Anxiety & Worry
Written by Dr Mieke Garrett | The Stress & Anxiety Doctor
Based on theory developed by Adrian Wells (Metacognitive therapy) & Aaron T Beck (CBT)
Worry can be a huge pain. We often use the terms "worry" and "anxiety" somewhat interchangeably. To be clear, worry is an active thought process. Something we deliberately (whether we know it or not) engage in, in the form of words and/or images. Anxiety is an emotion, often experienced in a strong physical capacity, which can be a result of worry.
Worry (in my words) is the process of engaging with fearful thoughts, and thinking about them over and over. In this handout I am talking about worry in general terms; the type where you worry about a range of subjects and things that may or may not happen in the future. There are other more specific worries and it’s important to note that phobias, panic, health anxiety, and social anxiety amongst others are all treated slightly differently. This handout focuses on generalised worry.
Worry can start to feel pretty constant, causing all sorts of issues such as knotted, sore stomachs, tight chests, tension, tears and more. It makes our minds foggy and we feel overwhelmed and more and more out of control. We imagine all of the things that we most fear happening, sometimes in vivid detail and with a real sense that these things could be a very likely and devastating eventuality. For example, worry could be centred around something bad happening to you or your family in terms of health, accidents, or finances. For others, worry could be about literally anything, and more often than not it encompasses a range of topics. So why do we do it??
First let's note that we ALL experience worrying thoughts. Some is normal and natural and necessary. It's natural for us to be on the lookout for threats, and to want to plan for them and try and prepare ourselves or avert them. We don't WANT undesirable things to happen and if we can exert some control over that, we most likely will. It's a modern day survival mechanism; particularly unique to humans thanks to our frontal lobes (the part of our brain at the front of our head involved in high order tasks such as planning ahead, multi-tasking, & problem solving amongst other things). Modern society too is equipped with many things that stress and worry us, such as juggling bills, disease awareness, cars and traffic accidents, crime and more. Not only do we deal with these things in the here and now but our frontal lobes allow us to imagine and predict what might happen with these things in the future, creating anxiety about things that haven't even happened yet (that is what anxiety stemming from worry is, after all - an emotion about things that may or may not eventuate in the future).
We all experience these stressors, threats, and worries to varying degrees. Some of us feel a bit anxious when we encounter them, but then for various reasons can carry on without getting too caught up in it other than doing what needs to be done practically. They can also often have periods of relaxation, contentment, and happiness even with some unresolved worries lingering in the background. They have found a way for both emotions to exist at the same time. Conversely, other people are prone to be strongly affected by their worries and get caught up in a real struggle.
People who worry a lot tend to be unable to tolerate ANY degree of uncertainty, or not knowing. Any small "what if" is completely unbearable, particularly if that "what if" is related to something very important to them, such as a loved one being in a car accident. The chance of it happening might be completely minuscule, but the thought of it is so awful that any chance is too much chance. In addition to this they tend to grossly over-estimate the threat of something going wrong and under estimate their ability to cope with it if it does go wrong. Honestly, you can't avert every single disaster but you might just find you surprise yourself if a feared outcome does happen with how you manage to cope, get through it, and become stronger for it even if it is very challenging.
In addition, the feeling of anxiety itself is not one these people find they can just sit with. They have an almost allergic response to it, like an itch that must be scratched or dealt to in some way. On a small scale, some people in my life remind me of this. When they get home from work, they are completely unable to relax if there are chores that will need doing at some point in the near future. To them, everything must be done, sorted and tidied before they can relax, otherwise it "plays on their mind". This is a good example of not being able to tolerate this discomfort, let it hang around in the background, and co-exist with other emotions such as relaxation. Learning to live and relax and enjoy life even when everything is not sorted or resolved, is key. Also knowing that you don’t have to feel happy or relaxed all (or even most) of the time can help. When you truly develop an understanding that happiness, anxiety, stress, relaxation, feeling down, and contentment can all co-exist at the same time, you will hold a very powerful tool indeed.
When someone with a tendency to worry excessively, and experience a lot of anxiety, encounters a "what if" thought (in other words, a worry, of which we have many pop into our minds each day), they generally do one of two things. They are often unaware they are even doing these things though, as they happen so automatically, and so quickly. These two things amount to this: They either engage with the worry excessively, or they try & get rid of it excessively. Let me explain these in more depth.
Unhelpful response #1 = Engaging with the worry
The first response mentioned above is to engage with the worry. They think "right, here's a worry. It makes me really anxious, and it would be terrible if it came true, so I better do what I can to stop it from eventuating." Or, they recognise it's a bit unrealistic and they logically know they are worrying excessively and can't do anything about the actual feared event, so they try and reassure themselves one way or another in order to feel better, for example by thinking it through in detail and trying to argue with the various points. If I was worried about losing my job for example, I might run through in my mind all the things I'd recently done wrong at work, and try and work out if they really were that bad, or if anyone noticed, or what the worst thing that might come of that might be. We do this under the guise of thinking it will
- Make us feel better
- Help us be better prepared
- Help problem solve
- Find us evidence that disconfirms our fears and reassures us
- Give us more control
- Catch or stop something bad happening / something going wrong
...and so on.
In other words, we think worry is a good idea. We think, if we can just work through each worry, we will come out the other side with it gone, feeling reassured, able to move on and forget about it.
There are several problems with this. The main one being, it doesn't work- or you wouldn't be here reading about how to address your tendency to worry too much! I am confident that you have given engaging with your worries a good go, and if you could have made it work so that you did feel better from it, you would have. But it doesn't make you feel any better; in fact it probably, almost certainly, makes you feel worse in the long run - do you know why? Firstly, worries by their nature are not solvable. They are things that have not happened yet. You can sometimes do some preparation for various eventualities. But beyond this, you cannot do more. If you are worried about someone breaking into your house, you can install better locks and alarms. You can store your valuables in a safe. You can back up your photos. But, worrying each day about what if they broke in and how terrible that would be is not going to add anything. There is only so much you can do and beyond that you are using up valuable energy with no extra outcome. This leads to the next issue - worrying about all the "what ifs" makes the worry snowball. Soon, you are not only worrying about being robbed, but also being attacked while you are at home, your loved ones dying, losing all your possessions, being too traumatised to work, losing your faith in the whole human race even more than you already have, and how you will be broke forever and never recover. By asking yourself "what if" and trying to resolve it in order to feel better, you are creating more and more "what ifs", each one more terrible than the last. Finally, if, by some miracle, you were able to solve a worry, do you think you would be happy, finally able to relax? No. The nature of worry is that the next worry will then just come up. Then the next. No matter how much you believe you just need to work through THIS particular worry, trust me. They will never leave you alone. You may notice, that the more you try and gain control and relief, the more out of control and anxious you feel. There are countless uncertainties in life. Rather than trying to address each one, and rationalise the reasons you won’t be burgled, your attention needs to shift to changing the process by which you respond to such worries, such that you do not give them so much of your time. Of course, this is going to involve a degree of sitting with and tolerating an uncomfortable feeling of anxiety at first. But, over time, this is going to result in less anxiety, not more, which is what you’ll currently be experiencing if you engage with your worries.
So, the remedy for excessive engagement with your worries is two-fold.
First, it’s important to learn how to sort worries from problems. They are different things.
Second, you need to learn how to solve the problems you can solve (and what's stopping you doing this), and then let worries that you can't solve go. Letting worries go is something I’ll address at the end of this handout.
Sort your problems from your worries
For argument’s sake, here is an example of a problem and a worry for you to check these criteria against.
Problem: I have run out of petrol and money and have no way of getting to work tomorrow.
Worry: What if I get in a car crash on my way to work?
- Are focused on the here and now - Are often “what ifs”
- Are within your control to do something - Are future-focused
about (even if it’s not your preferred outcome) - Are often worst-case outcomes
- After generating some options have - Go around in circles when
a clear plan or solution generating potential solutions
- Often make you feel more certain and clearer - Make you feel more uncertain
after solving them & worse the more you think about
Problem Solving 101
This is a format you can use to address any problems. Not worries.
… Although the example below may be one you don’t relate to, I’ve chosen it as a straight forward clear example to outline the process. Try this with one of your problems, even a more complex problem; you may be surprised how helpful it is writing it out, especially if you don’t ordinarily do this.
You can tailor this using the structure as a starting point to fit your needs. For example you might decide to do pros and cons of every option even the “silly” ones. Or, you might decide to give each pro and con a weighting out of 10 and add them up to produce a net score. Have a play with the structure and come up with one that works for you.
1 Define your problem
2 Generate all potential solutions
3 Write out the pros and cons of your favourite solutions
4 Choose your final solution
5 Make a plan & then review
I need to get to work by 8am tomorrow and my car has no petrol.
I have no money to put petrol in it until Thursday.
2. Potential Solutions (even “silly” ones):
- Quit my job
- Call in sick
- Ring & explain the situation to them
- Ask workmates for a ride
- Ask online in my suburbs facebook group if there is anyone
in my area going that way I can carpool with
- Borrow money from a friend
- Take a bus
3. Pros & cons of favourite solutions:
- Ask workmates for a ride
Pros: I know there is someone in my area who would be happy to take me
It would be a really easy & convenient solution, and free
Cons: I feel embarrassed asking them
They leave work at a slightly different time to me
- Borrow money from a friend
Pros: I’d be self sufficient in terms of getting there
I can go & leave when I want
I’d have petrol to go to the supermarket too
Cons: I feel embarrassed asking for money.
I’m worried they’ll think less of me.
- Take a bus
Pros: The bus is only $5 and I think I can find the coins for that around my house
I don’t have to ask anyone for anything
Cons: It’s a bit of a walk
It’s inconvenient if it rains
I have to stick to the bus timetable rather than my own
4. Final solution
Borrow money from a friend.
5. Make a plan then review
This has the most pros that are of most value to me.
I will likely feel embarrassed but I know that there are valid reasons I don’t have petrol or money at the moment. I also know this friend will understand.
I can either pay him back or I can do another favour in return.
… After carrying this out I will review how successful it was.
If it doesn’t work out, I will go back to my options in Step 3 and work through another.
Remember: What to do with unsolvable worries is detailed more at the end of this handout.
Unhelpful response # 2 = Trying to get rid of the worry
We've been talking so far about giving our worries too much attention because we think that is going to be helpful in some way. The other response to worry that gets us in trouble, is the flip side of this: trying to get rid of worry. It is ironic that we often hold both views at the same time- that we both need worry and need to get rid of worry. So sometimes we think about it heaps, and other times, often when this gets too much, we try to make ourselves stop thinking about any worries at all. It is understandable too, that we would think we need to get rid of it. Worry and anxiety are not pleasant, and can get to a point where they feel both dangerous and uncontrollable and we can develop fears (or worries) about the worry itself. Many people worry that worry and anxiety will cause physical harm to them if not kept under control, or that it might cause mental harm. It is not uncommon to fear that one might "go crazy" from worry. People also become afraid that their worry will become progressively more out of control; that it will take over, escalate to a point of overwhelming them completely; and will never stop.
The thing is, worry is neither dangerous, nor uncontrollable. However if you believe that it is, you will spend a lot of time fighting worry and trying to get rid of it. The problem with fighting worry is that the more you do this, the more it will increase. An analogy we often use in psychology is trying to not think of a “pink elephant”. You’ll find that if you think of the pink elephant, then just get on with your day, without it mattering whether the pink elephant is in the back of your mind or not, it will just sit there and not become much of a focus. If the pink elephant does come to the fore of your mind, it simply doesn’t matter, and because of this, it remains a fairly uneventful presence when it does surface. However, if I told you that you mustn’t think of a pink elephant under any circumstance, for the next few minutes, and that if you do think of it there will be dire consequences, then you’ll instantly start to feel anxious. The very nature of trying not to think about it means it will become your focus, and you’ll start to think about it more. The more you push it out of your mind, the more you have to pay it attention, and the more it will come back. Trying NOT to think of something and completely empty it of your mind doesn’t work. In order to be successful at this, you’d have to keep your brain absolutely constantly occupied and distracted, which is not sustainable long term. If you think of the pink elephant as a metaphor for anxiety, you might start to notice how you are responding in a similar, unhelpful way to your anxiety.
Now, it’s somewhat unlikely you will stop fighting your worry just because you now know that is an unhelpful response. Two things are going to need to happen before you approach worry in a different way. The first is to help you truly believe the fact that worry is not dangerous or uncontrollable. The second is to learn what to do with your worries instead of engaging them or trying to get rid of them (covered at the end of this handout).
Have a think about what your views are on worry being dangerous. Do you think it is? If so, what are the potential dangers you think it poses? Many believe that worry will, if you don’t stop it, cause you to “go crazy”, or “lose control”, or that it might cause a panic attack, heart attack, or other calamity that is imminently harmful to your health.
As I discuss with all my clients, none of these fears are based on fact. Worrying is NOT dangerous. I have never seen anyone “go crazy”, “lose control”, or have a heart attack or similar just from worrying, even worrying very excessively. A huge amount of people worry a lot, are not experiencing any catastrophic outcome from it other than finding it interfering with their lives and making for an unpleasant experience. When I work on this fear with clients, we do experiments such as trying to worry a whole lot in-session in order to “go crazy” or “lose control” and test whether this happens or not (it never does). We try and define what “going crazy” or “losing control” means or looks like to them, and by saying this out loud in specific terms many admit it doesn’t sound very realistic once it’s out there. We also try to define how exactly worry would lead to this and again, it’s quite murky once you say it out loud. It really is just a fear that we don’t take time to examine or question properly.
Worry can definitely start to feel uncontrollable the more you try to control it, but that’s because of your responses to it and the battle you start to get in to. If you would like some more ideas on how to examine these fears further, there is a reference at the end of this handout that I find helpful.
What to do instead: Let your worries be there!
I know, I know. This sounds ridiculous. Every client I have suggested this to has at first said that doesn’t sound helpful at all, in fact, it sounds really anxiety provoking. I came to you to get rid of my anxiety and feel better, not for you to tell me to just live with it. I totally get it. However, this really is the answer you’ve been looking for. If you’d been doing the most helpful things already, your anxiety would not be bothering you nearly as much. So, perhaps it is time to consider a different approach!
This approach will not get rid of your worries, nor will it make you feel 100% better or anxiety free. What it will mean, though, is that you will be able to let your worries come and go without them bothering you a great deal or causing you a huge amount of anxiety. All the people around you who you think seem so care-free – it’s not because they have NO worries or anxiety, but because they just let them be when they arise. They know which ones to respond to, and which ones they can’t do anything about. They let themselves feel a little anxious and don’t push for complete certainty or relaxation.
Here’s what would ultimately be great for you to master.
Every time a worry comes into your mind, simply notice it. Say “oh, there’s another worry”. You may notice that it’s another health-related worry for example (so, you could categorise it). You may notice that it makes your chest tense up and your heart rate go up a little. You might label this anxiety. And that’s it. You simply observe everything that naturally happens in your body. This is consistent with a mindfulness based approach.
Seem too simple? Think about it. That response is vastly different from what you may be doing at present. Currently, when a worry pops into your mind, you likely have a lot of judgements about this. You think “oh my gosh, another worry, this is terrible.” You feel immediately very anxious and you think you must get rid of these thoughts & feelings, or it will become out of control, or you will just continue to feel worse and worse. Already, this worry, which is ultimately just a thought and nothing more, is producing a great deal of distress for you. And so you begin the process of trying to think it through in order to feel better, or push it out of your mind to get rid of it. And thus, the cycle begins and the worry not only receives a lot of attention and sticks around for a very long time, but probably grows in size and power and collects other worries along the way with it too.
… Achieving this kind of a relationship with worry (one where you are living with it and it lives in the background, as opposed to dominating your life and having you hide from it), takes time and work. It’s not going to happen immediately. You might like to read up some more on mindfulness. For now, here are a few ways in which you might like to start to play with your worries in a new way, if imagery suits you.
When you have a worry thought,
turn it into a long string of giant words
in your mind. Imagine you are in a room with two doors, and the words slowly drift in one door,then out the other. They may continue to
When you have a worry thought,
turn it into a long string of giant words
in your mind. Play around with turning
the string of words into various shapes,
different colours, sizes, and fonts.
Imagine a conveyor belt slowly moving along in front of you. Whenever a worry thought comes into your mind, place it on the conveyor belt and watch it drift along. Continue to do this with each thought. It can continue to loop around if you wish.
Imagine a peaceful, bubbling brook / river. Imagine you’re sitting under a big leafy tree with sun trickling through. Pick up a leaf and observe its size, texture etc. Each time a worry thought comes into your mind, place it on the leaf. Place the leaf gently on the stream and watch it bob around, slowly drifting along.
Another strategy you could try is worry time. Allocate yourself 30 minutes a day, preferably nearer the end of the day (but not too close to bedtime), where you allow yourself to sit and worry. You can do this in absolutely any way you wish, just worry as you normally would. At the end of this 30 minutes, do something nice and get a change of scenery. You can do this each day. During the rest of the day in the time leading up to the worry period, every time you have a worry thought pop into your mind, tell yourself that you will not think about it in detail right now, but will come back to it during your worry time later that day. That way, you are acknowledging it and knowing you will come back to it, but it doesn’t have to dominate your day or be processed many times over. When you get to your worry time, if you no longer need it, that’s absolutely fine! It may have gone by then.
These strategies allow your worries to be present (so you’re not trying to get rid of them), without engaging with them. You’re just noticing them. Practice it and notice what happens to your worries over time. If you find yourself starting to think about the content of the worry, it will likely start to grow. If this happens, just gently guide yourself back to the core task at hand.
For example, noticing your worry looks like this: “Oh, I see another worry has popped into my mind. If I turn it into a string of words, it says “What if I lose my job?”. Hmm. My heart rate goes up a little when I look at those words.
On the other hand, engaging with your worry (which I don’t want you to do) looks like this: “What if I lose my job?” “That would be terrible. How will I pay any bills?” “I’d have to sell my house” “I’m terrified of that! I need to work out what to do about this”.
Remember, we’ve already decided that this is a WORRY and not a PROBLEM. If it were a solvable problem, you’d use the problem solving steps above and come up with a concrete solution. But because it’s a worry with no solution at this stage, engaging with it is not going to change anything. It’s just going to make you feel worse.
If you think this is interesting and useful, and would like to work on it further, a clinical psychologist will be able to help you more. Someone who works with CBT, Metacognitive therapy, or ACT will be able to use these same principles especially well.
See my PDF link on my "resources" page to open a printer-friendly PDF version of this blog post.
Helpful worry resources:
Centre for Clinical Interventions – “What? Me Worry!?!” Module. http://www.cci.health.wa.gov.au/resources/infopax.cfm?Info_ID=46
Bev Aisbett’s books – The book of IT