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Every afternoon, I slide a thermometer under my tongue until the metal tip is pressed into my lingual frenulum (the piece of skin connecting your tongue to the bottom part of your mouth). If the thermometer moves around too much, I start over. If the initial reading seems high, I wait a few minutes and try again. I usually take my temperature again before bed too, just to see how my body’s doing. 

I didn’t even know I owned a thermometer until about six weeks ago, when I found a dinky $2.99 one in my medicine chest. I also didn’t used to periodically sniff items in my fridge to confirm I could still smell. But then a chorus of ambulance sirens became the soundtrack to New York, and I became acutely aware of itchy eyelids, indigestion, charley horses and all other unpleasant or unfamiliar physical sensations — including, one time, a sore lingual frenulum.

When it comes to preventing and detecting COVID-19, we’re our own first line of defense against a highly contagious disease that we don’t understand well and don’t yet have any vaccine or treatment for. In this situation, according to experts, it makes sense to have some anxiety about your health and be more attuned to potential signs of illness as a result. Feeling anxious can be an adaptive response that motivates us to go through the rigamarole of disinfecting groceries and seeking medical attention. But adaptive anxiety stops being adaptive if it gets in the way of the important stuff — sleeping, getting your job done, singing show tunes to your dog, etc. Fortunately, we have effective strategies to manage anxiety related to health, whether the problem is situational or rooted in a preexisting condition.

So if you’re a little more reactive or neurotic than usual, your brain’s just doing its job. And if your googling sprees are reaching deeper and deeper into the night, you can do something about it.

What is health anxiety, exactly?

Health anxiety is a general term, not a diagnosable condition. There are formal disorders characterized by anxiety and/or obsessive behavior related to health and sickness, but the clinical language is still evolving. The most widely known term, hypochondria, has actually been phased out. Instead, the DSM-5 (the bible of mental health conditions) splits hypochondria into two disorders: Illness anxiety disorder (IAD) and somatic symptom disorder (SSD). IAD, the closest analog to hypochondria, is characterized by worrying about being ill despite having no symptoms. With SSD, the worry is that harmless bodily sensations indicate a serious illness.

Emily O’Bryan, a postdoctoral fellow at the Anxiety Disorders Center at the Institute of Living in Hartford, Connecticut, thinks of health anxiety as existing on a continuum; it “ involves excessive worry about having or acquiring a serious illness or disease and can range in severity from mild to severe.” O’Bryan, whose research focuses on identifying and targeting risk factors for health anxiety, says that someone with severe health anxiety may be diagnosed with IAD or SSD, depending on the presence of symptoms.

Health anxiety also overlaps with obsessive compulsive disorder, says Dr. Peter Tyrer, a community psychiatrist at Imperial College London. Highly health-anxious people often engage in hypervigilant behaviors, such as repeated hand-washing or compulsive symptom-checking.

Cyberchondria, another term related to health anxiety, means compulsively searching for health information online. It’s not a diagnosable condition either, and experts describe it in a few different ways, including as a form of hypochondria, a potential symptom of several different anxiety disorders and a generally unhealthy activity that can fuel anxiety.

If you weren’t especially anxious about your health until the coronavirus came along, then the coronavirus isn’t going to cause you to develop IAD or SSD, which require at least six months of persistent symptoms for a diagnosis. “Core health anxiety tends to persist, as sufferers regard themselves as the only true monitors of their health and trust no other,” says Tyrer. 

But you can still experience health anxiety that’s not attached to a disorder. “Many people can have brief episodes of health anxiety after the trigger of another physical illness, or indeed with impending COVID-19, and these resolve quickly when the threat disappears,” Tyrer says.

How anxious is too anxious right now?

Part of what makes the current situation nerve-racking is the amount of uncertainty we’re required to tolerate: We’re supposed to use common-sense measures to protect ourselves from catching and spreading a virus that doctors and scientists are still just learning about. The facts on how and how far it can spread, for instance, seem to change weekly.

We’re also supposed to monitor our health and get in touch with a doctor if we develop COVID-19 symptoms. This isn’t necessarily a straightforward task. While the hallmark symptoms, like fever, dry cough, shortness of breath and fatigue, are the most common early signs of infection, they’re not the only ones. Pink eye, diarrhea and others are on the list too. And if you do suspect you have COVID-19, you may not be able to get a definitive diagnosis unless you become sick enough to require hospitalization, which can bring its own sets of anxieties. 

Given the circumstances, it’s understandable to have concerns about being ill, says Michelle Pargman, a licensed mental health counselor in Jacksonville, Florida. “Depending on how much we are inundating ourselves with the news, and to what extent we know others with the virus, it is incredibly common right now to feel alarmed about our health status,” she says.

Pargman says she’s noticed increased awareness of bodily symptoms. “Personally and professionally, I certainly have experienced more acknowledgment among people in general that they are more acutely aware of aches, pains, breathing and GI issues.”

That’s not necessarily a problem. Mild, adaptive anxiety about getting sick can propel you to take critical safety precautions like washing your hands as often as you should or MacGyvering a T-shirt mask. “If I wasn’t at all worried about COVID-19, I’d be engaging in more risky behaviors,” says O’Bryan. “However, worry can become excessive, even in the context of a pandemic. Excessive worry can have costs, including distracting people from what they value and unnecessarily increasing distress.”

Stephanie Woodrow, a therapist in Washington, DC, who specializes in anxiety disorders, says that anxiety becomes maladaptive “when it interferes with us doing what we want to do [and exceeds] what most others experience in a given situation.” (Meanwhile, Tyrer says, “Some people I know who have been chronically health-anxious have been saying to me, ‘I feel more normal now, as everyone I see now is feeling the same as I have done for years, and that’s quite reassuring.’”)

“If a person is concerned about contracting COVID-19 but can still work from home, engage with family at home or friends over the phone, and get pleasure from activities such as watching a movie or reading a book, seeking professional help is probably not necessary,” Woodrow says. “However, if a person cannot focus on other things, it might be time to reach out to a therapist.” 

While nonemergency in-person care is limited right now, teletherapy has never been more accessible. Psychiatrists and therapists have a number of tools at their disposal to treat health anxiety. The most common approach is cognitive behavioral therapy. This results-oriented method helps people understand and reframe their disordered thoughts and then form new behaviors. When appropriate, therapists may use other methods too, including exposure and response prevention, which involves confronting obsessive thoughts surrounding fears of illness, and acceptance and commitment therapy, which helps people accept negative thoughts but change how they react to them. 

You can also try to manage health anxiety on your own. Some helpful DIY tips happen to be core tenets of CBT, although some therapists strongly recommend doing CBT with a professional to guide you. O’Bryan says the same treatment methods and anxiety-relief strategies are applicable across the health anxiety spectrum, whether someone has IAD or is a new member of the “worried well.”

• Crowdsource: A helpful first step is simply talking to friends or family members to see how anxious they feel, and what they’re doing to monitor their health, says Carla Manly, a clinical psychologist in Sonoma, California. Is your level of anxiety out of whack with theirs? Do your habits seem a lot more extreme? During such unusual times, checking in with other people can help clarify where the new normal is. 
• Step away from your internet browser: This is a CBT staple. Choose one or two reliable sources of COVID-19 information and limit the amount of time you spend consuming news. Think minutes, not hours, says Woodrow, who recommends just 10 minutes each day: “Anything more is feeding into the fear.”
• Make a plan: Identify what you’re concerned about, and then come up with a plan of action for the relevant scenario(s). “If you are worried about getting tested, develop a plan in case you need to be tested,” says Steve Sultanoff, a clinical psychologist in California. If you’re scared of getting COVID-19, figure out what you’d do in that situation — do you have a doctor? Do you have all your health insurance info ready? Do you have someone who could drop off groceries, or take out your dog or otherwise help out if you’re laid up? The goal here is to do what you can, realistically, to prepare yourself to face the threat, so that you learn to accept what isn’t within your control.
• Get mindful: Set aside some time each day for mindfulness exercises, such as progressive muscle relaxation, to help you manage stress and focus on what you can control, rather than everything you can’t. This is also a good way to increase self-compassion, which has well-documented health benefits (learn more here).
• Be actively grateful: Research shows that practicing gratitude can help relieve stress and anxiety. Pargman suggests writing down three things you’re grateful for each day. Try not to use the same ones twice.
• Help out, however you can: Altruism can help relieve anxiety by helping you shift focus away from yourself and onto the positive impact you can make. Even now, Pargman notes, there are plenty of ways to volunteer, including virtually.

I’ll admit it: Meditation is not my strong suit, and I can be a tad close-minded when it comes to things like gratitude journaling. But if there’s ever been a time to embrace a “why the hell not” attitude, and challenge my natural eye-rolling instincts, it’s now. So, in addition to doing online workout classes, replete with hashtaggy mantras, I’m trying to be more present, grateful, centered and so on. Above all else, I’ve found it exceptionally helpful to do two things: 1) remind myself how privileged I am to have good health insurance, good overall health and the option to stay home, where I can do my job without risking coronavirus exposure; 2) find ways to help people who aren’t in the same boat.

Also, I’m still pretty attached to my thermometer, but we all have our things.

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