“I’m sure it’s something serious this time”

Health anxiety (often with generalised anxiety disorder) presents as repeated normal investigations, fleetingly-effective reassurance, bodily checking and catastrophic interpretation of benign somatic symptoms — and the trap is to order another scan or refer for "certainty", which reinforces the cycle. The skill set: VALIDATE that the symptoms are real (anxiety genuinely causes palpitations, paraesthesia from hyperventilation, tension headaches and fatigue — she is not imagining it), explain the mechanism confidently, and gently NAME the reassurance/testing cycle (brief relief, long-term maintenance) without dismissing her or refusing to assess genuinely new red-flags. The examinable hidden agenda is the trigger — a close friend’s sudden death — which shattered her sense of bodily safety; surface it, connect it, screen mood/grief, and redirect to treatment in line with NICE CG113 stepped care (CBT adapted for health anxiety through NHS Talking Therapies, psychoeducation on checking/Googling/reassurance-seeking, sleep, consider an SSRI — sertraline first — if she chooses medication). Avoid both poles — dismissiveness ("nothing wrong, stop worrying") and collusion (endless scans) — and safety-net proportionately with specific new red-flag symptoms so she is treated, not abandoned.