by Michael D. Anestis, M.S.
What if I lose my job? What if I get sick? What if North Korea launches nuclear weapons? What if my dog runs away? What if somebody makes fun of my child? What if I get fat? What if I lose my wallet? What if...what if...what if....
We all worry from time to time. For some of us, it is an infrequent nuisance that ultimately causes very little long term stress or impairment. For others, particularly those diagnosed with generalized anxiety disorder (GAD), worry is a constant burden that leads to physical, psychological, and social upheaval. For some individuals, worries bounce from topic to topic without any clear cause. For others, worries are focused on one primary issue (e.g., financial distress). Some individuals believe their worrying is uncontrollable and others believe it is an important tool for motivation. All individuals who worry, however, experience the phenomenon as highly aversive.
Researchers define worry as a thought style that focuses on potential undesirable future outcomes (MacLeod, Williams, & Bekerian, 1991). Because it is accompanied by the psychological and physiological symptoms of anxiety, worry can lead to fatigue, insomnia, and other problematic outcomes. The concept of worry is very similar to rumination, which we have covered in numerous prior PBB articles; however, one key difference is that worries tend to focus on events that have not yet occurred whereas rumination involves dwelling upon the past.
Generally speaking, worrying is an unproductive enterprise. Nonetheless, much like with rumination, individuals who engage in this type of thought often believe that their worry is an important problem solving tool or a key factor in preventing problematic outcomes. This distorted belief is reinforced by the fact that the things people worry about rarely occur, and individuals frequently make the mistake of interpreting this fact as a sign that their worrying played a role in the outcome. In other words: I worried, my feared outcome didn't happen...looks like my worrying did the job. Of course, the outcome would not have occurred even if the individual had not worried, but negative reinforcement can be driven by expectations.
For some individuals, worry is seen as important because they believe it represents an effort on their part to give due attention to important topics. In this sense, shifting thoughts towards other topics comes to represent laziness or an unwillingness to face important but difficult situations. In this case, individuals essentially become defensive about their worrying and are upset by others' attempts to get them to diminish the behavior.
Clinicians are thus faced with a difficult situation in their attempts to reduce worries in clients. Quite often, clients either believe that their worrying represents a vital problem solving technique or that worrying is beyond their control and outside the bounds of therapeutic interventions. Simply telling individuals not to worry will not serve to overcome these obstacles, so an alternative approach is needed. In cognitive behavioral therapy (CBT) for GAD, such an alternative exists.
Paradoxical as it seems, CBT therapists encourage their clients to schedule "worry time" every day. Oftentimes, the plan will be for the client to schedule 30 minutes of worry time each morning. Outside of this 30 minute window, the client is told to acknowledge that there is a topic that prompted worry, but to delay that worry until the next scheduled worry time. In this sense, they are not ignoring the topic, but rather allotting a specific time for it during the day. When the worry time window arrives, the client is to sit down and do nothing but worry for the entire span. Sounds awful, right?
What makes this approach useful is what actually tends to happen once the client embraces the approach and implements it into their daily routine. First of all, the client learns that, even though worrying seemed uncontrollable, they were able stop worrying and delay the process until a later time. As such, one distorted belief - that worry controls them rather than vice versa - is challenged. Additionally, despite the belief that there is an infinite number of worries that could not possibly be covered in a mere 30 minutes, most clients find themselves bored no more than 10 minutes into the worry session. At that point, they realize that they are going over the same topic(s) repeatedly and that the worries are not as strong or anxiety provoking as they had seemed before. In this way, the client realizes that they generally tend to worry about one small set of topics and that, when worrying is delayed, the urgency of those thoughts diminishes substantially. By having scheduled worry time, the client is giving the worry inducing topic its due attention, but by delaying it, they come to realize that it was not as pivotal as it had once seemed.
Worry time helps clients learn to take control over their own thoughts and to challenge their distorted beliefs about the importance of worry and their ability to control it. If a topic truly requires concern, it will still be anxiety provoking when worry time comes around and the client can work to enact a specific plan to adjust to those circumstances. Most worries, however, will not have this impact and, as a result, the client will find themselves with a new sense of calm in their lives and a greater ability to handle ambiguity.
If you would like to learn more about the nature of worry and empirically supported methods for controlling it, we recommend the following resource and encourage you to consult our online store. Additionally, we recommend that you consult the website for the American Institute for Cognitive Therapy.
- The Worry Cure: Seven Steps to Stop Worry from Stopping You
- by Robert Leahy, Ph.D.
Mike Anestis is a doctoral candidate in the clinical psychology department at Florida State University
Subscribe in a reader
