessive worries about normal aches and pains we all experience every once in a while. People with illness anxiety disorder may misinterpret those puzzling-but-actually-fine bodily sensations as signs of a serious condition, like cancer.
Health anxiety could also overlap with the symptoms of obsessive-compulsive disorder, Wheaton said. People with this condition are typically more focused on the potential to contract an illness in the future rather than on possibly having an illness already.
“We also see a lot of what we call 'safety behaviors' where people will take more extreme measures to protect their health,” Tull said, which might include avoiding all contact with other people, excessive hand-washing or spending a lot of time seeking out information about a particular health condition.
What does health anxiety feel like?
Remember, it’s not inherently problematic to be worried about your health. “Anxiety is a normal human emotion that can be beneficial,” Wheaton said. It can be protective and help keep us safe.
“But with health anxiety, it starts to go too far,” he explained. “The amount of anxiety that you feel doesn’t match the situation, or you’re anxious about things that are false alarms.”
Especially during a pandemic, it makes sense to be at least a little bit vigilant about what your body is doing and to take precautions to stay safe, Farris said. But for people with health anxiety, those protective steps don't alleviate their concerns. Instead, their anxiety usually becomes more severe.
But the exact way health anxiety manifests can be different for different people. "There's so much diversity in terms of how people present," Cynthia Radnitz, of CBT Specialists of New Jersey, told TODAY.
People with health anxiety might worry that they’re sick without having any specific symptoms or might worry that a transient ache is a sign of a serious undiagnosed issue. They may frequently turn to their doctor or seek out testing for reassurance. Or they might spend hours scrolling online to learn more, but not be satisfied with what they find.
In the early days of the pandemic, Wheaton said, “a lot of people that I was seeing were very concerned about different potential routes of getting COVID.” He recalled people experiencing shortness of breath or a scratchy throat and their minds immediately jumping to COVID-19. Others, he said, would repeatedly check their oxygen saturation level or their temperature to monitor themselves even without symptoms.
These behaviors may be so severe that they interfere with daily life, making it difficult to get enough sleep or complete tasks at work, for instance. As a rough guideline, if you're spending more than an hour a day occupied with worry, anxiety or compensatory safety behaviors, that's a significant amount of time, Wheaton said. And at that point, you might want to think about seeing a mental health professional.
How can you manage health anxiety during the pandemic?
There are a few ways to manage and work through health anxiety right now, experts told TODAY.
Start by assessing whether or not your level of anxiety is proportional to your actual risk.
Humans are not exactly the best at accurately assessing risk, and depending on your individual risk factors for COVID-19 (or other illnesses) the actual risks may be different for you than those around you.
But if you feel yourself getting anxious, Farris recommended a technique she calls "evidence-based thinking" or "checking the facts" to find the most plausible explanation for what you're feeling and to see if you may be overestimating the need for concern.
For example, if you're someone who gets seasonal allergies every year and you develop some congestion around that time, it makes sense to be a little concerned and maybe to even take a COVID-19 rapid test just to be sure. But you can use your past experiences with allergies and trust in your body to navigate that situation.
Notice when your thinking becomes catastrophic or all-or-nothing.
These thought patterns may cause people with health anxiety to cling to a mask or to social isolation as all that stands between them and severe illness, Farris explained. But no single public health precaution can fully prevent COVID-19. Instead, we are living in the uncomfortable, mushy gray area where there is a spectrum of risk — as well as precautions we can layer to make ourselves safer.
Set limits, even small or incremental ones, on the amount of time you spend seeking information and reassurance.
Whether it's scrolling through social media posts, endlessly Googling symptoms or constantly texting your doctor with questions, people with health anxiety often feel compelled to seek out more information or reassurance about what they're feeling or what they're afraid of.
"People use this kind of consumption of information to decrease their perceived threat level," Radnitz said. While it can be helpful to a certain degree, it crosses a line if that information-seeking is regularly keeping you up late at night or otherwise interfering with your life. And, again, if you find answers you're looking for but don't feel satisfied (or even begin to feel more anxious), that could be a sign of a more concerning pattern.
"At what point does it cause more stress than it should? Or more distress than it should? At what point does it start interfering with your functioning? And at what point do you get diminishing returns?" Radnitz said. The limit may be different from person to person.
Stick to reputable, reliable sources of information.
"One of the biggest things people can do is be careful about the information that they seek out on the internet," Tull said. "With all the misinformation out there, that can definitely can have a negative impact on perceptions of risk."
But when even reputable sources of information disagree with each other (and, sometimes, with major public health agencies), the experts TODAY spoke to all agreed that it can be genuinely challenging to know what's best. If you have access to a primary care doctor, check in with them about what makes sense for your individual situation, Wheaton said.
And Farris recommended looking for where expert advice overlaps (on COVID-19 vaccines and boosters, for instance) and what most reputable experts generally agree is the correct approach.
Recognize when your attempts to soothe anxiety are no longer helpful — or just lead to more anxiety.
For instance, if you simply feel more comfortable wearing a mask even in situations where it's not strictly necessary according to official guidelines, that's understandable. But if wearing the mask doesn't help alleviate your discomfort, that could be a sign that your level of health anxiety is elevated, Farris said.
Consult local guidelines or your doctor about the specific precautions you should take.
"How we've been trying to help people with this is (to tell them) to just follow the guidelines and don't go above and beyond the guidelines," Wheaton said. If the guidelines say to wash your hands for 20 seconds when you come inside, you don't need to wash them for longer than that, for example.
This may be tricky knowing that your individual risk factors might make blanket public health guidance less relevant for you, like you may need to keep masking due to an underlying condition even though those around you can go without. If that's the case, check with your doctor to get recommendations for your specific situation.
How to ease anxiety about returning to "normal" activities
If mask mandates ending, calls to return to the office and other "normal" activities are causing you anxiety, the experts suggested a few ways to work through that — while keeping in mind that the pandemic is ongoing and the local COVID-19 picture may look different from place to place.
Brainstorm ways to engage in meaningful activities — especially those that provide social support — while still maintaining some precautions, Tull recommended. "The more that people start going out there and doing the things that they need to do, the idea is that there's a greater tolerance of or habituation to some of that anxiety and, ultimately, it will reduce," he explained. When it's safe to do so in your area, think about activities you can do with friends outside or while still wearing a mask, for instance.
Ground yourself with mindfulness exercises and try not to follow every anxious thought to its catastrophic conclusion. If there are scary thoughts crossing your mind, "we want to be careful not to respond to them as if they were true," Wheaton said. "We just want to say 'OK, what's a realistic way of looking at this?'" Tull also recommended using mindfulness exercises to "connect with the present moment and take a step back from some worrisome thoughts."
Accept that there is still plenty of uncertainty around COVID-19. But remember that you can approximate the risks and still take appropriate precautions. "It's a tricky thing," Wheaton said, but part of this is "about not necessarily demanding that the situation be completely safe." Think about what level of risk you're willing to accept in order to participate in certain activities while knowing that "absolutely no risk" is probably not going to be a viable long-term option.
Have compassion for yourself and what you're feeling, whether that's anxiety, grief or something else. "It's important to not beat yourself up about having anxiety or being concerned; it means you care, and it's your health — it's important to you," Farris said. "It's just not helping you in the way that you need right now. So you're kind of teaching your brain how to help you better."
Be compassionate to those around you, too. Keep in mind that others may have different levels of risk tolerance and COVID-19 risk factors in their lives, which may lead them to make decisions or engage in behaviors that are not the same as yours. If you're a manager or someone in a position of authority, "give people some space to talk about those fears and that anxiety," Tull said, "and recognize that there might need to be some flexibility." Going immediately from having precautions to having no precautions will just cause more anxiety and resistance in those who are experiencing that anxiety, he said.