PERSPECTIVE
Keeping Dr. Google under control: how to prevent and manage
cyberchondria
The Internet has become the main source of health informa­
tion, which is usually obtained via online health search using rel­
evant engines –­a behavioral pattern also known as “Dr. Google”.
Online health search has had an empowering effect, allowing an
easy access to hitherto difficult-­to-­find health information. How­
ever, it can also become problematic and lead to cyberchondria.
Cyberchondria is an excessive and/or repeated online health
search that is associated with increased distress or health anxiety
and persists despite interference with functioning and negative
consequences1. The latter may include disruptions in the rela­
tionships with physicians and in the usual patterns of seeking and
receiving health care2.
It has been suggested that cyberchondria represents a com­
pulsive form of “problematic usage of the Internet”3, with the key
issue being a precarious control over online health search. This
search is driven by a need to alleviate health anxiety, which how­
ever increases with persisting search, and then spirals out of con­­­­
trol4. Studies have confirmed strong relationships between cyber­
chondria and health anxiety, problematic Internet use, and symp­
toms of obsessive-­compulsive disorder1.
Prevention of cyberchondria may entail improvement in on­
line health information literacy, because people with greater liter­
acy have been found to have lower levels of cyberchondria5. A spe­
cific approach to prevention requires addressing the factors that
increase the risk of cyberchondria, including erroneous expecta­
tions of the Internet, poor coping with information overload, un­
certainty, and confusion about trustworthiness of the sources of
online health information4.
A prevention program needs first of all to clarify what the In­
ternet can and cannot do. It is important to debunk unrealistic ex­
pectations, e.g., that the Internet can provide definitive explana­
tions for all health-­related queries. Accumulation of information
does not necessarily translate to a better understanding or more
knowledge. In the context of online health search, having more
information does not equate to also having an explanation, for in­
stance a diagnosis. Attempting to diagnose oneself via Dr. Google
should be discouraged, because it can spiral out of control, cause
more distress and thus lead to cyberchondria.
Second, an abundance of online health information (informa­
tion overload) during online health search, especially when that
information is inconsistent or conflicting, can lead to a sense of
being “stuck” or losing control whilst performing the search. Pro­
viding education about the effects of information overload and
improving coping with this overload may afford protection against
cyberchondria.
Third, an adequate uncertainty management may also play an
important role in preventing cyberchondria. Online health infor­
mation is often ambiguous and can be confusing, thereby ampli­
fying uncertainty. Intolerance of such uncertainty and trying to
cope with it through further search to arrive at a “closure” (e.g.,
World Psychiatry 22:2 - June 2023
a diagnosis) opens a pathway to a vicious cycle of reassurance
seeking. Therefore, if online health search makes no progress and
seems to only generate distress, the strategy needs to change and
relevant health information should be obtained from an alterna­
tive source, including one’s physician.
Fourth, an ability to distinguish between trustworthy and un­
trust­worthy sources of online health information provides an ad­
ditional layer of security when engaging in online health search.
Health information obtained from reputable sources (e.g., aca­
demic and research organizations or governments) is usually more
trustworthy, although it may be “impersonal”. Health information
found in forums and blogs often reflects personal experience and
may be valuable as such, but it is not necessarily applicable to oth­
ers.
People with cyberchondria usually do not seek help for it di­
rectly, perhaps because of the perception that this is not a “recog­
nized” condition. Instead, they tend to present to clinical services
with hypochondriasis, anxiety disorders, problematic Internet
use or even “Internet addiction”. Largely due to cyberchondria’s
ambiguous conceptual status and its relatively “hidden” nature,
approaches to its management are still in their infancy.
Management of cyberchondria should be based on an under­
standing of each person’s circumstances. In other words, why is
that person presenting with cyberchondria at this particular time?
What precipitated cyberchondria and what is its purpose? Is it a
specific symptom or health concern that initiated online health
search, and is the person primarily seeking reassurance? What
are the consequences of cyberchondria and how has one’s life
changed because of excessive online health search? For exam­
ple, has the person been avoiding his/her doctor or visiting the
doctor too often? Why does excessive online health search per­
sist despite the problems it has caused? Is it because the search
is experienced as a way of coping with uncertainty? Answers to
these questions are likely to shape the management approach
and determine treatment targets.
Common treatment targets in cyberchondria include certain
facets of psychopathology (e.g., health anxiety and obsessive-­
compulsive symptoms), personality traits (e.g., perfectionism,
trust/mistrust imbalance, intolerance of uncertainty, and poor
time management), behavioral responses to anxiety-­provoking or
distressing stimuli (e.g., reassurance seeking or avoidance), infor­
mation management issues (e.g., poor coping with abundant or
conflicting online health information), and specific aspects of
the interactions with computers and the Internet (e.g., unrealistic
expectations of the Internet or assumption that the order in which
the results of online health search are presented reflects the likeli­
hood of these results providing an explanation for health-­related
queries). These targets can be addressed using a combination of
educational and psychotherapeutic approaches.
Existing psychotherapeutic methods can be adapted to treat
233
cyberchondria. One study has demonstrated that a modified
Internet-­delivered cognitive-­behavior therapy (CBT) for hypo­
chondriasis/health anxiety that also addressed cyberchondria
was efficacious in the treatment of both6. In that study, cyber­
chondria-­specific components of CBT included measures that
improved online health information literacy and psychoeduca­
tion about ways of making search productive and avoiding exces­
sive and un­necessary search.
Cyberchondria is increasingly regarded as a public health prob­
lem3, which is uniquely and largely related to its potential to affect
health care. In view of this recognition, developing prevention and
management programs for this condition and testing their effi­
cacy should be prioritized.
Vladan Starcevic
Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
1.
2.
3.
4.
5.
6.
Starcevic V, Berle D, Arnáez S. Curr Psychiatry Rep 2020;22:56.
Barke A, Bleichhardt G, Rief W et al. Int J Behav Med 2016;23:595-­605.
Vismara M, Caricasole V, Starcevic V et al. Compr Psychiatry 2020;99:152167.
Starcevic V, Berle D. Exp Rev Neurother 2013;13:205-­13.
Rogala A, Nestorowitz R. Proceedings of the 37th International Business Infor­
mation Management Association 2021;6222-­9.
Newby JM, McElroy E. J Anxiety Disord 2020;69:102150.
DOI:10.1002/wps.21076
The Wellcome Trust: new funding for mental health science
The Wellcome Trust is one of the world’s largest health research
funders. The charity has committed to spend £16 billion over the
coming decade (2022-­2032) on just four priorities. First, to fund
curiosity-­driven basic research on any topic that advances under­
standing of life, health and well-­being, through thrice-­yearly open
schemes available to researchers at different career stages. Sec­
ond, third and fourth, to address three global health challenges
that are in urgent need of scientific solution, where Wellcome
funding and convening can have maximum impact: infectious
diseases, climate and health, and mental health. The fact that
mental health is one of these priorities makes Wellcome poten­
tially the largest independent funder of mental health research
globally. We seek to use this position to advance our vision of a
world where no one is held back by mental health problems.
We wish to encourage mental health researchers to apply for
all forms of Wellcome funding to help make this vision a reality.
They can do this through our regular researcher-­driven curiosity-­
led schemes, where applications can be on any aspect of mental
health or neuroscience. Proposals must be led by a researcher in
the UK or a low-­or middle-­income country, but can involve col­
laborators from all countries across the world. Researchers could
also consider applying to specific calls related to infectious dis­
eases or climate and health where relevant, which are generally
open to the global community.
We also wish researchers to consider applying for our targeted
Mental Health Awards, which are designed to advance Well­
come’s specific mission to create a step-­change in early inter­
ventions for anxiety, depression and psychosis. Applications for
Mental Health Awards are generally open to researchers in any
country globally (with the exception of those not permitted by
national policy or UK sanctions) and at any career stage.
Over the next few years, we plan to run two Mental Health A­­­­
wards per year. These will be on key topic areas where Wellcome
feels that bold science may lead to breakthroughs in relation to
its mission. Awards launched so far (now closed) focused on new
ways of addressing cognitive deficits in psychosis; research to
­illuminate the relationship of sleep and circadian rhythms with
anxiety, depression or psychosis; and back-­translation projects
234
designed to understand how effectively treatments work for one
or more of the target conditions. Details of Mental Health Awards
planned up to 2024 are available on our website (https://wellcome.
org/what-we-do/mental-health).
We are committed to meaningfully involving people with lived
experience of mental health problems in our work. Within our
mental health team, lived experience experts shape our govern­
ance, direction, decision-­making and daily work. Our team of
lived experience consultants includes people based in the UK,
Rwanda, Kenya, South Africa, Indonesia, India and Australia.
Unless in exceptional circumstances, we require lived experience
to be a key part of everything that we fund.
To achieve our mental health mission, we fund with the inten­
tion of advancing three goals: a) better understanding of how the
brain, body and environment interact in both the development
and resolution of the target mental health conditions; b) bet­
ter ways of identifying and grouping (stratifying) people with, or
at risk of, these conditions, so that we can provide more timely
and personalized interventions; and c) new and improved ways
of intervening at the earliest possible stage in anxiety, depression
and/or psychosis.
Below we share some examples of projects we have funded so
far. These by no means represent a comprehensive review of our
portfolio, but are intended to give a flavour of the diversity of pro­
jects with potential for achieving our goals.
To advance basic understanding, we need to unpick the com­
plex interplay between biological, psychological and social deter­
minants of both the origins and solutions to mental health prob­
lems. This includes an interest in the collection and analysis of
longitudinal data. We have funded Sage Bionetworks, US to lead
a collaboration testing different models of stewardship for men­
tal health data in the UK, South Africa and India. We are funding
Prof. L. Kenny from the University of Liverpool, UK to supplement
a new cohort to collect microbiome data at birth in the UK, with
follow-­up to assess impacts on anxiety and depression at later
stages. We have also commissioned a global mapping of large-­
scale longitudinal datasets relevant to our focus worldwide to en­
courage use by mental health researchers and to consider oppor­
World Psychiatry 22:2 - June 2023