What Keeps Health Anxiety Going?
A maintenance-cycle explainer on how body-checking, googling, and seeking reassurance bring short-term relief but keep health anxiety going, and how to break the cycle.
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
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What Keeps Health Anxiety Going?
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The trap
If health anxiety has stuck around, it is not because you are not trying. Health anxiety has a trap built into it: the very things you do to feel reassured and safe are the things that keep the worry going. This handout shows how that cycle works, and, more importantly, how it can be broken.
The health anxiety cycle
It usually runs like this. You notice a sensation in your body, a twinge, an ache, or a change. You read it as a sign that something could be seriously wrong. This sparks a wave of anxiety. So you check the area, take your pulse, search your symptoms online, or ask someone for reassurance. For a moment the anxiety drops, which feels like relief. But that relief quietly teaches your brain that the sensation really was dangerous and that checking saved the day. So the next time a sensation appears, it feels just as alarming, and you watch your body even more closely. Round and round it goes.
Safety behaviours
Safety behaviours are all the things you do to feel safe or to put your mind at rest. They are completely understandable. Tick any that you notice yourself doing.
Why reassurance backfires
Reassurance feels helpful, but it works against you in the long run. The relief it brings is short-lived, often lasting only minutes or hours before the doubt returns. Each time you check or ask, you escape the worry before you ever learn that the sensation was harmless all along. So you never get the chance to find out you were safe. Worse, the doubt often comes back stronger, and you find yourself needing more reassurance, more often. The relief is real, but it is a trap.
How the cycle breaks
The way out is to gradually reduce the checking, googling, and reassurance-seeking, so the worry has nothing left to feed on. Alongside this, you learn to refocus your attention away from your body and onto the world around you, and to reinterpret sensations as the ordinary, harmless things they usually are. At first this feels uncomfortable, because the urge to check is strong. But as you sit with the uncertainty and the feared illness does not appear, your brain gets the new information it needs, and the anxiety begins to settle. This is usually done step by step, with a therapist.
Over to you
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When to use ‘What Keeps Health Anxiety Going?’
‘What Keeps Health Anxiety Going?’ 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 8 minutes. It moves through six short steps:
- The trap — If health anxiety has stuck around, it is not because you are not trying. Health anxiety has a trap built into it: the very things you do…
- The health anxiety cycle — It usually runs like this. You notice a sensation in your body, a twinge, an ache, or a change. You read it as a sign that something could…
- Safety behaviours — Safety behaviours are all the things you do to feel safe or to put your mind at rest. They are completely understandable. Tick any that you…
- Why reassurance backfires — Reassurance feels helpful, but it works against you in the long run. The relief it brings is short-lived, often lasting only minutes or…
- How the cycle breaks — The way out is to gradually reduce the checking, googling, and reassurance-seeking, so the worry has nothing left to feed on. Alongside…
- Over to you
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, ‘What Keeps Health Anxiety Going?’ 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:
- Warwick, H.M.C. & Salkovskis, P.M. (1990). Hypochondriasis. Behaviour Research and Therapy, 28(2), 105-117. doi:10.1016/0005-7967(90)90023-C
- 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. (1991). The importance of behaviour in the maintenance of anxiety and panic: A cognitive account. Behavioural Psychotherapy, 19(1), 6-19.
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 →Health Anxiety
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.
Health Anxiety
Health Anxiety Monitoring Diary
Track health anxiety episodes — the trigger, misinterpretation, anxiety level, safety behaviour used, and the actual outcome.
Health Anxiety
Reassurance-Seeking Reduction Record
Track urges to seek reassurance, whether you resisted, and what happened — building evidence that you can tolerate uncertainty without reassurance.
Health Anxiety
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.
Health Anxiety
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.
Health Anxiety
Health Checking Reduction Diary
Track gradual reduction in body checking behaviours — setting targets, monitoring frequency, and recording what happens when you check less.
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