The OCD Stories, Episode #508: Michael Stier – Health Anxiety

Host: Stuart Ralph
Guest: Michael Stier, LCPC – Director of Education & Training at Anxiety Specialists of Atlanta
Released: October 19, 2025

Overview

In this engaging episode, Stuart Ralph sits down with Michael Stier, an experienced therapist, educator, and co-author of the book "Overcoming Health Anxiety." The discussion delves deep into the complex world of health anxiety (also known as hypochondriasis, illness anxiety disorder, and somatic symptom disorder) – unpacking its definition, how it manifests, why it can feel so convincing, and the nuances of effective treatment. Michael shares both clinical expertise and lived stories, aiming to help listeners feel heard, understood, and empowered to take meaningful steps toward recovery.

Main Discussion Points & Insights

Michael's Therapy Story & Interest in Health Anxiety

• Natural problem solver and lifelong learner: Michael describes his initial draw to therapy as a mix of loving challenge, solving complex problems, and teaching, noting parallels between his education background and the therapist’s role ([02:58]).

• Drawn to complexity: He recounts being “hooked” after working with his first client experiencing scrupulosity (religious/moral OCD), leading to a deeper dive into OCD and related anxieties.

• Writing the book: Michael explains his motivation for co-authoring a book on health anxiety with Dr. Josh Vital Neck – wanting a resource that feels like a relatable therapy session, peppered with metaphors and humor to lighten a heavy subject ([05:28], [07:53]).

  ”If treatment is always as serious as health anxiety is, that’s gonna be a really grinding process. So sometimes I really like to…do it in a joking, playful, humorous way.”
  — Michael, [09:14]

What is Health Anxiety?

• Definition & Subtypes ([11:21]):

  • Illness Anxiety Disorder: Preoccupation with the idea of being ill but with minimal actual symptoms.
  • Somatic Symptom Disorder: Preoccupation with health, accompanied by significant, life-altering symptoms.
  • Anxiety Around Health: Preoccupation following an actual diagnosis (e.g., coping post-stroke).

• Common Thread: Preoccupation and hypervigilance about health, which significantly impacts daily life and functioning.

  ”That preoccupation with our health that starts to impact life, that starts to get in the way — that's what we're really looking at with health anxiety.”
  — Michael, [11:21]

• Hyper-attention to bodily sensations: Michael emphasizes that a key hallmark of health anxiety is getting “hyperfocused or hypervigilant” about bodily sensations, leading to a self-perpetuating cycle of worry ([12:51]).

  • Example: Focusing on itching after mentioning it can make everyone notice sensations on their skin.

  ”As soon as our attention goes in and focuses on some of those body areas, it’s got us.”
  — Michael, [13:54]

Health Anxiety and Insight

• Rationality and perceived possibility: Stuart posits that health anxiety often carries lower “insight” compared to other OCD themes because the feared event (getting sick) is realistically possible, unlike, say, the sudden urge to harm.

• Real-life overlap and medical boundaries: Health anxiety management uniquely involves collaborating with the medical system—sometimes necessary to get a check-up, but challenging to know when pursuit becomes unhelpful ritual ([17:26]).

  ”There’s a lot of boundary walking with this and trying to really meet the client where they’re at.”
  — Michael, [18:11]

• Managing medical reassurance-seeking: Rather than urge clients to never see another doctor, Michael helps them schedule appointments thoughtfully and focus on living meaningfully in the interim ([22:33]).

  • “Can you delay urgent checking and focus on values-based living while waiting for the appointment?”

Evidence, Believability, and “Stickiness” of Health Anxiety ([30:25] onward)

• OCD’s Reasoning Categories: Health worries feel especially convincing because they fit into all the “reasonings” OCD uses: facts (people do get ill), personal experience, hearsay, rules (better safe than sorry), and possibility.

  • This abundance of “evidence” makes health anxiety extremely sticky—it always feels a bit plausible even though “none of that means we’re ill.”

  “With health anxiety we can put a ton of stuff [in the ‘evidence’ categories]… But actually when we break those down, none of that means we’re ill.”
  — Stuart, [36:36]

• Rules and Responsibility: Michael notes how rules like “better safe than sorry” or feelings of responsibility (especially for parents, caregivers) can further entrench compulsive behaviors ([32:38]).

  “Sometimes delaying those or not pursuing [symptoms] starts to kind of feel wrong, irresponsible, like I’m not doing things that I need to do.”
  — Michael, [33:04]

Responding to Bodily Sensations: Mindfulness & Acceptance

• Differentiating “sensation” from “symptom” ([39:47], [57:26]):

  • Using “sensation” (neutral, descriptive) helps short-circuit catastrophic storylines that “symptoms” (implied diagnosis) often trigger.
  • Example: “My chest is tight” vs. “I have chest pain, maybe it’s a heart attack.”

• Acceptance: True acceptance doesn’t require liking or loving the sensation ([42:59]).

  ”We never accept anything that we really like...When we have a sensation, we do have to work with acceptance and a willingness to experience the sensation.”
  — Michael, [42:59]

• Productive vs. Unproductive Coping: Pursue medical care when appropriate, but minimize unproductive avoidance and checking (e.g., endless doctor visits, symptom googling).

  ”If there’s anything that makes that sensation feel better, do it…But if it is helpful to do some type of stretches or [PT], wonderful, please do it. I don’t want you to be miserable.”
  — Michael, [45:32]

• External focus & attention shifting: Learning to “re-direct externally” instead of ruminating on bodily feedback; accept the “unwelcome guest” (sensation) and still engage in valued activities ([48:52]).

The Role of Validation in Treatment ([63:05])

• Many with health anxiety feel dismissed or invalidated by healthcare providers, who often don’t recognize the impact.

• “No ‘fake’ symptoms”—whether the cause is psychological or physical, the distress is always real and deserving of empathy.

  “You can have a real symptom and there’s no fake symptoms…The one thing that we’re going to really work on in therapy is, but does the chest tightness mean what your health anxiety thinks it means?”
  — Michael, [65:55]

Values, Risk-Taking, and Moving Forward

• Calculated risks and values-based action: Recovery means shifting focus from symptom elimination to re-engagement with life and meaningful action, even when uncertainty persists ([68:55], [70:40]).

• Building confidence: Each risk or exposure increases self-efficacy—not just lowering symptoms, but building resilience.

  “You are more capable than what your brain thinks.”
  — Michael’s billboard statement, [71:07]

Notable Quotes & Memorable Moments

• On the sticky nature of health anxiety:

  “There’s a chance that these medical things can happen, but with the information I have right now, there’s nothing that draws me to the conclusion that’s happening right now. So can I operate off the information I currently have?”
  — Michael, [38:23]

• On acceptance and sensations:

  ”If we don’t have a willingness or an acceptance of the experience that we’re having, we’re going to start to fight the experience. And…the more we fight any experience… it’s going to build up more tension. The more tension that we feel, the more the sensation we’re going to feel, the more we’re going to get freaked out.”
  — Michael, [43:29]

• On the perils of avoidance:

  “You might still be alive, but you’re not living.”
  — Michael, [67:06]

Key Timestamps for Major Segments

| Timestamp | Segment/Insight | |------------|------------------------------------------------------------------------| | 01:47–05:03| Michael's background, path to anxiety specialization | | 05:03–10:00| Writing the book; using humor and “therapy-room feel” | | 11:21–15:28| Defining health anxiety: subtypes, signs, bodily vigilance | | 17:00–22:10| Insight, cognitive “fusion,” and unique clinical challenges | | 22:10–28:03| Navigating health system, productive vs. nonproductive coping | | 30:25–37:38| OCD reasoning, “sticky” evidence, personal/medical stories | | 39:35–52:40| Bodily sensations: mindfulness, nonjudgment, acceptance, shifting focus| | 63:05–68:55| Validation, the importance of feeling heard, therapy as hope | | 68:55–73:17| Advice to younger self & all listeners, billboard message |

Tone & Approach

Candid yet compassionate, blending therapist wisdom with day-to-day relatability. Michael’s style mixes validation, gentle humor, and actionable insights—emphasizing that recovery is possible, though not about certainty but about living well with uncertainty.

Final Takeaways

• Health anxiety is serious, sticky, and often isolating—but hope and relief are possible.
• Bodily sensations are normal; hyper-focus and avoidance reinforce the suffering.
• Mindfulness, acceptance, and values-based actions are foundational tools.
• Real-life engagement (even with some uncertainty) builds resilience and can give life back its richness.
• Above all, validation and compassion are non-negotiable—both from therapists and self.

For further resources:

• Michael Stier & Dr. Josh Vital Neck’s book: Overcoming Health Anxiety
• The OCD Stories podcast library
• Therapy (ERP/ACT/CBT) with a licensed mental health provider