Health Anxiety · Kitchener, Waterloo & Cambridge
Health anxiety is worry about being ill, or becoming ill, that takes up so much of your time it starts to take over your life, and that a clear examination or test result does not settle. Cognitive behavioural therapy is the best-studied treatment: a pooled analysis of 19 trials found a moderate to large benefit. CARESPACE’s counsellors are Registered Psychotherapists and Registered Social Workers, and one of them is your first visit.
What health anxiety is
It used to be called hypochondria, a word that has been dropped because of its negative overtones. Clinicians now use two diagnoses. Illness anxiety disorder is a preoccupation with having or getting a serious illness that has lasted at least six months, with few or no physical symptoms. Somatic symptom disorder is the name used when there are significant physical symptoms and the concern is mainly about the symptoms themselves. Health anxiety is the everyday term, and the one the research uses.
The sensations are real. Anxiety itself produces symptoms such as headaches and a racing heartbeat, and those are easy to mistake for signs of illness. Having a diagnosed condition does not rule health anxiety out either: some people have both, and what separates health anxiety from reasonable concern is the amount of fear and how much of life it disrupts.
It usually starts in early adulthood and affects men and women about equally. Milder forms are common.
It can look like its neighbours. In panic disorder the fear comes in sudden attacks that peak within minutes; health anxiety is a steadier preoccupation that lasts months. General anxiety spreads across work, relationships, health and money; here the worry keeps returning to illness.
Signs of health anxiety
- Worrying about your health constantly
- Checking your body often for lumps, tingling, pain or other signs of illness
- Asking other people, again and again, to reassure you that you are not ill
- Worrying that a doctor or a test has missed something
- Looking up health information obsessively, online or in the media
- Avoiding anything to do with serious illness, such as medical TV programs
- Acting as if you were ill, for example by avoiding physical activity
It tends to go one of two ways. Some people see clinicians often; others stay away from medical care altogether, afraid of what might be found.
What is behind it
The pattern is this: ordinary body sensations are read as signs of serious disease, anxiety produces more sensations, and the fear holds on even after a thorough medical evaluation has been reassuring. Health anxiety is more common in people who have a physical health condition.
How health anxiety is diagnosed
After a medical evaluation, not instead of one. Illness anxiety disorder is diagnosed when the fear has lasted six months or more, persists despite a thorough medical assessment, and is not better explained by depression or another condition. A diagnosis, where one is needed, and any medication come from a physician, nurse practitioner or psychiatrist; Registered Psychotherapists and Registered Social Workers provide counselling and do not diagnose or prescribe. A counsellor cannot tell you whether a symptom is medical.
When to get urgent help
Health anxiety does not make anyone immune to illness. A symptom that is new, severe or unlike your usual worry needs same-day medical care, or 911 or an emergency department if it is severe or sudden. Nobody at CARESPACE can rule out an emergency.
If you are thinking about suicide, or you do not feel safe, do not wait for an appointment: use the numbers below.
If you are in crisis or thinking about suicide, help is available right now.
- Call or text 9-8-8, the Suicide Crisis Helpline, at any hour.
- Call Here 24/7 at 1-844-437-3247 for addictions, mental health and crisis services in Waterloo Region, at any hour. here247.ca
- Call 911 or go to the nearest emergency department if you or someone else is in immediate danger.
The emergency departments in Waterloo Region are:
- WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
- WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
- Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge
If you cannot get there safely, call 911.
What the evidence says about treating health anxiety
- What we looked at. Two pooled analyses of clinical trials (2017: 14 trials; 2019: 19 trials and 2,008 people), plus the NHS, the Merck Manual and HeretoHelp in British Columbia. We did not find a Canadian or UK guideline written specifically for health anxiety.
- Cognitive behavioural therapy (CBT) has the strongest evidence. The 2017 analysis found a large effect for CBT against comparison groups that included usual care, waiting lists, medication and other psychological therapies. The 2019 analysis put the effect at moderate to large, and a little lower once it allowed for studies that may have gone unpublished.
- Many people respond. In the seven trials that reported it, 66 in 100 people responded, meaning their health anxiety fell by about a fifth to a third. In the five trials that reported remission, about half reached it.
- The benefit holds. The effect was still large at 6 and 12 months in the first analysis, and largely sustained 12 to 18 months after treatment in the second.
- Online CBT looks as good. Internet-delivered CBT had effects comparable to face-to-face CBT, although trials comparing the two directly have yet to be done.
- It is not a long course. One-to-one, in-person CBT in the trials averaged between 10 and 11 sessions.
- Medication, and one steady clinician, may help. The Merck Manual says SSRI antidepressants may be helpful and that people benefit from a trusting relationship with a caring, reassuring clinician; a psychiatric referral can be added if symptoms are not relieved. The NHS says a family doctor may offer a medicine for anxiety.
How CARESPACE helps with health anxiety
Counselling & Psychotherapy
CBT for health anxiety, as tested in the trials, starts from a shared picture of the problem: what sets the worry off, what you do next, and what that costs you. Then the beliefs are tested. Behavioural experiments check a feared belief against what actually happens. Exposure work means approaching what you have been avoiding, whether that is a body sensation, a medical TV program or reading about an illness, in agreed steps, while holding back from the checking and reassurance-seeking that would normally follow. A counsellor does not tell you whether you are ill or act as one more source of reassurance; that is the method, not a lack of sympathy. Cognitive behavioural therapy is available at CARESPACE. When you book, ask for a counsellor who works with health anxiety, and ask whether they offer exposure work.
More about cognitive behavioural therapy (CBT) →
Nurse Practitioner
The medical half belongs with a physician or nurse practitioner: a proper assessment of symptoms that nobody has examined, and one clinician who knows your history, so that new symptoms are assessed once and in context. If you already have a family doctor you trust, that relationship does the same job.
See our nurse practitioner team →
Where most people start
With a counsellor, unless you have a symptom that has not been examined. In that case see a physician or nurse practitioner first, then book counselling.
How your team works together
The two jobs stay separate on purpose: symptoms go to a physician or nurse practitioner, and the worry goes to counselling. Counselling carries the treatment.
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Available today Weekend availability
Cliann Dsouza, BA, MA, RP (Qualifying)
Psychotherapist
You may be feeling overwhelmed, emotionally drained, or caught in worries that are difficult to switch off.
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Evening availability
Ummehani Rehmani, BSc, MSc, RP (Qualifying)
Psychotherapist
You may be functioning on the outside while feeling anxious, emotionally exhausted, disconnected, or uncertain underneath.
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Weekend availability
Josh Zettel, BA (Hons), MA, RP, CMPC, CCC
Psychotherapist, Certified Mental Performance Consultant, Clinic Director, Assistant District Manager
You do not have to keep carrying anxiety, pressure, or life-transition stress alone when the right support can help you feel steadier in both mind and life.
Browse by service: counselling and nurse practitioner.
What to expect at your first visit
Before your first visit, which is with a counsellor, think about:
- The fear itself. Which illness or illnesses, since when, and what tends to set it off.
- What you do about it. Checking, searching, asking, booking appointments, or steering clear of them.
- What medical care you have had. A counsellor does not interpret results.
- What it takes from you: time, sleep, work, money, patience at home.
You leave the first visit with a plan.
What you can do at home
- Keep a diary for a week of how often you check your body, ask for reassurance or look up health information, then bring the number down gradually.
- Draw two columns. Write each health worry in the first and a more balanced thought beside it in the second.
- When the urge to check comes, do something else for a while: call a friend, or take a walk on the Iron Horse Trail.
- Go back, a step at a time, to the things you have stopped doing because of the worry, such as sport or seeing people.
- Practise a breathing or relaxation exercise.
The aim of these is to cope with anxiety and uncertainty, not to get rid of anxiety altogether, and they suit mild to moderate health anxiety best. See a physician or nurse practitioner, or book counselling, if the worry is stopping you living a normal life or self-help is not working.
Outlook
Health anxiety is often long-lasting; in some people it comes and goes and in others it is steady. In the trials, the benefit of CBT was largely still there 12 to 18 months after treatment.
Health anxiety treatment in Kitchener, Waterloo and Cambridge
Kitchener. Counselling in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.
Waterloo. Counselling in Waterloo and Nurse Practitioner in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.
Cambridge. Counselling in Cambridge. Location: Hespeler Road.
The city pages linked above show the locations and practitioners for each service, with their next availability.
Common questions
What if I really am ill?
Both can be true: some people with health anxiety also have a medical condition. That is why a new or changed symptom should be assessed by a physician or nurse practitioner, and why counselling is aimed at the fear and the checking, not at deciding whether you are ill.
Will a counsellor tell me that I am healthy?
No. A Registered Psychotherapist or Registered Social Worker cannot assess physical symptoms, and reassurance is not how the therapy works. One recognized sign of health anxiety is asking for reassurance again and again, and CBT includes learning to hold back from seeking it.
How is health anxiety different from panic attacks?
A panic attack is a sudden surge of fear that peaks within minutes. Health anxiety is a worry about illness that persists for months, with repeated checking and searching. See our Panic Attacks & Panic Disorder page.
Should I stop looking up my symptoms?
Cutting down gradually is the usual advice. The NHS suggests keeping a note of how often you look up health information, check your body or ask for reassurance, and reducing it step by step over a week.
Is counselling for health anxiety available in Cambridge?
Yes, at CARESPACE Hespeler Road, and at our Kitchener and Waterloo locations. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.
Do I need a referral?
No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →
Sources
- Cooper K, Gregory JD, Walker I, Lambe S, Salkovskis PM. Cognitive behaviour therapy for health anxiety: a systematic review and meta-analysis. Behavioural and Cognitive Psychotherapy, 2017 (author copy, Cardiff University repository).
- Axelsson E, Hedman-Lagerlöf E. Cognitive behavior therapy for health anxiety: systematic review and meta-analysis of clinical efficacy and health economic outcomes. Expert Review of Pharmacoeconomics & Outcomes Research, 2019.
- NHS (UK). Health anxiety, reviewed November 2023 (its next review was due November 2026).
- Dimsdale JE. Illness Anxiety Disorder. Merck Manual Professional Edition, reviewed 2026.
- HeretoHelp (BC Partners for Mental Health and Substance Use Information). Health Anxiety (info sheet written by Anxiety Canada), revised 2024.
- 9-8-8: Suicide Crisis Helpline. 988.ca.
- Here 24/7 (addictions, mental health and crisis services, Waterloo Wellington). here247.ca.
Related conditions
Ready to book?
Book online with a counsellor, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.