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Health Anxiety~25 min

Health Anxiety Formulation (Salkovskis & Warwick)

A formulation based on the cognitive-behavioural model of health anxiety — mapping the vicious cycle of misinterpretation, anxiety, checking, and temporary reassurance.

Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed

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This formulation shows how health anxiety is maintained by a cycle: you notice a body sensation or health information, interpret it as meaning something is seriously wrong, become anxious (which produces more sensations), and then engage in checking, reassurance-seeking, or avoidance — which temporarily reduces anxiety but reinforces the belief that you were right to worry. Work through it with your therapist.

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Health Anxiety Maintenance Cycle

Health Anxiety Model (Salkovskis & Warwick)

100%

Trigger

Misinterpretation

Health Anxiety

Increased Body Focus

Safety Behaviours

Temporary Relief → Reinforcement

Protective Factors & Strengths

What resources, strengths, and supports might help in recovery?

Reflection

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When to use the Health Anxiety Formulation (Salkovskis & Warwick)

The Health Anxiety Formulation (Salkovskis & Warwick) is an interactive cognitive behavioural therapy (CBT) worksheet, most often used in CBT for health anxiety.

It is designed to be used within therapy rather than as a standalone self-help tool: a therapist introduces it, works through it collaboratively, and helps make sense of what it surfaces. You can preview the full worksheet above, then assign it digitally for clients to complete between sessions on any device — or download it as a print-ready PDF.

How it works

Most people work through it in around 25 minutes. It moves through three short steps:

  1. Health Anxiety Maintenance Cycle
  2. Protective Factors & Strengths — What resources, strengths, and supports might help in recovery?
  3. Reflection

Completed on the Formulate platform, your client's answers are saved automatically and shared straight back to you, so you can review them before the next session rather than waiting for a paper copy to come back.

The CBT approach behind it

In common with other CBT methods, the Health Anxiety Formulation (Salkovskis & Warwick) works by mapping how the parts of a problem connect and keep it going (formulation). The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going — and practical, testable ways to change it.

Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.

Evidence & sources

This worksheet is grounded in established cognitive behavioural therapy theory and practice. Key sources include:

  • Salkovskis, P.M. & Warwick, H.M.C. (2001). Making sense of hypochondriasis: A cognitive model of health anxiety. In G.J.G. Asmundson et al. (Eds.), Health Anxiety. Chichester: Wiley.
  • Salkovskis, P.M., Rimes, K.A., Warwick, H.M.C., & Clark, D.M. (2002). The Health Anxiety Inventory. Psychological Medicine, 32(5), 843-853. doi:10.1017/S0033291702005822

For use alongside professional support

Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.

If you need urgent help now:

  • Emergency services: 999 — if you or someone else is in immediate danger
  • Samaritans: 116 123 — free, day or night, 365 days a year
  • SANEline: 0800 689 5555 — 4:30pm–10:30pm, every day

More Health Anxiety worksheets

View all Health Anxiety worksheets →

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Health Anxiety Monitoring Diary

Track health anxiety episodes — the trigger, misinterpretation, anxiety level, safety behaviour used, and the actual outcome.

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Reassurance-Seeking Reduction Record

Track urges to seek reassurance, whether you resisted, and what happened — building evidence that you can tolerate uncertainty without reassurance.

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Body Vigilance Experiment

Test how attention to the body creates and amplifies sensations — demonstrating that body scanning is part of the problem, not the solution.

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Health Behaviour Cost-Benefit Analysis

Weigh up the costs and benefits of specific health anxiety behaviours — checking, Googling, reassurance-seeking — to build motivation for change.

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Health Checking Reduction Diary

Track gradual reduction in body checking behaviours — setting targets, monitoring frequency, and recording what happens when you check less.

Worksheet~5 minInteractive

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Understanding Health Anxiety

A plain-language explainer on what health anxiety is, why it happens, and how scanning the body and seeking reassurance keep the worry going.

Worksheet~8 minInteractive

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