Cognitive-Behavioural Model of Health Anxiety
Warwick & Salkovskis (1990) · Health anxiety
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
Warwick and Salkovskis's cognitive-behavioural model of health anxiety (1990) explains how ordinary bodily sensations come to be read as signs of serious illness, and how checking and reassurance keep that fear in place.
Cognitive-Behavioural Model of 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.
Understanding the model
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.
Questions therapists ask about this model.
Frequently asked questions
What maintains health anxiety here?
A trigger brings health to mind — noticing an ache or a lump, hearing about an illness, reading something online. Interpreted as evidence of serious illness, it produces anxiety, and anxiety itself generates more bodily sensations, while attention narrows onto the body so that ordinary variations become newly noticeable and seem to confirm the fear. Checking, searching, asking others and booking further appointments each ease the worry briefly and leave attention fixed on health.
How does it differ from the panic model?
In panic the catastrophe is immediate and the cycle turns on arousal: sensations of a fast heart or breathlessness are read as collapse happening now. Here the feared illness is longer-term and often not yet detected, and the cycle is sustained by checking, searching and reassurance rather than by escalating fear. Clark's panic model (1986) and this one frequently both apply to a single client.
Is health anxiety the same as hypochondriasis?
The early papers used the older term: Salkovskis and Warwick (1986) and Warwick and Salkovskis (1990) wrote about hypochondriasis, while treating it as the severe end of a continuum of health anxiety that everyone sits somewhere on. Health anxiety is now the more common and less stigmatising name, and the model is applied across that range, including the severe and persistent presentations described by Salkovskis, Warwick and Deale (2003).
Worksheets and reading for this model
Using this model in session — for therapists
How to introduce the model, guided-discovery questions, treatment targets and a behavioural experiment are available to signed-in therapists.
References
- Warwick, H. M. C., & Salkovskis, P. M. (1990). Hypochondriasis. Behaviour Research and Therapy, 28(2), 105–117.
- Salkovskis, P. M., & Warwick, H. M. C. (1986). Morbid preoccupations, health anxiety and reassurance: A cognitive-behavioural approach to hypochondriasis. Behaviour Research and Therapy, 24(5), 597–602.
- Salkovskis, P. M., Warwick, H. M. C., & Deale, A. C. (2003). Cognitive-behavioral treatment for severe and persistent health anxiety (hypochondriasis). Brief Treatment and Crisis Intervention, 3(3), 353–367.
This diagram is a reconstruction of the published model for clinical and educational use, grounded in the sources above.
Cite this page (APA 7)
Vermani, T. (2026). Cognitive-Behavioural Model of Health Anxiety. Formulate. https://formulatetools.co.uk/tools/formulation/health-anxiety-cognitive-model
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
Build this formulation with your client
Create a free account to open the interactive formulation builder, complete this model collaboratively, and export it as a PDF or share it with your client.