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Health anxiety and telehealth psychology in Sydney: what it is, how CBT works, and how to find a psychologist

If you spend a lot of time worrying about your health — checking symptoms, seeking reassurance from doctors, researching conditions online — and the worry itself is causing significant distress or interfering with daily life, this guide explains what health anxiety is, how psychologists treat it, and how telehealth fits into that.

What is health anxiety?

Health anxiety refers to excessive preoccupation with having or developing a serious illness, despite medical reassurance to the contrary (or in the absence of significant medical findings). It involves both a pattern of anxious thought and a set of behaviours that maintain the worry over time.

Health anxiety exists on a spectrum. At a mild level, most people experience occasional health worries. At a clinical level, health anxiety causes significant distress and interferes with relationships, work, and daily functioning. People with significant health anxiety often report that worry about their health consumes hours of each day and that reassurance — from doctors, from the internet, from family — provides only brief relief before the anxiety returns.

How health anxiety is classified

The term "hypochondria" (hypochondriasis) was used in older diagnostic systems but has largely been replaced. Current diagnostic frameworks use:

• Illness anxiety disorder: High anxiety about having or developing a serious illness; few or no physical symptoms; significant reassurance-seeking or avoidance of medical care.
• Somatic symptom disorder: Distressing physical symptoms present; excessive thoughts, feelings, and behaviours related to those symptoms in a way that is disproportionate and persistent.

In everyday usage — including by most GPs and many psychologists — "health anxiety" covers both presentations. The distinction matters for formal diagnosis but does not fundamentally change the psychological treatment approach.

What does health anxiety look like day to day?

Health anxiety is more than occasional worry about health. It typically involves a cluster of patterns that interact and reinforce each other:

Body monitoring (hypervigilance)

People with health anxiety often engage in frequent checking of their body — scanning for symptoms, noticing and dwelling on sensations that others might not register. The problem with this is that focused attention on any part of the body tends to amplify the sensations coming from that area. Noticing your heart beating or a tightness in your chest is much more likely when you are paying close attention to it.

Reassurance-seeking

Common forms of reassurance-seeking include:

• Frequent GP visits, specialist referrals, and medical tests
• Searching symptoms on the internet (often called "cyberchondria" — see below)
• Asking family members or friends to confirm that a symptom is not serious
• Checking the body repeatedly (e.g. checking lymph nodes for swelling, checking skin lesions)

Reassurance provides relief — but usually briefly. The anxiety returns, often accompanied by a new doubt ("But what if the doctor missed something?"), which triggers another cycle of seeking. Over time, reassurance can make health anxiety worse rather than better by preventing the person from developing tolerance of uncertainty.

Avoidance

Some people with health anxiety avoid medical appointments (fearing a bad diagnosis), avoid health-related media or conversations, or avoid activities they associate with health risk. Like reassurance-seeking, avoidance provides short-term relief but maintains anxiety by preventing exposure to, and toleration of, uncertainty.

Cyberchondria

Cyberchondria refers to health anxiety that is driven or worsened by online health information searching. Research has found that people prone to health anxiety tend to interpret online health information in the direction of their fears — focusing on rare or serious conditions — and that searching typically increases rather than decreases anxiety. Searching can become compulsive, consuming hours.

What causes health anxiety?

Health anxiety is not a sign of weakness or irrationality. Several factors are understood to contribute:

• Past experiences of illness: Growing up with a serious illness yourself, or having a parent or sibling with a serious illness, can establish early learning that illness is dangerous and unpredictable. Significant medical events in adulthood (a serious diagnosis, a medical scare in a loved one) can also trigger health anxiety in people who were not previously prone to it.
• Intolerance of uncertainty: A broader tendency to find uncertainty difficult to tolerate is a common transdiagnostic factor in anxiety presentations. When health is the domain where uncertainty feels most threatening, health anxiety can result.
• Amplified perception of body sensations: Some people have heightened awareness of and sensitivity to their internal physical state, making them more likely to notice and attend to bodily sensations that others would not register.
• Information environment: The ready availability of detailed medical information online, combined with the tendency of search algorithms to surface dramatic or alarming content, creates an environment that can amplify health concerns in people who are already anxious.

How do psychologists treat health anxiety?

Cognitive Behavioural Therapy (CBT) has the strongest evidence base for health anxiety, though other approaches (including Acceptance and Commitment Therapy, ACT) are also used. Treatment typically involves a combination of the following:

Psychoeducation

Understanding the anxiety cycle — how attention, reassurance-seeking, and avoidance maintain health anxiety — is an important early step. This is not about being told "it's all in your head"; it is about understanding the mechanisms that are keeping the worry alive.

Cognitive restructuring

This involves identifying, examining, and modifying unhelpful thought patterns. In health anxiety, common cognitive distortions include catastrophising (assuming the worst-case interpretation of symptoms), probability overestimation (overestimating the likelihood of serious illness), and confirmation bias (selectively attending to information that confirms health fears and dismissing information that does not).

Cognitive restructuring does not aim to convince you that you are definitely healthy. It aims to help you reason more accurately about probability and uncertainty, and to reduce the dominance of worst-case thinking.

Exposure and response prevention (ERP)

For health anxiety, ERP involves deliberately exposing yourself to health-related triggers (a health news article, a bodily sensation, a medical setting) while refraining from the safety behaviours that usually follow (such as reassurance-seeking, checking, or avoidance). This is graduated — starting with lower-fear triggers and working upward — and is designed to build tolerance of uncertainty over time.

Response prevention is the "and response prevention" part: not doing the reassurance-seeking or checking after the exposure. This is the component that most people find hardest, and it is where working with a psychologist provides real support.

Attention retraining

Techniques for redirecting attention away from the body (when body-monitoring is maintaining anxiety) and for engaging flexibly with sensations rather than compulsively monitoring them.

Acceptance-based approaches

ACT-based components may be included to help develop a different relationship with uncertainty and health-related thoughts — observing them, making space for them, and not treating them as commands to act. This is particularly useful where the goal of "eliminating" health worry has itself become a source of distress.

Is telehealth suitable for health anxiety treatment?

Yes, telehealth is well-suited to CBT for health anxiety for most people with this presentation:

• The core work is cognitive and behavioural. Restructuring thoughts, practising response prevention, and completing exposure exercises between sessions are all achievable via video.
• Reduced medical-setting avoidance. For people who avoid medical environments, attending a psychology practice in a medical building can itself trigger health anxiety. Telehealth removes this barrier to engaging with treatment.
• Practical for internet-use and cyberchondria work. If searching is a key behaviour to address, working through this in your own home environment — where the actual device is present — can be practical in exposure and response prevention exercises.

As with any presentation, a psychologist will assess whether telehealth is appropriate for your specific situation and discuss alternatives if needed.

Medicare rebates apply equally to telehealth psychology sessions as to in-person sessions. See our guide to costs and Medicare rebates and our guide to getting a Mental Health Treatment Plan from your GP.

A note on seeing a GP first

Before engaging with psychological treatment for health anxiety, it is reasonable to have discussed your symptoms with a GP — particularly if symptoms are new or unexplained. Health anxiety is a diagnosis of psychological presentation, not simply a label applied when no physical cause is found. If a GP has assessed you and considers anxiety to be a significant contributing factor, a referral via a Mental Health Treatment Plan is the appropriate next step.

Treatment for health anxiety is not about telling you that your symptoms are not real. Symptoms are real. The work is about understanding the role anxiety plays in amplifying and maintaining your relationship with those symptoms.

What to look for in a psychologist for health anxiety

• AHPRA registration. Verify at ahpra.gov.au before booking.
• Experience with health anxiety or OCD/anxiety presentations. Health anxiety has specific features (particularly the reassurance-seeking and body-monitoring cycles) that benefit from targeted experience. Psychologists who work with OCD often have particularly relevant skills.
• Familiarity with ERP and cognitive approaches for health anxiety. Ask prospective psychologists what treatment typically looks like for health anxiety in their practice.
• Non-dismissive approach. A good psychologist will take your concerns seriously and work collaboratively — not dismiss your symptoms or minimise your distress.

Our directory of telehealth psychologists for anxiety in Sydney lists registered practitioners offering telehealth sessions across NSW.

Frequently asked questions