Warwick & Salkovskis (1990) · Health anxiety
Warwick & Salkovskis (1990)
Trigger
A trigger that brings health to mind — noticing a bodily sensation or change (an ache, a lump, a skin mark), hearing or reading about an illness, or a medical appointment.
Misinterpretations
Misinterpretation of the bodily sign or symptom as evidence of a serious illness — 'this headache must be a tumour', 'this means something is badly wrong'. Driven by underlying assumptions about health, illness and bodily signs.
Anxiety
Health anxiety — apprehension, dread and preoccupation with the feared illness, with physiological arousal that itself produces more bodily sensations.
Body Scanning / Sensations
Selective attention to the body and body checking. Scanning and checking increase awareness of normal sensations and variations, which are then taken as further evidence of illness.
Safety Behaviours
Safety and reassurance behaviours — repeated checking, searching symptoms online, seeking reassurance from others or doctors, repeated appointments and tests, or avoidance of illness reminders. They reduce anxiety briefly but prevent lasting reassurance and keep attention on health.
The published model, shown for reference. Switch to “Blank” to see the empty template you complete with a client.
It's natural to worry about our health sometimes. For some people, though, the worry takes hold, and ordinary bodily sensations start to feel like signs of serious illness. This model shows how health anxiety keeps itself going.
It often starts with a trigger — noticing an ache or a lump, hearing about an illness, or reading something online. If that sign is read as evidence of something serious ('this headache could be a brain tumour'), strong anxiety follows.
Anxiety makes the body produce more sensations, and worry narrows attention onto the body. The more you scan and check, the more you notice — and ordinary sensations that were always there can suddenly seem alarming. This seems to confirm that something is wrong.
To feel safer, people often check their body, search symptoms online, ask others for reassurance, book repeated appointments, or avoid anything that brings the fear to mind. Each of these eases the worry briefly, but it returns — and checking and reassurance keep attention fixed on health, so the cycle continues.
How to introduce the model, guided-discovery questions, treatment targets and a behavioural experiment are available to signed-in therapists.
This diagram is a reconstruction of the published model for clinical and educational use, grounded in the sources above.
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
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