Health Anxiety and the Black-or-White Thinking Error

People with health anxiety often see health and illness in rigid, inflexible terms. Thinking errors, or cognitive distortions, are inaccurate, biased thoughts. All of us have these distorted thoughts at times. However, people with health anxiety tend to have them more frequently than those without health anxiety. And they can cause significant distress because they lead us to draw inaccurate conclusions about our current or future health.

Black-or-White Thinking

One type of thinking error is called "black-or-white thinking" (or "all-or-nothing thinking"). This type of thinking involves viewing health and illness in absolute categories, instead of taking a more balanced approach and seeing things on a continuum. People with health anxiety often engage in this thinking error because they assume one is either perfectly healthy or deathly ill, leaving very little room for anything in between those two extreme categories.

This type of rigid thinking leads us to jump to conclusions and catastrophize about every symptom because we believe a symptom = illness and illness = eventual death.

How to Challenge This Thinking Error

The reality is that health status is not a light switch ("on" or "off"). Health and illness exist on a spectrum. The vast majority of us are not perfectly healthy. Many of us have minor health issues and arguably all of us have at least some ways that we can improve our health. What's more, having a health issue is not a death sentence. Many people with chronic and/or serious health issues can live very long (and very fulfilling) lives. Start changing your thinking by seeing health and illness on a spectrum or continuum.

Brittney Chesworth

Next, if you find yourself spiraling when you notice a symptom or bodily sensation that indicates you do not have "perfect health," pause and ask yourself a few questions:

• If this symptom or sensation is indicative of an actual health issue, how can I "hang out" in the middle of the spectrum? What are all of the "in-between" possibilities (i.e. the non-terminal illnesses)? Try and consider the many possible minor issues that could lead to this symptom other than the worst-case scenario.
• Am I drawing general conclusions about how bad it would be if I got a disease based on one or a few situations I have seen or heard of?
• Do I know anyone in my personal life who has faced an illness and been able to cure it or treat it/manage it effectively?
• Have I faced an illness in the past? How was I able to manage/overcome it, physically and/or emotionally?
• How could I emotionally cope with an illness if I did have one? My social support system, personal resilience, faith, therapy, adaptive coping skills, support groups, self-help books, personal hobbies and resources? Have any of these things helped me to cope with illness or other struggles in the past?
• How could I physically cope with this disease? What medical resources would allow me to manage, treat and/or overcome this disease or illness?
• What would it look like to cope with and live well with this disease?
• Have I witnessed any examples of people in my life that have managed to cope with having a disease, physically and/or emotionally?
• If I did have X illness/disease, am I overestimating the chances this will be incurable, debilitating and/or terminal?

Changing your way of thinking about illness takes diligence and time! Keep these questions handy and use them if you find yourself getting caught in the all-or-nothing trap. Over time, if you keep working on these thoughts, you will be less likely to assume that any illness = death and will, therefore, become less anxious about symptoms.

Remember, as with most things in life, there are many other explanations besides the two most extreme possibilities! Keep working on this stuff and don't give up. You can improve health anxiety by making small changes in how you think and behave each day.