Health anxiety is the one difficulty Wells’ ATT chapter follows all the way through as a worked case[1]. That makes this page unusually concrete — and it also makes the limits unusually clear, because what the case describes is a therapist working with a patient over eight sessions, not somebody practising from an app.

What the pattern looks like in this condition

The manual maps its model onto hypochondriasis directly. The thinking component shows up as worry about symptoms and rumination about what they might mean and what causes them[1]. Threat monitoring shows up as mentally scanning the body for signs, physically checking parts of it, checking bodily processes and mental functioning — the manual’s examples include palpating the abdomen and checking your memory for names — and searching for information about symptoms[1].

It also lists the coping behaviours that come with it: excessive resting, avoiding exercise, taking unnecessary medications that change bodily function, trying to control automatic physiological functions such as breathing, and avoiding medical information[1].

Anyone who recognises that list will notice something: almost all of it is attention, pointed inward and kept there.

The case

A 43-year-old man with hypochondriasis and panic attacks, with a range of unexplained symptoms — abdominal pain, chest pain, arrhythmias, dizziness and feelings of unreality. His medical evaluations had been extensive and unremarkable, and he was worrying that the tests might have failed to detect something serious[1].

The therapist proposed attention training to see whether it could reduce his excessive body-focused processing[1], and framed the rationale around regaining control of attention and reducing worry and the significance given to symptoms, so that body awareness could return to a normal state[1].

ATT was practised across eight treatment sessions. In the third, the therapist added worry postponement and instructed the patient to ban his bodily checking — to stop checking his pulse and stop running the mental scan over his body that he did several times a day[1]. Later sessions challenged his positive beliefs about the importance of focusing on and worrying about symptoms[1].

In this case, the manual concludes, ATT formed a substantive component of metacognitive treatment for hypochondriasis[1]. A component — alongside worry postponement, a checking ban and belief work.

The demonstration worth knowing

Before starting, the therapist ran a small experiment that explains the whole model in about a minute. The patient was asked to focus on sensations in his fingertips and say whether there was anything there; he described tingling. He was then asked to be aware of his fingertips but shut out that feeling — and found he could not do both[1].

The point the therapist drew from it: turning attention toward the body and dwelling on sensations can lock attention onto them, changing what you subsequently notice[1].

There is a second illustration in the case, about significance rather than sensation. The patient was asked whether he had noticed, after buying his most recent car, that many more people suddenly seemed to be driving the same model. Assigning personal importance to something makes you witness more of it, even when little has actually changed — cars, or symptoms[1].

What this does and does not license

It does not license self-treatment. One clinician-delivered case, inside a full therapy, with three other interventions running alongside it. The manual presents it as illustration, not as evidence for ATT used alone.

It does not license banning your own checking. In the case that instruction came from a therapist, in the third session, as part of a plan. Deciding to police your own checking behaviour without that structure is a different act with different risks.

And it does not license skipping medical care. The patient in the case had already had extensive evaluation[1]. Nothing here is a reason to avoid getting a symptom looked at.

What it does offer is a clear account of why body-focused attention is self-sustaining, and why an exercise containing nothing about your body at all might be aimed at it.

If you practise anyway

The general rules hold and matter more here than usual. Practise on a schedule when you are not in a state of anxiety or acute worry[1] — not during a symptom scare, which is exactly when you would want to. Do not use it to make a sensation go away; that is named in the manual as misuse as avoidance or symptom management[1]. And judge sessions by whether you kept returning your attention, not by whether the symptom changed[1].

If health anxiety is a significant part of your life, the case above is an argument for seeing a clinician — that is what it describes.

Questions and answers

Does ATT help with health anxiety?
Wells' manual works through a single case of hypochondriasis in which ATT formed a substantive component of metacognitive treatment. That is one clinician-delivered case inside a full therapy, not evidence that practising ATT alone treats health anxiety.
Why does checking my body make symptoms worse?
The manual's account is that turning attention toward the body and dwelling on sensations locks attention onto them and changes what you subsequently notice — it demonstrates this to patients with a simple fingertip exercise.
Should I stop checking?
In the manual's case the therapist banned bodily checking outright, alongside worry postponement — but that was a clinician's decision inside treatment, in the third session, not a self-help instruction.

References

  1. Wells, A. (2009). Metacognitive Therapy for Anxiety and Depression. Guilford Press. Chapter 4: Attention Training Techniques.

Published by the makers of Heed, an app for practicing ATT-style sessions. iPhone · Android. Heed is a self-practice tool inspired by ATT research — not therapy, and not a medical device.