Guest blog from Ditte Hoffmann Frydendal
One of the defining features of health anxiety is not that people feel more sensations than everyone else, it is that they interpret ordinary bodily sensations as signs of serious illness.
A skipped heartbeat becomes evidence of heart disease. A headache signals a brain tumour. Forgetting a name must mean Alzheimer’s disease. The body, which should be a place to live from, gradually becomes a place to monitor, and life begins to revolve around detecting danger before it is “too late.”
This creates a challenge not only for the person experiencing health anxiety, but also for the therapist. We naturally want to avoid overlooking a genuine medical condition. The temptation is to keep evaluating symptoms to make sure nothing is missed, or better yet, offer reassurance to say there’s nothing to worry about. Yet if therapy becomes another place where every sensation is investigated or reassured away, we may either unintentionally strengthen the belief that the body is inherently dangerous and must be constantly checked or locate the solution (reassurance) as outside of the client.
The goal is neither to check every symptom or convince someone that they are healthy, because absolute certainty is impossible. None of us can eliminate the possibility of illness or ultimately control death. The more we struggle to achieve that certainty, the more our lives become organised around fear rather than living.
ACT offers a different direction.
Instead of asking, “How can I be certain nothing is wrong?” the question becomes, “Given that uncertainty is part of being human, how do I want to spend my life?”
As attention shifts from controlling the possibility of death to engaging with what gives life meaning, the relationship with the body also changes. Sensations no longer have to dictate every decision. They can simply be part of the background while a person moves towards what they value, whether that is being present with family, pursuing meaningful work, or reconnecting with activities they have been avoiding.
A central paradox of health anxiety is: the more someone tries to protect themselves from death by controlling every bodily sensation, the smaller their life becomes. ACT directly addresses that paradox by shifting the focus from controlling uncertainty to living in accordance with one’s values.
A former patient of mine once said after ending treatment: “I would claim that you don’t get cured if you suffer from health anxiety, but you learn to live beside it. For some people this is a really bad answer, because you just want to get rid of it. But it actually means you are not suffering from it anymore.”
Treatment of health anxiety is rarely about finding the perfect reassurance. Instead, it involves gradually learning that uncertainty is a normal part of life and that anxiety can rise and fall without needing to be “solved” every time it appears. When people begin to break the reassurance cycle, even in small ways, they often discover something surprising: confidence doesn’t come from proving they are healthy over and over again, but from trusting their ability to tolerate uncertainty and choose actions guided by their values rather than by fear. In this way, treating health anxiety is not about eliminating uncertainty. It is about building a life that is bigger than it.
Join Ditte for training
Ditte joins us in March 2027 for an online training session, ACT for health anxiety, offering practical, ACT-grounded approaches that focus on function over diagnosis. Ditte will share a practical, theoretically grounded toolkit for practitioners to use during clinical work as well as helping participants to understand the function of health-anxious behaviours and distinguish between different presentations.