Surveys of health anxiety indicate that, on average, individuals who report a high level of health anxiety do not have a more or less healthy lifestyle than others in the same community (Kellner et al., 1987).
This is surprising, considering the high degree of health concern they experience.
An assessment of lifestyle may identify positive goals to help channel health concerns in more realistic directions. Goals in this area may be integrated with the goal-setting process outlined earlier. In assessing functioning in these areas, it is helpful to explore previous successful and unsuccessful experiences related to health behavior. Knowledge of this history is useful in developing realistic goals. It is helpful to explore these areas at the time of the initial assessment. The following questions may be helpful in evaluating the client’s health behavior:
Do you have a pattern of regular exercise?
Both cardiovascular exercise and exercise focused on strength and flexibility are important to
long-term health. If these are areas of limited activity, your client may benefit from focusing on developing a schedule of regular exercise.
Individuals are more likely to maintain an exercise routine if it involves social contact (a friend, family member, or group activity) and if it fits easily into the daily routine.
Regular exercise has positive effects on mood and ability to manage stress.
Do you have any difficulties with your sleep?
Sleep difficulties and preoccupation with sleep are very common among people with problems with anxiety, depression, chronic pain, or somatic concerns.
There are very effective approaches to sleep difficulties that involve an understanding of behavioral aspects of sleep. It is helpful if the therapist is informed about the evidence-based treatment approaches in this area (see, for
example, Morin & Espie, 2003).
Do you have healthy eating habits?
Could your eating pattern be improved?Ahealthy diet also has a very positive impact on health. Many clients are aware of difficulties in their diet and improvements in this area may be a worthwhile area for behavior change.
Do you have enough time in your day so that you are not always rushed?
In order to enjoy life, it is important to have enough time to enjoy both work and leisure activities without a constant feeling of time pressure.
Many people benefit from work on managing time and activities to reduce feelings of time pressure. For many people with anxiety, perfectionism may be an issue that should be addressed.
Do you have adequate time for leisure each day?
We encourage people to arrange work and family commitments so that they have some time for leisure and relaxation each day. This may be particularly challenging for parents of young children.
How are your relationships with family? Are there any relationships that are difficult for you? [If applicable] How about your relationship with your partner? Are there any areas that are difficult for you? How are your relationships with friends? Do you see friends regularly?
Relationships with family and friends are an important area of satisfaction for most people. When people are experiencing problems with health anxiety or somatic concerns, these relationships may be neglected or disrupted. In some cases, difficulties in relationships are a source of stress that may improve with problem solving. In other cases, increasing contacts with friends and family may increase the amount of enjoyment in life.
This is an area for considerable clinical attention because relationships are so important to the enjoyment of life.
Are you smoking regularly?
Quitting is a major challenge for most smokers. A complication is that nicotine allows people to tolerate unpleasant
emotions with less distress. We suggest that smokers first work to manage difficulties with anxiety and depression. When they are experiencing a lower level of everyday stress, we encourage people to become involved in a structured smoking cessation program. Some of the best programs achieve rates of nonsmoking in the range of 25{469390b6394adac8732ab759dd553e726854a6c7964b69450d6f7f25a7965e2d} by six months after the program is completed.
People should understand that they may have to make several attempts in order to successfully quit smoking.
Many people have a few drinks when they are with friends or after work.
Do you have a favorite drink? How many drinks do you usually have in an evening on your days off? How about on a work day?
Many people risk health problems because of heavy alcohol use. One guideline is that more than four drinks regularly on one occasion or even daily alcohol use at slightly lower levels carries some health risk. Heavy alcohol use
can also contribute to problems with anxiety and depression.
When a pattern of excessive alcohol use is identified, addressing this issue is a high priority in treatment.
Many people experiment with recreational drugs such as marijuana and cocaine, especially when they are younger. What have been your experiences with this? As is the case with alcohol use, current excessive use of street drugs should be addressed in planning treatment.
Most people have some sources of stress in their lives. They may be related to financial pressures, work pressures, problems with children, problems with family members who are ill, family disagreements, and so on.
What are the pressures in your life right now?
The clinician should review the identified areas of stress to see if some work on problem solving as part of the treatment would be appropriate.
CONCLUSION
The work on establishing goals, including those related to a healthy lifestyle, is used to create a focus during treatment on moving toward valued goals.
As much as possible, the clinician allocates time during each session to this topic to balance the work on overcoming symptoms.