Free Health Anxiety Worksheet: Mapping Body Checking and Reassurance Seeking as Safety Behaviours

What it helps with

• Turning a vague sense that something is wrong into a specific prediction that can be tested.
• Listing safety behaviours across four channels: bodily checking, information seeking, asking other people and avoidance. Clients tend to under-report the ones they consider sensible.
• Logging how long relief lasts before the doubt returns. Most clients find it lasts minutes, which undermines the behaviour more than any argument from the clinician.
• Seeing where checking manufactures its own evidence, such as repeated pressing that produces tenderness or sustained attention that makes swallowing feel effortful.
• Writing predictions as observable events with a timeframe, then recording what actually happened and what was learned that was not expected.
• Ordering behaviours by difficulty and planning a week-by-week reduction, with a client-authored agreement for family and clinicians about what to stop providing and what to offer instead.

How clinicians use it

• Complete the behaviour inventory in session rather than as homework. The categories a client leaves out are usually the highest-frequency ones.
• Run the relief-duration log for a full week before planning any withdrawal. The client's own half-life data is the strongest argument available and it belongs to them.
• Write each prediction as an event, not a feeling. "I will feel awful" cannot be tested. "By Thursday the lump will look bigger in the mirror" can.
• Frame dropping a behaviour as gathering information, not as enduring discomfort. High anxiety alongside a clearly violated prediction is still a good trial, and saying so protects the work.
• For ADHD clients, replace the week-long hourly log with three or four fixed check-in points a day, and let ratings be a quick circle on a 0 to 10 scale rather than written notes.
• For autistic clients, keep the wording literal, agree the reduction schedule in advance rather than changing it each session, and offer a written or symbol-based scale as an alternative to numbers.
• Where a symptom is new, changing or not yet assessed, medical review comes first and the formulation waits. Target the checking that happens between medically indicated appointments, and say plainly that this is what you are doing.

Clinical Implementation Guide

1. Run the relief-duration log for a full week before planning any withdrawal, so the plan rests on the client's own data rather than on advice.
2. Write predictions as observable events with a timeframe. A feeling cannot be disconfirmed; an event can.
3. Set up the reassurance agreement with the people involved before reducing anything. Reassurance withdrawn without warning by a partner is experienced as abandonment and escalates conflict.

What the worksheet looks like

Clinical cautions

Health anxiety and undiagnosed physical illness are not mutually exclusive, and clients with health anxiety do develop serious disease. Nothing here is a basis for concluding that a symptom is psychological, for discouraging appropriate medical assessment, or for a clinician without medical training to comment on a physical sign. Do not withdraw reassurance from a client who has not agreed to it or does not understand why; reassurance reduction is collaborative or it is a rupture. Distinguish health anxiety from illness-focused OCD, from somatic symptom presentations where distress attaches to the symptom itself and from panic disorder where the feared outcome is immediate catastrophe during the episode. Take particular care where health anxiety follows bereavement, a serious diagnosis or medical trauma, since a behavioural reduction plan applied without that formulation is experienced as being told the fear is silly; consider a compassion-focused approach first. This worksheet is a clinical template for use by qualified practitioners within a formulation-led treatment plan. It does not diagnose any condition, is not psychological treatment in itself, and is not a substitute for individual face-to-face therapy, for medical assessment or for emergency crisis support.

References

1. Abramowitz, J. S., & Braddock, A. E. (2008). Psychological treatment of health anxiety and hypochondriasis: A biopsychosocial approach. Hogrefe.
2. Asmundson, G. J. G., & Taylor, S. (2005). It's not all in your head: How worrying about your health could be making you sick and what you can do about it. Guilford Press.
3. Furer, P., Walker, J. R., & Stein, M. B. (2007). Treating health anxiety and fear of death: A practitioner's guide. Springer.
4. Warwick, H. M. C., & Salkovskis, P. M. (1990). Hypochondriasis. Behaviour Research and Therapy, 28(2), 105-117.
5. Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10-23.
6. Tyrer, P., Cooper, S., Salkovskis, P., et al. (2014). Clinical and cost-effectiveness of cognitive behaviour therapy for health anxiety in medical patients: a multicentre randomised controlled trial. The Lancet, 383(9913), 219-225.

Part of

Cognitive Behavioral Therapy (CBT) Foundations

Related worksheets

• Safety Behaviours Worksheet
• Expectancy Violation Worksheet
• Intolerance of Uncertainty Worksheet