The Anxious Patient Needs Psychosomatic Primary Care

Horst Gross, MD

May 19, 2022

A balance between fear and relaxation is normal. However, mental dispositions and the continuous influence of environmental stimuli can disrupt this balance. A failure in therapy can often conceal unvoiced fears.

This article is based on the lecture "State of the Art: Treating Anxiety Disorders" by Christian Albus, MD, director of the Clinic and Polyclinic for Psychosomatics and Psychotherapy, University Hospital Cologne, Germany, at the 128th conference of the German Society of Internal Medicine.

Hidden Fears

Poor compliance often has a simple cause: the patients are scared. They are afraid of bad news, for example through further investigations. Taking tablets regularly reminds them over and over of their threatening problem. Those affected rarely speak about these delicate issues of their own volition, said Albus. But latent fears are no trivial issue, as cardiologic investigations have proven.

Cardiac Prognosis

A third of those affected by acute coronary syndrome (ACS) subsequently suffer from long-term anxiety disorders. The fear that they will relive their experiences overshadows their zest for life. As a result, signs of clinical depression can be detected in 50% of patients with ACS. Posttraumatic stress disorders have even been observed in up to 30% of patients. Fear also exacerbates the prognosis. Patients suffering from heart attack and subsequent cardiac failure demonstrate a significant correlation between stress and increased mortality.


The fact that we are living in an age of fear is influenced by technological advances. Dr Google is the first source to be consulted for almost a half of adults who need their symptoms explained. Well-informed patients improve patient–doctor communication. But unfortunately, many people are becoming addicted to searching for diagnoses and symptoms online. Primarily harmless symptoms are associated with catastrophic diagnoses. Regrettably, Google's search algorithm also increases this tendency. If someone starts to look for serious diseases, Google will show you these sorts of potential catastrophes on an ever more frequent basis. Google ultimately orients itself around the interests of its users. The result is a spiral of fear that can cause illness.


Compulsive searching on the internet for more and more new dangers to health has now developed into its own medical condition, termed cyberchondria. The therapy is strict internet abstinence. The gross exaggeration of health problems by the media also contributes to this. This is because it's not just sex that sells, but also fear. The current example is long COVID. In the much-cited Gutenberg study, over one half of coronavirus patients subsequently exhibited the typical symptoms: fatigue, concentration disorders, and breathing issues. Most media ignore the crucial detail that the same problems were also registered in 40% of the coronavirus-free control group. Albus points out that it's no wonder that so much fear is being spread by long COVID.

The First Step

Responsible medicine must counteract these developments. The first step is actively to address the fear problem. Patients who seem tense benefit enormously from the simple question, "How are you otherwise?" This question may open doors. Suddenly, patients begin to talk about their anxieties and fears. Of course, this approach to patients is time-consuming. Still, this time must be taken, said Albus. In a survey of oncology patients, the majority reported that none of their physicians are ever interested in their emotional state. This is a sign of inadequate care, since psychosomatic primary care should be a standard nowadays in every specialty.

This article was translated from Coliquio.

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