The cognitive theory of emotion

The interaction between thoughts, emotions and the physical consequences of these, and subsequent behaviour are illustrated in the diagram below (Fig. 2.1). This is derived from Beck's original formulation (Beck et al, 1985), but of course the physical symptoms may include many that are not directly those of anxiety. Each element is interdependent on the others, often coloured by the particular context or specific environment in which symptoms arise. This model encapsulates the theory on which all cognitive therapy is based, although in the case of health anxiety it is modified for the specific problems associated with this condition. It illustrates to the patient not only how their fears are maintained, but also how work in any of the domains can produce benefits in all the others. Problems in all these areas are addressed during the course of therapy.

How health anxiety develops

Misinterpretation of bodily symptoms and sensations

The cognitive explanation for the development of health anxiety follows directly from the tendency to misinterpret bodily sensations and changes as evidence of underlying serious physical illness (Salkovskis & Warwick, 1986; Warwick & Salkovskis, 1990). The impact of these misinterpretations is dependent on the degree of threat that they carry, and how ‘awful’ the consequences would be for that person if they had that particular condition. The ‘awfulness’ does not just comprise pain and suffering, but includes wider consequences such as general disturbance of life functions, with possible inability to continue work or maintain a role within the family, especially in the longer term. Individuals with health anxiety may acknowledge that the risk to them may be tiny, but it is hugely magnified by the awfulness component, usually inflated far beyond the likelihood of illness. If the risk of developing the feared disease is much higher, for example where there is a strong family history of breast cancer, the consequent anxiety generated can be completely overwhelming.