When the urge comes

You can agree with every chapter so far and still find your thumb typing the symptom at ten to eleven. The urge to search is strong, and it's had a lot of practice. This chapter is about the minutes when it arrives. Most of it follows the NHS's self-help advice for health anxiety, and I'll say which parts are mine.

Start by knowing what the urge is. It's a spike of anxiety with an action attached. The action promises to bring the anxiety down, and chapter 5 explained why the promise is only half kept. What the urge doesn't tell you is that the anxiety will come down anyway. Left alone, a spike of worry rises, levels off and falls. How long that takes varies, and I've no measured figure to give you. You can find out by timing it once. Searching brings the worry down sooner, but it means you never find out that it would have come down without the search.

Delay. This one is mine. When the urge comes, tell yourself you can search in twenty minutes if you still want to. You aren't forbidding it. Then do something else for those twenty minutes that uses your hands or your attention. The NHS advice is similar. When you get the urge to check, it says, distract yourself by going for a walk or calling a friend. At ten to eleven that might mean getting up, making a drink without caffeine in it, and reading a chapter of a novel in another room. Often the twenty minutes pass and you find the urge has dropped enough to go to sleep.

The diary. It's the NHS's first suggestion. Note how often you check your body, ask people for reassurance, or look at health information. Then try to reduce how often you do these things gradually, over a week. The note can be a tally on a card, with a mark for each search, each body check and each time you ask someone whether it looks all right. Counting makes you notice the habit while it's happening. It also lets you see yourself improving, because a week with nine marks is followed by a week with six.

The two-column table. This is also from the NHS. In the first column you write the health worry. In the second you write a more balanced thought. Their example has "I'm worried about these headaches" on one side and "Headaches can often be a sign of stress" on the other. The second column isn't there to convince you that you're well. It reminds you that the ordinary explanation exists, which is the one the search passes over.

Where the phone sleeps. This one is mine. Most searches happen in bed. If the phone charges in the kitchen, a search at ten to eleven requires getting up, walking through a cold house and standing at the worktop, and you'll do that far less often. An alarm clock costs a few pounds.

The people you ask. If your partner has become part of the pattern, tell them what you're doing and ask for a specific change. When you ask whether the mole looks bigger, they shouldn't answer the question. They can say, "What did the page say to do, and have you done it?" It will feel unhelpful to both of you at first. But they've had months of answering the question, and you both know it didn't help.

Checking. If you've been testing the leg or pressing the spot or looking at the mole every day, treat it as you treat the searching. Count it and cut it down. If the NHS page says to keep an eye on something, decide how often is sensible. Once a week at a set time is plenty for nearly anything a page tells you to watch. Do that and no more.