Have you ever suffered from a physical illness, which has had lots of physical symptoms, had treatment to clear it up, but still not felt “quite right”? Many illnesses can leave us feeling very tired afterwards, and very nervous about certain symptoms persisting or returning. This isn’t unusual but it can be incredibly frustrating and debilitating. For many years I have had bouts of cystitis which follow exactly that pattern. I experience the heartsink feeling of trying to tell myself I don’t need the toilet at 2am whilst knowing that I am going to need anti biotics to clear it up as soon as possible. Fortunately, the treatment usually works, and I gradually feel more comfortable. But the feeling of needing the toilet or the fear of being out and being “caught short” can persist for many days after the doctor has told me that the infection has gone. It hangs around and will make me feel very anxious, tense and worried that I am still ill.

With longer illnesses this pattern of experiencing symptoms once the main cause has been successfully treated can greatly interfere with someone’s ability to get on with life again.

Vertigo is a good example of this. Labyrinthitis is an infection in the inner ear which causes balance problems for the sufferer and can produce constant feelings of dizziness, nausea and vomiting for weeks. These symptoms can understandably make someone quite incapacitated. However, many people find that once the infection has been treated, they still experience dizziness, brain fog, nausea and other physical symptoms. It can cause anxiety about going back to work, driving, being in public places and other worries. In fact, these experiences become a form of health anxiety and are much more fuelled by psychological responses rather than infection-related biological responses.

This happens because our minds start generalising the symptoms. If they have been unpleasant whilst we have been ill, we get tuned in to look for them – trying to check if they are still there. We become hypervigilant, and can even “test” ourselves a lot: “Do I still need the toilet? Am I sure about that?” “Can I walk in a straight line without falling over or is my balance still bad? If I swivel my head quickly will I feel sick?”

We inadvertently keep checking ourselves and generally, the more you look for a sensation, the more likely you are to feel it. Panic attacks can develop from these behaviours and people start avoiding everyday things which would  provide distraction, so a vicious circle of hypervigilance, sensation and avoidance happens.

To help calm these feelings down, try to focus on regulating your breathing and notice what happens to symptoms when you are relaxed and breathing properly. Look for times when the symptoms ARE NOT around rather than when they are. If you are watching a good programme, enjoying time with a good friend, engrossed in a project or concentrating on work, are the symptoms still there, or do they calm down and go away? If they go away when you focus on something else, or are distracted, it’s a sign that the physical symptoms you get are more psychological, because your brain has got sensitised to look for them. All of these tips should gradually help your mind to understand that you have control over your body again. The symptoms should calm down and go away, leaving you to get on with your day again.

If it is hard to get over it on your own, cognitive behaviour therapy can be very helpful to tackle this problem – please don’t feel you have to “just put up with it”. There is help out there for this type of problem so do talk to someone about it.

Dr Sue Webb
Chartered Clinical Psychologist
January 2023