The hint of a headache at your temples, an itch at the back of your throat, a fever so slight you barely feel it. You know that it’s probably nothing, but, still, part of you wonders: Could it be?
In this new reality where quarantine is a daily reality and even a trip to the grocery store could prove life-threatening, many of us are, understandably, feeling stressed. Not surprisingly, there’s a long list of emotional consequences associated with our current situation, ranging from insomnia to increased alcohol consumption and even post-traumatic stress symptoms. But among the most concerning possible psychological outcomes of the COVID-19 pandemic is what’s known as health anxiety—the belief that bodily sensations are symptoms of being ill.1
“Almost everyone experiences health anxiety to some degree,” write Gordon Asmundson and Steven Taylor in a recent editorial for the Journal of Anxiety Disorders.2 The authors explain that being vigilant can help identify early signs of health problems, but excessive worry makes us prone to misinterpreting bodily sensations. That creates more anxiety, which influences our ability to “make rational decisions.” And misinterpreted physical sensations (sometimes known as “somatic” symptoms) not only cause unnecessary personal distress. For society, these symptoms could increase the burden on our already overloaded medical system, dedicating scarce resources to people who, in fact, do not need them.
In an email, Ilaria Setti, an associate professor in work and organizational psychology at the University of Pavia in Lombardy, Italy, where COVID-19 has left a path of destruction, writes, “It is essential to consider this problem in a preventive perspective … I think that it is important to know which type of symptoms will probably arise … with the aim of revealing them in advance and being able to effectively manage them.”
Experiencing stress fundamentally changes the way we interpret physical ailments.
Anticipating symptoms may be especially important when it comes to certain groups, like emergency response workers, who are often susceptible to health anxiety.3 “Potentially, all people working in ‘high-risk’ contexts … and all helping professionals (physicians, nurses, psychologists, etc.) are at risk of developing such types of symptoms, if not supported and correctly managed,” Setti writes. The same is true for people who have suffered from trauma, people who are highly sensitive to sensory stimuli, and those who are currently experiencing considerable stress in their lives.
This is because experiencing stress fundamentally changes the way we interpret physical ailments. “All of your experiences shape how you perceive even physical injuries,” explains Shaheen Lakhan, vice president of research and development at the digital brain health and therapeutics company, The Learning Corp. “You can have a physical complaint—your insult or injury—but it has to be modulated by the brain.” In other words, stressful situations—both past and present, physical and psychological—can increase the likelihood that your brain will interpret a minor ache as a major pain.
All of this spells bad news for our well-being in the context of COVID-19. “When you undergo a very bad public health disaster, then that could change the frame or the lens in which all of that information is perceived,” says Lakhan. The high levels of stress associated with the pandemic could cause everyday headaches to feel more like migraines, or harmless muscle pain to manifest as fever symptoms. You may be suffering from a common cold—or even be perfectly healthy—but your body might feel like it is struggling with something more sinister.
To make matters worse, these psychological symptoms can, over time, lead to real physical complaints. “Such cognitions amplify their bodily sensations, which produces actual stress,” says Toru Takahashi, a clinical psychologist and a graduate student at Waseda University. This stress, in turn, reduces immune function, increasing the chances of becoming ill.
Of course, on the one hand, a bit of health anxiety could be helpful in the context of this pandemic; staying home when you feel ill is one of the best ways to slow the spread of the virus.4 But on the other, believing that you have COVID-19 could raise your stress levels, reduce your immunity, and, ultimately, increase your susceptibility to infection.
Luckily, a growing body of evidence suggests there are ways to counteract health anxiety and the somatic symptoms that sometimes accompany it. Mindfulness, Takahashi says, is one of them. Previous studies have shown that meditation, mindfulness-based therapy, and similar practices can help ease somatic symptoms, as well as reduce anxiety and improve mental well-being more generally.5 Mindfulness encourages people to let anxious thoughts come and go, to acknowledge worries about physical symptoms without judging or catastrophizing them.
Lakhan agrees. He explains that one of the strengths of a mindfulness practice is its ability to help refocus thoughts on the present moment, to the aspects of our lives that are within our own control. This shift can be especially important for people who tend to worry a lot about the past or future—as is often the case with people suffering from somatic symptoms. “There are certain factors, like the virus, that we can’t change,” he says. “But there are things that we could take control of: our mind, our body, our physical distancing efforts, our loved ones, those relationships that we all hold. Those would be the strongest way to mitigate somatic symptoms in this time.”
Remember that physical distancing does not have to mean social isolation.
There are other strategies that can help too, says Patrick O’Connor, a professor of kinesiology at the University of Georgia. In a 2019 study, he and his colleagues found that women who exercised regularly experienced fewer somatic symptoms than women who exercised less or not at all.6 O’Connor says that, while more research needs to be done in this area, these results could help people who are struggling to stay healthy and happy during COVID-19.
“If people are sedentary then doing even 10 to 20 minutes of low-to-moderate intensity physical activity will yield anxiety reduction, stress relief and increased feelings of energy compared to being physically inactive,” O’Connor writes in an email. Practicing yoga, he adds, may be particularly beneficial. “Yoga involves exercise combined with a mindset that involves acceptance”—in other words, it brings together the benefits of mindfulness and physical activity.
Developing routines could also prove helpful during this difficult time, especially for kids, adds Kristi Wright, a clinical psychologist and associate professor of psychology at the University of Regina. “For anxious kids, it is good to try to set up a structure,” she says. “It doesn’t have to be so regimented that you can’t break it, but one that lets them see what’s going to happen or transpire from day to day can be helpful.” Wright’s research has shown that people young and old who have a hard time tolerating uncertainty tend to struggle more with health anxiety, which is why having a clear, predictable structure is so important.7
Wright adds that physical activity can also prove beneficial. “If you’re healthy, it’s good to get kids out every day,” she says. “Alternatively, there are online options such as on YouTube to encourage fun physical activity for children that can be done indoors.” Not only is physical activity good for mental health, it can also help provide that structure that is so essential for anxious kids. The same is true for sleep: Sticking to firm bedtimes can make a world of difference. But perhaps the most important thing, Wright says, is to provide opportunities for conversation. “Encourage your kids to ask you questions and provide comfort if they’re concerned,” she says. “Acknowledge those feelings. Don’t try to brush them off, keep it open for them to have those discussions with you.”
According to Moritz de Greck, a physician who specializes in psychosomatic medicine, the same might be said for adults. In de Greck’s clinical experience, he has found that feeling socially isolated—as so many of us undoubtedly do at this time—is one of the strongest predictors of somatic symptoms. He attributes this relationship to our hunter-gatherer past, in which social belonging was core to survival. “Even if nowadays, social isolation is not dangerous at all … in former times, it was very, very dangerous,” he explains. “People who were excluded from the social group had a very high risk to die.” Even today, the threat of being alone can increase our stress levels and, by extension, our likelihood of experiencing health anxiety.
So, as we weather the COVID-19 crisis, de Greck reminds us to remember that physical distancing does not have to mean social isolation. “Try to seek contact,” he says. “Talk about how you feel, and try to be honest.” In turn, he urges us to listen to others’ worries and anxieties, to support our friends and family when they need it most. “Tell them that if they are getting ill, you will care for them,’” he says. “Let them know we will go through this together.”
Alice Fleerackers is a freelance writer and a doctoral student at Simon Fraser University, where she studies how controversial science is communicated in the digital sphere. Find her on Twitter @FleerackersA.
1. Brooks, S., et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet 395, 912-920 (2020).
2. Asmundson, G. & Taylor, S. How health anxiety influences responses to viral outbreaks like COVID-19: What all decision-makers, health authorities, and health care professionals need to know. Journal of Anxiety Disorders 71 (2020).
3. Setti, I. & Argentero, P. The role of mindfulness in protecting firefighters from psychosomatic malaise. Traumatology: An International Journal 20, 134-141 (2014).
4. What To Do if You Are Sick Centers. CDC https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html
5. Lakhan, S. & Schofield, K. Mindfulness-based therapies in the treatment of somatization disorders: A systematic review and meta-analysis. PLoS ONE 8, e71834 (2013).
6. O’Connor, P., Herring, M., McDowell, C., & Dishman, R. Physical activity is indirectly associated with pain in college women through associations with somatization and panic disorder symptoms: a cross-sectional study. Annals of Epidemiology 33, 37-43 (2019).
7. Wright, K., Lebell, M., & Carleton, R. Intolerance of uncertainty, anxiety sensitivity, health anxiety, and anxiety disorder symptoms in youth. Journal of Anxiety Disorders 41, 35-42 (2016).
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