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Michael Stier: Health anxiety (#508) - The OCD Stories | Wave AI Podcast Notes

Michael Stier: Health anxiety (#508)

Sun Oct 19 2025

In episode 508 I chat with Michael Stier. Michael is a Licensed Clinical Professional Counselor (LCPC) and Director of Education and Training at the Anxiety Specialists of Atlanta. We discuss his therapy story, working with health anxiety, the health...

Summary

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

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Transcript

A (0:00)

You're listening to the OCD Stories podcast hosted by me, Stuart Ralph. The OCD Stories is a podcast dedicated to raising awareness and understanding around obsessive compulsive symptoms. I do this for interviewing inspired therapists, psychologists and people who have experienced OCD. Welcome to the OCD stories and welcome to episode 508 of the podcast. And in this one I chat with Michael Steer. Michael. Michael is a licensed clinical professional counselor and director of education and training at the Anxiety Specialists of Atlanta. And in this we discuss his therapy story, working with Health Anxiety, the health anxiety book he co wrote, what is Health Anxiety, Insight in Health Anxiety, Bodily sensations, Values based living and much more. And thanks to our podcast partners. Nocd. If OCD is interfering with your life, NOCD can help their licensed therapists specialise in exposure and response prevention therapy. The most proven therapy for OCD with NOCD, effective treatment that is 100% virtual, is available for children and adults with OCD and most members can get started within seven days on average. No hassle, just real science backed help and support between sessions. Begin your journey@nocd.com or I'll put the link in the episode description. I thoroughly enjoyed this conversation with Michael. I hope you do too. And whether you have health anxiety or not, the way he talks about treatment will be very relatable to other themes. So thank you to him for his time and of course thank you to you guys for listening. As always, it means a lot. Without further ado, here is Michael. Welcome to the podcast, Michael.

B (1:47)

Thanks for having me on, Stu. I appreciate it. I hear at the beginning of every podcast a lot of people are saying, praising you and thanking you so much for all the things that you do. And so I guess I'll just pile on at this point. I was just thinking about like all the episodes that I've listened to just personally and all the ones I've been able to send to clients. You know, they come in with some theme that it's like, I don't think anybody has ever dealt with this before and I'm like, actually did you know that OCD Stories has done a whole podcast on this and like, wow, that's amazing. Like this, you know, still scared but you know, so I'm just glad to be able to be here to add to the wealth of information, knowledge and education and just ready to talk about some things with health anxiety today too.

A (2:33)

Yeah, no, I appreciate that and, and yeah, I'm the same with my clients. I'll dig out episodes and send it to them if I Think, you know, that they need the info. So it's great to hear you and others are doing it. So as you know, what I like from therapists and clinicians is initially just hearing why, why be a therapist? And, and then ultimately why into health anxiety.

B (7:53)

I think if anybody's ever read the book, it's written in A little bit of a different way. We try to use some humor, some metaphors, but I think one of the things that we talked about whenever we sat down to first do this was if we're going to write something, I want it to feel as much as possible like somebody's sitting in a therapy room with me. It's hard to be able to bring a relationship into a book just because it's such a one, you know, one way type of experience. But I think that's one of the things that we really wanted to be able to do is that, at least in my therapy, and I know Josh is pretty similar, I use a ton of stories and metaphors and memes and goofy stuff and things that people roll their eyes and they're just like, oh, my goodness. But to me, that's part of the therap, which is how can we bring some things that help people relate to things to. Also, I've always been a big advocate. Especially I think one of the things that we talk about or we try to look at in the book is like, anxiety is serious. Health anxiety is serious stuff, right? Like, people suffer and OCD is serious. But if treatment is always as serious as health, health anxiety is, that's gonna be a really grinding process. And so sometimes I really like to kind of use that almost as a diffusion technique within the therapy process of, you know, can we still treat this as something that's very serious that require serious interventions, but can we also do it in a joking, playful, humorous way? And so far, I think, you know, there's been some not great reviews every once in a while, which is fair. You know, there's been some comments about, like, little too many dad jokes, and I'm like, you know, all right, you got me. However, the other thing that's been really positive is a lot. I think a lot of people have just given us feedback about how it feels like it's a book that they can really connect to and that they can really kind of like it. Just kind of. They get it. And I think if that was what if that's how it's kind of connected with some people, I think we've accomplished our goal, because that's what I hope to be able to do in therapy is not only just feel like we're doing some serious interventions, but for them to really kind of resonate and relate to it and being like, okay, I get this. So I think that's been the really cool thing to be able to hear.

B (11:21)

Yeah, so I'll try to kind of give a macro view just so we can kind of talk about like a subsection of that that I think is important. You know, really just a preoccupation with health is a good way to just at least start with that. And if we're going to break that down into three categories, we could look at it as an illness anxiety disorder, which is usually a preoccupation with health with very little symptoms present. Somatic symptom disorder, which is preoccupation with health. But usually there's some pretty significant life altering symptoms present and then really a kind of a third category which is sometimes I just a little play on words of health. Anxiety is usually a lot of times when we don't really have anything that is diagnosable and it creates a lot of anxiety. If we flip those words sometimes anxiety around. Health could be the third category which is there's times where we're just going to get diagnosed with something and it's scary. And so I think that's the third category that a lot of times I look at, which is that can kind of be health anxiety. Although it may not be always what we think of it as that. You know, if you get a diagnosis of something and I've had clients that they've had a stroke and it's scary trying to cope and adjust with that. So really 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. And most importantly, right Is, you know, there's a lot of little subsections off that with OCD with health themes. It's kind of the same story, right? Is like how, you know, even in our book we use the acronyms of TOS and C's in terms of trigger obsessions, compulsions. And so that's how I would start to kind of categorize those. And that starts to give us a little bit of feedback about, like, what we need to do to move forward as well in terms of treatment. Because if we can assess kind of where a person is at, whether or not, like, are you having any significant symptoms? Have you been to the doctor? If you haven't, you need to go there first. Because we can't really do psychotherapy if you haven't had some kind of workup at first, or if it's more about adjustment and coping, maybe that's where we need to kind of dig into. The one area that I see a lot of times that we can talk a little bit more about today is where I see people get into the tendency to get hyper focused or hyper vigilant about their symptoms or sensations that they have in their body. And to me, that's a pretty big hallmark of health anxiety, which is either one. I'm looking out for things. So did I feel this? Did I feel that? There's kind of the preemptive anxiety of, am I going to feel this? Or just a constant checking. You know, you might be going along today, doing a podcast, and then all of a sudden you're like, oh, I probably should check in on my arm now. How does that feel? And the hard part about that is, even though those are pretty hallmark with health anxiety and also some other things like emetophobia with panic attacks, a lot of times there's a lot of focus on, how does it feel? Am I panicking? Does my heart hurt? All of these things, Is my stomach upset? It really becomes a trap. Because as soon as our attention goes in and focuses on some of those body areas, it's got us. Because as soon as you focus on your body, you know that you're going to feel something. We had a group yesterday, and actually I'm not upset, but somebody in our group gave a great example and I'm like, dang, I really wish I would have thought of that, but I'm going to steal it. And they were just talking about itching and they were like, I'm pretty sure if we just kept on talking about itching today, Stu, between me and you and probably all the listeners, everybody's. I'm already noticing it. I'm like, oh, my goodness, like, I wonder if anything itches on me. And we start to feel those sensations. And so that's such a big part of health anxiety. I think we have to talk about how it happens, how it develops, but then also what do we do with that? Because otherwise, I think that's how health anxiety just like sucks us back into that cycle.

B (17:26)

With being working with a lot with OCD as well. If we're working on contamination, I'm not often having people work on contamination exposures and at the exact same time having the CDC set up an appointment with their house to come and swab things. Not doing that, we're not doing those things at the same time. But with health anxiety, we do. Right. Like, we're kind of navigating these two realms where it's like, okay, so there's some preoccupation with if there's something health related going on. And also, very realistically, you might have to go to the doctor to try to figure out what's going on in some cases. So how do we pursue effective medical care without getting into the preoccupation with it? So that is a bit of a unique challenge that I think I. A lot of times I'll tell clients or I'll tell other clinicians of like, you know, there's a lot of boundary walking with this and kind of trying to really meet the client where they're at. If I do have a client that comes in that's very kind of cognitively fused on and be like, this is going on with me. This is, you know, this is wrong. I can't be the one to be like, no, you're fine, you're good. Mostly because I don't want to be. Not, you know, be wrong at that point, but it's also not respectful of meeting the client where they're at. And so I think there is definitely a part of that that I do feel like I see there's a little bit more investment or cognitive fusion of like, no, this is really going on. And in those cases, a lot of times what I'll do is I'll encourage them and be like, hey, if you really think that's really concerning, let's go to the doctor, let's see what's going on. A lot of times encourage people in those cases to try not to do it so abruptly, to run to the urgent care, the er. A lot of times I'll want people to like, schedule an appointment with your doctor. And they're like, great, they told me they can get me in next week. And it's like, cool, well, me and you can work on how are we gonna manage the anxiety that you feel until next week. And then you can go to the doctor and you can really address that concern. And so there's a lot of blood balance between these two things of trying to meet people where they're at, while also trying to encourage them to recognize the patterns that are happening too. And so sometimes we can come back to those pieces where a lot of times we'll focus a lot of times on valued actions which Is, you know, there is this very realistic part of, like, you know, we could be sick, we could have cancer. That's not outside of the realm of possibility. However, I start to work with people in terms of, like, but in what ways are all of your, you know, what we call rituals, you know, or all the things that you're doing to try to be able to make sure that that's not happening? In what ways is that getting in the way of life or the things that you would really like to be able to pursue? And so then we have a little bit of a balancing act of, like, I know it's really scary that these medical things could still be going on. And also, in what ways is all those pursuits actually maybe taking you further away from life than maybe you would really like? And at that point, then we start to kind of look at it like, well, what are some risks that maybe we would be willing to take? I know it's still scary. It could still be cancer. And also, if that's going to get in the way of other things in life, would you be willing to take that risk? And so I think there's a very much of a balancing act with that. And there's some. A little bit of some cognitive or metacognitive interventions that we can use in those cases, too, where I really start to kind of ask people about, not necessarily to challenge a thought, but I really like to have them look at it with some skepticism, which is essentially, can we look at the pattern that's happened in the past and say it's like, well, how many times has your brain convinced it you are going to die and you're still here? So not to say that it's going to be wrong or that it's going to be right, but we can start to kind of get into this discussion with people of. But if this is what it's always said and it's never panned out to be the case, how do we know we can trust it now? And if we can bring a little bit of a skeptical mindset to that, then maybe we can help people say, it's like, well, you know, how many times have you told me I was going to die? And maybe, I don't know if I need to listen to you this time. So that's where we start to try to break down some of those walls where people really kind of get caught in. Because those are tough times when people come in and they're like, no, I'm really convinced this is going on. And the one thing we can't do is just being, trying to fight them or it's like it's not going on and it's like that's unfortunately not going to work.

B (28:03)

Yep. And I think sometimes my clients roll my eyes when we start to talk about productive versus unproductive, which is like, you know, I'm all for productive pursuits, you know, so at least going to the doctor is going to give you a chance to be able to find something. Sit. I've never heard anybody sitting up in bed at night, waking up the next morning and being like, wow, I'm really glad I sorted all those things out. No, never. It's always just like, I'm really tired and I probably shouldn't have just like, sat there and worried about that last night. So I think that productive piece is important. Some. One of the tree examples I sometimes try to use is, you know, a lot of times with these, like when we're talking about how cognitively fused people can get, sometimes they just see their tree as just like one trunk. Right. And it's Just like A is B, right? And be like I have this symptom means it's cancer. And I try to encourage people to remember is like we're not going to try to be able to, we're not going to be able to know, you know, with certainty what this is happening. But if we imagine that tree is like I do have this symptom which is the trunk, but then a tree branches out to thousands of different places. And I think it's important for us to remember and kind of work with people to be able to recognize of like we might have a conclusion about what we think this symptom is. And if we can also open up our mind to the variety of other possibilities of what could happen, that can be important. It starts to kind of shift that flexibility a little bit to be able to understand. We're not going to try to convince ourselves of other possibilities, but it is important to recognize of like just like you have a chance that you do have cancer, there's also a chance you don't. Can we also embrace that uncertainty of like, well, can I embrace the possibility that maybe nothing is going on and if I was going to embrace that uncertainty, my actions might look completely different. I might just go out to dinner and do those things as opposed to if I was going to go with my initial thought which would be I do have cancer, I'm going to have a long night of doing a lot of checking and monitoring ahead of me. So I think there is that possibility that sometimes is important for people to consider because a lot of times in that cognitive fusion there's such the assumption of this means that. And you can't talk me out of it at that point.

B (32:38)

Is like that kind of starts to feel like a rule or there's a lot of times, there's a lot of responsibility that I think a lot of times people feel in health anxiety, which is like, why if, you know, if I'm a parent or if I'm a family member or if I'm a spouse or whatever your relationships are like, isn't it just more like it's responsible of me to be able to go and make sure everything is checked out and everything is okay. And so it almost kind of seems like almost in a scrupulosity way that it starts to almost feel like practicing ritual prevention skills or, you know, like delaying some health appointments or maybe even taking some symptoms that we think normally we're like, I don't think this is anything. This is a symptom. I felt before. Sometimes delaying those or not pursuing those starts to kind of feel wrong, irresponsible, like, I'm not doing things that I need to do. So I think there's a lot of these rules based that can come up, which is. And those are sticking points. Right. Because if we're, if we're approaching therapy or taking risks, quote, unquote, in those ways, and we run into those rules, those can be really become blockades. And I think that's where like a lot of times what I'LL try to do in therapy in those moments is really try to just be curious around some of those rules. And another eye roller in therapy, which I'm sure maybe a lot of therapists or people that have been therapy know, is we start to use kind of like comparisons of like, well, are you telling other people in your life the exact same things? And they're like, no. And it's like, okay, but you're telling other people those things, but that's not the same thing you're telling yourself. Or you wouldn't criticize somebody else for being wildly, wildly irresponsible with their family. But that's how. That's the rules that you apply for yourself. And this is where I think this is one of the reasons I really love therapy is that there's so many complexities of not only how people relate to health anxiety, but then also how people relate to themselves and the stories and narratives and the beliefs that they have about themselves and the world and safety. And this also comes into play with health anxiety, specifically of previous medical things. I've had a lot of people that have maybe had cancer in the past have gone through treatment and in remission, they're doing amazing. But that also plays into our belief systems about. Then it's like, well, what is that? What is my relationship with my body? Then maybe I can't trust it as much as I think I can. Or even in just the medical system at large, which is like, you know, if somebody has less than stellar medical care at some point, that those beliefs really start to come in to be able to make some of those obsessions and compulsions even more difficult. Because there's a underlying belief system a lot of times people with health anxiety get caught into. And so that's really important to, you know, to be skeptical of, to really start to question. Sometimes I use the example of like a spam email, right? And it's like, well, we all get spam emails. They're all real emails. They really come to my email box. But, you know, I'm not going to always trust them. Why? Because they're shady. I don't know if I can trust what they say. It's not that I'm going to email them backstu and being like, by the way, if you really have $13 million for me, can you prove that you really are like, I'm not going to do that. I'm just going to get scammed more. And so what I'm probably going to do at that point is be able to say it's like, I don't know if this is all that trustworthy. I don't know if I can really, like, maybe there's some issues with this and if that's the case, it just might mean different things that I need to do at that point. So I think there's definitely that, that kind of goes back to that fusion where a lot of times people can get caught into these rituals because they feel required, they feel responsible in some ways. And if we can help loosen that dynamic to say it's like, but, but if it's not, if, if you wouldn't apply those rules to everybody else, maybe you could be, you know, afforded those same rules as well.

B (37:38)

Yeah. And just in my own personal reflection, a lot of times with health anxiety, just what I found is that a lot of times there's some stories behind where things have come from, whether it's their own illnesses. I have quite a few clients right now that even being pregnant and they've had some traumatic birth stories and just how that can shift the belief system. I think this just adds to this, this piece of like, I want to say believability or just like how much we're like, no, like this is, I can't trust this. And, and so, you know, in all these reasoning categories, to me, and I've kind of walked through those same things with clients, to me, where it ends is because of this, what do we need to do? You know, like what, what, you know, what's the next step at that point? Because the next step at that point could be further into the cycle or the Next step could be freedom from the cycle. And I think that's really what I want to lead people, which is, if we can't necessarily trust that email, are you going to respond or not? And it can feel really tempting to be like, well, but if I don't respond to this, I could have been, like, awarded millions of dollars. And it's like, yeah, but it seems a little risky, doesn't it? So could we take the chance that maybe it means nothing? And if we can take that chance with a pretty good answer. There's no absolutes. There's no. There's still going to be things that, like, what you're saying is, like, 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? And can I make meaning out of that? Can I actually go do something that's important? And that's where we start to kind of get to the redirection of attention, which is, instead of doing all these rituals, maybe it'd be more helpful for me to do a bunch of other things in my life that would make me feel much more happy, much more valuable, and would actually add to life instead of taking away.

B (39:47)

Yeah, I think that was one of the things that I see happen when we think about health anxiety. There's so many times where we get these bodily sensations and we start to monitor bodily sensations and we start to look out for them. And I think what's important to recognize is that there's a couple just points that I just wanted to make that I hope people find helpful to consider when we think about bodily sensations, because that's such a. I would categorize that as an internal trigger in our TOS and C's model. Right. Is that we could have some sensation that we happen in our body that can sometimes then spur on some obsessive thought about what that scary thing that it could be. And so when we think about that bodily sensation, a couple different points that I think is important just to consider with that, which is, one is a lot of times we get into very subjective descriptions. This is where I'm going to get a little mindful on us here, Stu, is like, a lot of times we have these very subjective descriptions about what the sensation that we're actually experiencing is. What it means to us or where it could develop or where it could go. And sometimes even in like, when I'm doing, like talking to clinicians or with clients, sometimes I really try to reframe some of the times where they use symptoms to actually just say sensations. Because if we think about, to me, a symptom comes with a story, right? It's like already halfway down the road of being like, oh, I'm noticing this symptom. I'm like, you already have an idea in your back of your mind of what exactly that symptom is. But if I can bring a person back to a little bit more of a non judgmental approach of like, oh, but I'm noticing the sensation in my body. I'm like, good, you can notice that. And instead of describing it subjectively of like, I hate this, you know, be like, I'm noticing my chest is really tight right now. Not really. You don't have to worry. Like, you don't have to walk me through any anxiety things, Stu. But just as an example, I'm noticing that my chest is really tight right now. Perfect. So we can really connect in a non judgmental way about a sensation that we have. Because I think as soon as we start to go into this piece of, like, what does this mean? You know, how does this feel now? Like, we start to get into that loop. So one of the things that I really encourage people to do is really start to think about those of, like, can I. Can I identify and even record some of the sensations that I feel? Really trying to practice that as that, that aspect of. Instead of going into all these judgments about what it means or what it, you know, what it could mean for me or the medical procedure that I might have, can I come back to, huh? I am noticing that. I'm noticing my chest is tight, or I'm noticing a pain in my side, or I'm noticing, you know, my leg feels kind of strange. So I think that's one thing just to kind of consider is trying to move that mindset from what we would call like a symptom to maybe really kind of going back to this piece of like, can I recognize that I am having a sensation? The. The next part that I would just make with that is that there's. And this is a real crowd pleaser. So I hope everybody's just like ready to go when we talk about acceptance or willingness, which is, look, we never accept anything that we really like. Yeah. Stu, what's your favorite food?

B (42:59)

So if I brought you a Greek salad. I'm pretty sure your response would not be like, oh, I suppose I'll try to accept this. No, you'd be excited. You'd be like, oh, great, I love Greek salad. Right. And so this kind of concept that we have to like things that we accept, I think I try to outline for people. It's like you never have to accept things that you really like. You just like them. When we have a sensation, we do have to work with this piece of acceptance and a willingness to experience the sensation. Otherwise we're going to get ourselves in a world of hurt. Now, I know we're talking about health, anxiety, but you could expand this out. When we think about sensory, motor, ocd, panic attacks, a metaphobia, like any of these, 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 we all should know how that goes at this point. Right? The more we fight any experience that we didn't even choose to have in the first place, 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. And it just starts to get into that step ladder. So when I think about acceptance and willingness, I don't expect people to say, oh, I'm noticing this really, you know, this sensation in the side of my, my body. And I'm really concerned about it. I don't expect you to be able to say, it's like, I love this and this is my favorite thing ever. But if we can come back to a place of. Instead of just being like, oh, my goodness, what is this? What is this? I don't want this. This is getting the way of life, right? I hate when this is present. This is going to ruin my entire day. Right. We're really getting into a lot of narratives that's actually really increasing a lot of stress and tension. And then the hard thing with any bodily sensations is the more tension we're under, more things you're going to feel. And so if we can really work on that willingness to be able to even come back to a statement like, you know, it's like, oh, I'm noticing this feeling inside. Oh, well, so be it. Like, I. I've handled this sensation before. I think I can handle it again. The other thing I like to throw in here, too, is that if there's anything that makes that sensation feel better, do it. So I don't want you to try to reassure yourselves of, like, that's not a tumor, that's not a tumor. That's not going to make it feel better. You're just going to feel worse. But if it is helpful to be able to do some type of stretches or if it's helpful if we have a, like a persistent sensation and it helps to do this type of exercise that a physical therapist told us, wonderful, please do it. I don't want you to be miserable and to continue to have physical sensations. So a lot of clients that I have, we will talk about, is there anything that's relatively appropriate that's been given to us by a doctor or physical therapist that would actually make us feel better and sometimes be like, yeah, you know, if I do X, Y and Z, it actually makes it feel better. I'm like, we're gonna do those things. So just by accepting or willing to experience a symptom doesn't mean we just have to, like, be miserable in it. We can actually do things to actually help with it. So we're moving from this place of all this judgment and all, like this real bad relationship with a symptom, and we're trying to soften that to being aware that it's happening, trying to be a bit more objective of, like, oh, it's back. I'm feeling this again. And then once we get into this piece of, like this transition, we're really focusing on now I'm faced with a choice because I can go two routes. I can either one, continue to go inward, where I continue to focus inwardly, keep paying attention to my body, keep checking myself right, keep looking at something, or can I actually focus my attention outward? What is around me in the world? Am I at dinner? Am I watching a movie? Because a lot of times I tell people is like, you know, it's kind of impossible to be able to move on from a symptom when you keep checking it. That's. It doesn't really work that way because we keep going back and you're like, yep, still there. And it's like, hi, I wonder why I can't move on from this. Yep, still there. And. And so we have to think about this aspect of like, well, if we can get external and we can focus on important things around us, it doesn't mean that we're trying to distract ourselves from symptoms. In our group yesterday, I used this example of, it's kind of like taking a little sibling to like, you know, if you're going to go, leave, and you're like, oh, I'm going to go to the mall. And your parents were like, oh, you can go, but take your little sibling. You're like, oh, dang it. All right, do I have to? Yes, he can go along then. Right? And one of the things that we want to be able to do is to try to leave without our sibling, like, you know, try to book it out of there. But we know we're going to get in big trouble if we do that. So our only really option at that point is, I just need to take them along. I just need a lot of them to exist. Now, there's some great act metaphors, like the unwelcome party guests, that a lot of times I like to use. It's kind of the same idea of, like, if I want a person to redirect themselves back onto. I don't know, maybe you're even listening to this podcast and you've noticed, oops, I've been thinking about how my shoulder feels. Well, that's okay. Just notice that. And then I want you to tune back into something external to you, like our discussion. And if we can do that, we can learn to exist with a sensation instead of trying to live despite a sensation. And so those are the three things that a lot of times I like to go through with people, because I feel like the opposite of each one of those gets us dug deeper into the hole, gets us focused more on the sensations, and then we get really concerned, because now not only can we not stop thinking about it, they're getting worse. One last example I like to use. I use, like, so many examples in therapy. I like them. I think clients like them. I. I kind of give the silly example of, like, if I was afraid of earthquakes and I went out and bought a seismograph. I don't even know if you can do that. I. I'd imagine maybe you do. Or maybe, like, the consumer version of a seismograph would just be, like, awful and just, like, not tell you anything. But if I did that because I was really afraid of earthquakes and I sat in my house and I looked at that seismograph, the thing that tells you, like, the.

B (52:40)

Yeah, and. And going to that third category that we were talking about, right. We talked about illness, anxiety, somatic symptom. And then, you know, finally, even if you get to a person to a place where maybe they're feeling less anxious about symptoms and they're engaging more in life, the inevitable reality is one of two things, which is, one is sometimes the sensation is still there. They're still having to deal with whatever this weird feeling is, or at some point in life, they just, they may have a diagnosis of something else that. That comes up. And so a lot of times it seems like, you know, like what you're saying with ACT and, and CBT seems to really kind of take that perspective of how can we learn to exist with something rather than, you know, exist in spite of something. And I think a lot of times that's what we really try to do, especially in maintenance with health anxiety, is that a person may be in a position where they're like, hey, maybe I'm feeling better. My mind doesn't immediately go to the places of, this must be cancer, this must be als. However, there's still things that we have to work on there because they could still be having, especially in the case of somatic symptom disorder, just weird symptoms that are going on that are painful or get in the way of life. And so I think a lot of times we try to use a lot of those interventions, especially in those last three that I talked about, which is how can we create a little bit more acceptance towards some of the sensations that we feel? And instead of those sensations defining our life, how can we make sure that we can make a place for them and validate them to say, yeah, this is really hard. And also, you know, how can I. How can I make a place for these and continue to live a valuable life anyway? And that might be my best option because otherwise, then I'm going to get stuck going backwards in avoidance and, you know, and then we're sitting at home not going to do things and when you're sitting at home and not doing things, guess what? You're going to be focusing on the sensations. Right. And so there's this piece of like, you know, trying to, you know, get people involved in important things. And that's why a lot of times I'd like to use a lot of and statements, you know, to really be validating of, like, I don't blame you at all. I would rather feel better. I would rather you not have this sensation. Can we also create an and statement that would say this is a really hard sensation or this is really bothering me today. And also, can I go out and get lunch with a friend? Or maybe that seems like too much today. Let's be kind to ourselves. Me like, oh, maybe that seems like too much. Maybe just a short walk around the neighborhood is enough for today. And I'll applaud them, be like, perfect, let's start there. Because each day is gonna be different and on days where you feel a little better, maybe you can push yourself a little bit further. That's cool too. And so I think that shift from internal to external is gonna be important. Otherwise, the more we get internal, we just get. Get into that step ladder of more tension, more stress, more anxiousness, smaller life.

B (57:26)

Yeah, I like to use it because a lot of times what there, there is usually so much of a story behind, you know, here's this feeling that I get in my body and here's everything that I go ahead and like my health anxiety says about it, you know, and be like, oh, well, that, that is this. You know, or the, the fact that you are maybe a little bit dizzy means, you know, this, you know, this. It goes to that story of like, here's what this means. And what I really want people to connect with is there could be still be something behind a sensation that could be a pulled muscle. But at the very root of something, there's this form that sometimes I give to people. It's called a felt sense vocabulary, which is instead of describing these things of like, oh, I've pulled my, you know, I pulled my calf, right? And being like, yeah, but what, what are you really sensing at that point? And being like, like, what does it really feel like? And be like, well, there's a tightness. I'm like, good, okay, so you may have really pulled your calf and maybe that's really why you're experiencing that tightness. But the sensation that you're getting is tightness that there. So can you connect with that? And what's really important with that to me with health anxiety is there's always this assumption of trigger some sensation I'm having in my body and then there comes the O right afterwards. And being like, that's what this is, what this means. And I want people to take a step back from that to say, we don't. We're not going to try to sort out if that's what that means or not. But what we are going to do is I just want you to connect to the very, in the, in the moment experience of like, but what are you really feeling at that point? I do the same thing when people talk about, like, they, they come in and they say, like, oh, I feel so anxious. And I say, that's fair. Yeah, like, I can understand that. But I want you to do is I want you to take a second. How do you know you feel anxious? Like, what do you actually, like, what's informing you that you're anxious at this point, because to me, anxiety or feeling anxious is also an interpretation of. Of some kind of sensations that we're feeling. So can I bring you back to the sensations, which sometimes are a bit more objective? It's a bit more objective to be able to say, I'm noticing some tension in my chest or some tightness in my chest versus going to this place of like, oh, this now means that I'm anxious. And we have to be careful with that with health anxiety, because there could be a lot of weird reasons why we get sensations in our body, especially as you get older, Right? Like, sometimes you just. I saw this meme one day that was pretty funny where you're just like, you and your teens, and you're, like, skateboarding and playing soccer and football, hockey, and. And then, like, you. You know, the person the next day is just like, running and jumping and they're all happy. And then it's like you in your 30s or 40s, and there's like, a sock that you've laid in your bed on in your bed, and you're like, oh, my back. And it's like your body does weird things. And so if we're really trying to focus on this jump from a trigger that we've had, which is sometimes a sensation, to this catastrophic outcome of what we think it is, I really want people to try to be intentional, to break that down, to be able to say, okay, this could be a sensation that's associated with ALS or cancer or whatever that might be, but can I come back to the actual experience that I'm having at this point to say, but what am I really feeling? And maybe I'm feeling kind of. As I think about my left toe, it feels a little bit more cool for some reason. I don't know why. And right now, my body feels pretty good, which I don't mean to brag, but this is what it feels like right now. What I really want people to be able to do is to try to create some space between them and. And some of the experiences they're having in their body, because if we can create a little bit more space, we can be a bit more intentional about what do I do about this sensation now that I feel it? And maybe you come to the conclusion of you're like, yeah, I might need to go to physical therapy or something. Or we may recognize that I think people are a little bit more likely to allow a sensation to pass without creating a story around it, as opposed to, if we really get into these catastrophes about all these terrible things that this might mean, we're going to be much more likely to be stuck in it.

B (63:05)

I think the only other thing that I would just like to say real quick, and I'll keep it brief because I think in a podcast that's going to be coming out before me, there might be some good discussion, is I always think it's really important to make sure that we notice the difference between real and reliable. Of, like, people have some difficulty in the medical system maybe being discounted, or we even don't. We do no research showing that, you know, people of color, women, are just treated differently in the medical system. And so I think we have to be very mindful and very intentional about that. And this goes for, like, families and supportive people, too, is that, you know, somebody is really having a difficult time with this, making sure that we're validating their concerns, that we're saying that they're. That the concerns are real in terms of like, well, you do have cancer. Too bad, right? It's like. But we can really acknowledge and validate, like, I know how hard this is for you and I know it doesn't make sense to me. Or I know you have like 15 different doctors notes Saying that you're okay, but in very. In a very similar way, right? Like, OCD kind of works in the same way of, like, creating that validation of, like. But I know how difficult this is you. How scary this is for you. And I think that's really important in health anxiety, just because a lot of people, their first point of contact is usually not a psychotherapy therapist, it's usually a doctor. And so by the time, a lot of times clients get to me, sometimes they do feel pretty invalidated and just kind of vulnerable in those moments of, like, nobody believes me, you know, like, I'm convinced that this is happening. So I think it's really important to be aware of that dynamic, because a lot of times in the beginning of therapy, especially with somebody with health anxiety, I'm probably going to give them a little bit more of an overdose of validation of, like, I know, like, I hear you. I believe you. I believe how, like, significant that this feels for you. And I think that's a really important part, because otherwise, I think that keeps people away, because a lot of times people shut down, especially when they feel like no one really gets it and no one understands. And I think that's one of the beautiful things that we've seen, like, with our book. And I think Josh had kind of mentioned some of the resources that we try to put out there on overcoming health anxiety is just trying to give people the sense. And I always love hearing the feedback in the groups of, like, oh, my goodness, like, even though, like, a lot of other people might think, like, what are you so concerned about, like, being able to read something or meet with people that have the similar concerns, feel so validating, and be like, okay, like, this is not just me. And so I think that's a really important part that we just. I want to make sure that either people with health anxiety hear is that you can have a real symptom and there's no fake symptoms. And then real symptoms, there's no fake chest tightness, and real chest tightness. It's all chest tightness, and it's all real. It's all scary. 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? And that's that distinction I want to make with people.

B (71:07)

I think I was thinking about this. I knew this was coming, Stu, so I was planning for this. Along the same lines, I think a billboard that I would want to put is, you are more capable than what your brain thinks. And I think that messaging going back to this piece of going for it or taking the risk, taking the chance. I think there's so many times that I see, whether it's me personally, other people around me, or it's clients that we get into this you know, there's a lot of I don't think I can handle it, I don't think I can do it. And I think the hard part about avoiding that, that I would want people to see is that the more that we don't pursue those things based off of the I can't handle them or I can't do those or that's not going to work out, is it actually kind of tanks our confidence at that point? Because as soon as we don't try to pursue those things and we don't get that experiential learning, we just go ahead and fall into the assumption of like, well, you see, that wouldn't have worked out anyway. And that's that a lot of times that brings our confidence in ourselves and the things that we can be able to handle really down. And I think this is a really testament to just erp, which is like, you know, erp to me is not just like making people scared. It's taking these expectations that people have for themselves of like, there's no way I'll be able to handle that anxiety. Be like, I think you can. Your brain doesn't think you can, but can we try it out? And I think a lot of times the experience of people trying new things, taking those risks, doing an exposure, challenging themselves, it can be hard. It can be anxiety provoking at times. But the feedback afterwards, to be able to see a person shift, to be like, huh, maybe I can do these things, to me, is one of the most important parts of therapy. Because now we're not even. We're not just about bringing symptoms down. It's really about building a person up. And if they can feel more confident in themselves, that's the ultimate.