(You do not have coronavirus)
First up, let me get something out of the way: My name is Emma and I have health anxiety. Despite having never been to hospital, had the flu, or broken a bone, I’ve worried to varying degrees of obsessiveness about my health. Thanks to some pretty good therapy I got in my late teens, it’s manageable much of the time, but if there’s one thing to induce a near constant low-level panic state, it’s the news of some new, rapidly spreading virus. Enter: coronavirus!
When the world is intent on sending you push news notifications containing the word OUTBREAK, or GLOBAL HEALTH EMERGENCY, it can be hard not to freak out – and my anxiety has been on high alert since the disease started hitting the headlines. They say be the change you want to see in the world, so I decided to create the content I needed to read: and speak to an expert on health anxiety about how I – and the rest of the world – can stop freaking out about coronavirus. Peter Tyrer is the Emeritus Professor of Community Psychiatry at Imperial College London’s Centre for Mental Health, and along with a focus on personality disorders, he’s specialised in the treatment of health anxiety, earning him a Lifetime Achievement Award by the Royal College of Psychiatrists for his work. I called him up.
DON’T OBSESSIVELY GOOGLE IT
With a virus like this, it can be hard to get away from: because the NHS is so stretched, the self-monitoring of your health is encouraged. As well as government social media spon-con encouraging people to be rigorous about hand-washing and sneezing ettiquette, there’s also the fact that the media will push the most extreme cases to the fore, using them for clickbait and column inches. “It’s like we’re almost moulded into being more health anxious then we were before.” Tyrer says. “Anytime there’s a health scare of any sort, that reinforces what anxiety might have been the background before. In a case like coronavirus, anyone who’s got a cough and a cold can be nervous about what’s going to happen next.”
One way people often deal with fears about illness is to look up their symptoms, but what can be intended to put your mind at ease may actually make the anxiety much, much worse.
In other words, Googling isn’t power: “We try and stop that very early on,” says Tyrer about treating patients with health anxiety. There’s even a name for it: cyberchondria. “You can consult Dr. Google anytime of the day or night, so really that increases (the anxiety),” he says, which in turn puts a strain on the health services; people search their symptoms and are immediately convinced they have a disease even if it’s extremely unlikely they could have contracted one, and so demand unnecessary tests.
“If you’re looking at Google, you can always find some sort of rare disease you think you might have. Even it’s a one in a thousand chance, the issue with health anxiety is that people always think they’re the one in a thousand.” (BTW, the chances of currently getting coronavirus are much lower than that).
BUT SOME LIGHT FACT CHECKING MIGHT HELP YOUR FEARS
While anxiety can be increased by exposure to NHS ads, headlines and news broadcasts, trying to block out any and all mention of the virus might not help either. I muted anything corona-related I could think of on Twitter, and when that didn’t work I logged out for about two weeks. (For context: I haven’t logged out of Twitter for that long in… ever.) But avoiding it wasn’t exactly helping: overhearing a snatch of conversation, seeing someone in a face mask, or reading the front page of an abandoned newspaper was enough to induce a cold sweat, and people were getting bored of me sticking my fingers in my ear and yelling TRIGGERED when they started talking about the virus. In my head, coronavirus had basically become the equivalent of a death plague set to wipe out 99 per cent of the world’s population. This, you won’t be surprised to learn, did not help my anxiety.
This is where fact checking comes in. “In the case of coronavirus, the fact check is that flu kills more people than it has,” Tyrer explains. (There have been nine cases of coronavirus in the UK – and per the Telegraph, eight of those people have already been discharged from hospital). “Fact checking is, ‘Who have I had contact with?’, ‘Are my symptoms coronavirus or health anxiety?’ It’s the worry of developing a disease which mustn't get out of control.”
In other words, some light research might help, but the key is balance. “Judicious use of the internet can be highly valuable, but non-judicious use, which includes never using it at all, or using it thirty times a day, can be highly negative for your health. So it’s always a question of balance.” This applies to other behaviours too: washing your hands when you get off the tube makes sense, but keep an eye on these behaviours to make sure they don’t spiral into obsessive territory. And no, that person sneezing on the bus is not about to infect you.
ASK YOUR LESS ANXIOUS FRIENDS TO HELP
It wasn’t until my girlfriend told me that coronavirus wasn’t the certain death sentence I’d made it in my head that I started to chill out a bit. Talking to someone, even if you know your health fears are somewhat irrational and therefore a bit shameful, isn’t a bad idea says Tyrer.
“If you’ve got someone who is reasonably sensible who you trust, then ask them, ‘I’ve got these symptoms and I’m worried I’ve got so and so.’ What do you think? And they, in fact, could be often remarkably helpful.” It’s important to pick the right person though – “Discuss it with someone you trust to give an honest reply and not just empty reassurance, which is the worst thing,” he says. “That’s a good way of going forward.”
“Judicious use of the internet can be highly valuable, but non-judicious use, which includes never using it at all, or using it thirty times a day, can be highly negative for your health. So it’s always a question of balance.” – Professor Peter Tyrer
YOUR SYMPTOMS MAY BE YOUR ANXIETY
True story: I got off a plane at Heathrow the other week and was immediately faced with a poster of coronavirus symptoms. I pretty much instantaneously started to exhibit one of them. I’ve been aware of my mental health for long enough to know this is just my brain trying it on – although knowing that doesn’t always help. This is where a very straightforward exercise can come in.
First up, grab a piece of paper and divide it down the middle. “On the left you say, ‘I think I’ve got the disease’ and on the right, ‘I think I’m worried about having the disease’. You’ll find that many more things go on the right hand side than on the left hand side,” Tyrer says. “The simple question we ask everyone is: which one of these options would you rather have? Would you rather have the disease or the worry that you might have the disease? Of course, when you ask people that, they always come down on the ‘worry that they’ve got the disease’ side. So we work out with them the evidence for each of the two options. Almost always there is a much longer list on the anxiety side.”
REMEMBER, THERE ARE MEDICAL EXPERTS ON THE CASE
In all my stress of a virus set to wipe out humanity, I’d kind of forgotten that there’s such a thing as the World Health Organisation, or people whose lifelong vocation is literally stopping, treating, and curing infectious diseases. It’s easy, of course, to fear the unknown: “The thing which is obviously puzzling about this new virus is that we don’t know that much about it,” Tyrer says, “but it looks like most people in fact don’t die from coronavirus. It’s not as serious as many of the others.”
And, “If you know anything about medicine, you’ll know they’re going to be developing a vaccine. They’re good at making vaccines for infectious diseases now so that will be sorted out by the end of the year.” More important facts: the majority of people who get coronavirus recover completely. “It’s mainly the elderly and infirm who have the danger of dying, so when you put all that together, the chance of you getting the disease are going to be low. Even if it does become an epidemic, the chances of you even getting anything and not recovering fully are very low.” And breathe.
“On the left (of a piece of paper) you say, ‘I think I’ve got the disease’ and on the right, ‘I think I’m worried about having the disease’. You’ll find that many more things go on the right hand side than on the left hand side” – Professor Peter Tyrer
KNOW THAT HEALTH ANXIETY CAN BE SUCCESSFULLY TREATED
If you do struggle with health anxiety, it’s good to know that the condition can now be successfully treated. “Normally it was regarded as something that was almost untreatable – there was this idea that you had to really tolerate hypochondriacal people, just jolly them along, but there was nothing really in the way of treatment,” Tyrer says. That is no longer the case: he carried out a study with a team of researchers who adapted cognitive behavioural therapy – a standard anxiety treatment – for those with abnormal worries about their health. The work received a grant of £2m and was expanded to 500 people, and was, he says, “remarkably successful”.
“Even more interestingly, our study ended after two years officially, but we continued to follow up patients for five years and eight years, and after eight years, the results are still showing the treatment is highly effective,” Tyrer says. “In other words, we have got a treatment which only lasts six sessions, and eight years after you’ve given it, it’s still much better than if you haven’t had the treatment.” Which, to be honest, is great news. The treatment is very effective when given by trained general nurses and NHS England is planning to expand pilot studies in this form of management shortly.
“And, of course, I know there’s several self-help books written about this which actually are pretty good,” he adds. He recommends a book co-written by his colleague, David Veale called Overcoming Health Anxiety, which uses CBT techniques you can do at home. Get your copy here, and remember: you almost definitely do not have coronavirus.