‘Janelle’ is a “worry wart” or at least that’s the reputation she has with her friends, family, and coworkers. A married 57-year-old mother of two adult sons, a senior partner in an accounting firm, a committed community activist, and a prospective grandmother expecting her first grandchild, even Janelle describes herself as an anxious person with a penchant for expecting the worst.
Ever since high school, she has worried about the possibility of impending doom. Now she worries about anything and everything—her own health and her husband’s, the recent decline in her financial investments and the looming prospect of retirement, her work performance, her daughter-in-law’s pregnancy, her younger son’s search for a new job, their plans to remodel a bathroom, even getting the housework done.
She has tried a number of interventions over the years, from anti-depressants and tranquilizers to repeated sessions with various mental health professionals, to yoga, meditation, nutrition programs, fairly strenuous aerobic exercise, and the like, but nothing seems to work.
As the years advance her worry only seems to get worse, and now Janelle feels trapped, with worry robbing her of what she thought would be “the best years of my life.”
Janelle suffers from pathological worry that is the central characteristic of a condition called generalized anxiety disorder (GAD). Worry is a common experience in most people’s lives, but the excessive worry associated with GAD is much more severe, persistent, and uncontrollable than “normal worry.”
GAD worry can last for hours, occurs almost daily, and involves multiple concerns. It typically takes a chronic course, lasting several months but more often several years or even decades. People with this type of excessive worry are generally anxious so they often feel more tired, frustrated, tense, distracted, restless, and sleep-deprived. Together with their excessive worry, this state of generalized anxiety disrupts your normal daily functioning.
In the last two decades, we have learned a great deal about worry. With these insights and a modified form of cognitive-behavioral coaching based on them, we can offer new hope for those caught in the grip of generalized anxiety disorder.
Understanding Generalized Anxiety
GAD is very common, affecting more than 700,000 adult Americans (3.1%) in a given year, tends to be chronic and even seems like a personality characteristic to many sufferers, who report always having been anxious and worried.
Perhaps this accounts for why it can be a difficult anxiety problem to treat. Medication and standard psychological treatment have shown an effectiveness rate of only about 50%, although recovery rates have been quite variable across studies and we still have limited information on the long-term effectiveness of treatment.
Anti-anxiety medications can be effective in reducing generalized anxiety in the short term, but they tend to lose their effectiveness after several weeks and can be difficult to discontinue when a person develops physical and/or psychological dependence.
Anti-depressant medication can also be effective and is probably the pharmacological treatment of choice for GAD, but relapse rates approach 50% after 6 months of stopping the medication.
However, progress is being made, and there is encouraging evidence that the newer forms of cognitive therapy that focus on the specific features of GAD may improve treatment outcomes and help people get off their anti-anxiety medication.
Why Do We Worry?
To get a handle on chronic worrying, we have to start with an understanding of what we mean by worry. For the purposes of this article, worry is:
a persistent, repetitive, and uncontrollable chain of thinking that mainly focuses on the uncertainty of some future negative or threatening outcome in which the person rehearses various problem-solving solutions but fails to reduce the heightened sense of uncertainty about the possible threat.
We can worry about a wide variety of things, from the most inconsequential daily task (such as getting to a hair appointment on time) to very significant personal tragedies (having a terminal illness) to major world affairs (failing to deal with climate change). No two people have exactly the same worry concerns, but as evidenced by Janelle, many of us worry about serious matters like our health, the potential for injury to or death of a loved one, our finances, work, and the state of the world. We also worry about all kinds of trivial things, like the logistics of daily schedules and routine tasks.
As with every other type of anxiety, a certain amount of worry is normal. So how does worry become persistent and uncontrollable for some people? Why are some people better able to control their worries than others, such as those with GAD, who seems paralyzed by the worry process? The following are features of excessive worry that account for its persistence and un-controllability.
- Catastrophizing: Exclusive focus on the possibility of a highly negative, disturbing, or threatening future outcome.
- Heightened anxiety: Worry process associated with a personal sense of anxiousness or nervousness that can involve physical symptoms like muscle tension, feeling on edge, restlessness, and so forth.
- Intolerance of uncertainty: Difficulty accepting the uncertainty of future events and so striving to gain assurance that the imagined dreaded catastrophe won’t happen.
- Difficulty accepting risk: Attempts to eliminate or at least minimize any possibility of future danger, disappointment, or failure.
- Futile problem solving: Repeated efforts to prepare an effective response to an imagined catastrophe but feeling dissatisfied with each potential solution generated.
- Striving for perfection: Attempts to find a perfect solution for the imagined negative event that will bring relief and a sense of personal safety or security.
- Failed worry control: Repeated efforts to stop worry that are ineffective and actually strengthen the worry process.
- Dysfunctional worry-related beliefs
- Worry about worry: The process of worrying about not being able to control worry can intensify the whole process.
Let’s say you work for a company that is experiencing economic difficulties and has already laid off many employees. It would be perfectly natural and realistic to wonder, “Am I next? Will I lose my job as well?” But how you think about this concern will determine whether you shift from normal worry to a persistent and uncontrollable state of worry that causes significant distress and interference in your life.
Based on the preceding list of contributing factors, we can outline a way of thinking about the possibility of unemployment that would make it a persistent and uncontrollable concern. You could begin by catastrophizing, thinking only about the 20% of employees who lost their job rather than the 80% still working for the company. You could refuse to accept that the future is uncertain and unknowable, that both good and bad events happen without our ability to forecast their occurrence. You could continually remind yourself that you hate risks, and so you could endlessly try to think about how you’ll deal with unemployment.
Of course, anything you come up with seems frightening and unsatisfactory, so you keep going around in circles. You try hard not to worry, but it doesn’t stop, and you end up feeling even more anxious and discouraged. You’re thinking that you should be worried about losing your job, that it’s better to be prepared for the worst than to be blindsided by it, but the worry is relentless, and now you’re afraid that it’s having a negative impact on your health and work performance.
You worry about being so worried, that your worry could lead to the very thing you fear—loss of your job. And so you remain stuck in a pathological process of worry.
Do We Worry Because Sometimes It’s Productive?
We can agree that most worry is useless at best and counterproductive at worst because we can waste so much time and endure so much misery dealing with the what-ifs that we don’t enjoy any aspect of the present moment—and most of the time the object of our worry doesn’t materialize anyway. Yet our history is filled with cautionary tales about what happens when one doesn’t “worry” about the future and thus ends up unprepared for predictable challenges. So where is the line between productive and unproductive worry?
Let’s examine Janelle’s worry about her bathroom remodeling. When she thinks about the bathroom renovations, which she does every day, Janelle becomes completely stuck on highly negative scenarios like “What if the contractors we hired are incompetent and do a poor job?” and “What if they don’t listen to what we want and we end up with renovations we hate?” and “What if they get started and then leave for weeks on end to do other jobs?” and “What if we go way over our budget?”
She tries to think about various ways to deal with the contractors that will guarantee they will keep to their schedule, do the job to her satisfaction, and not run over on costs. But nothing seems to help, and she ends up with a sick feeling in her stomach that the whole project will be a disaster. She tries to stop worrying by reminding herself that it’s just a bathroom renovation and everything will be fine, but she can’t convince herself.
She begins to worry that her uncontrolled worry about even the most mundane matters is taking a toll on her health and that she will end up having a “nervous breakdown” or a heart attack from all the stress.
If Janelle engaged in “productive worry” about the bathroom renovation, her thinking process would look much different. She would go through a checklist to remind herself what she has done to hire the most competent contractor (e.g., checked references, obtained a detailed work estimate, signed a contract). She would talk with friends who had done similar renovations and would work on learning to live with the risk and uncertainty of hiring contractors.
She could remind herself that there are lots of things in her house she would like to change but has been able to live with, so if she is not 100% satisfied with the bathroom renovation, she can live with that as well. She would also focus on the fact that any improvements will be better than the existing bathroom, which she has lived with for years. If the contractors renege on the contract, she has legal avenues for dealing with that problem.
Finally, she could re-frame the problem and remind herself that a new bathroom has little impact on her life satisfaction and meaning. Even if she feels a little apprehensive about launching into a bathroom renovation at this time, she’ll normalize these feelings and accept them, realizing that most people feel uneasy when they spend a significant amount of money.
The Worried Mind
We all experience troubling thoughts or images that suddenly pop into our minds, become the focus of our attention, and interrupt whatever task we’re doing. The thoughts, images, or memories literally intrude into conscious awareness. These mental intruders may be about irrelevant, even silly things, and we easily ignore them, or we might say to ourselves “That’s weird—why did I just think about that?” (I just had a thought about melting snow—strange, even stupid, certainly irrelevant, and easily ignored so I can get back to writing!)
However, not all intrusive thoughts are stupid, random thoughts. Some of these intrusions are what-if thoughts about the future, and often they involve the possibility of some future threat, danger, or a negative outcome. The following are some examples of a distressing, future-based intrusive thought or image that could start a worrying episode:
- Thinking of going into next week’s meeting without your report ready.
- Remembering a friend telling you she saw your husband with another woman at a restaurant.
- Being reminded of the bank foreclosing on your mortgage.
- Imagining that your child is seriously injured at daycare.
- Remembering the doctor telling you of a positive test for breast cancer.
- Thinking of meeting with an important client and saying something really stupid or embarrassing.
- Thinking that people are looking at you.
- Imagining the house is a disaster and the neighbors arrive unexpectedly for a visit.
- Thinking about your investment losses.
The average person has dozens, maybe even hundreds, of intrusive thoughts in a typical day, involving everything from mundane, trivial issues to really serious, important, and even life-threatening matters. Most of the time we ignore or easily dismiss our intrusive thoughts, but occasionally a thought will grab our attention and we can’t let go of it. These attention-grabbing intrusive thoughts and images can start the worry process.
What types of intrusive thoughts have you experienced that may have started you worrying about some important issue in your life? Do you wonder if your worrying is becoming a problem?
“Worry Wart” Checklist
Read through the following items and consider how you worry when you think about these concerns. Circle “yes” if the statement characterizes how you tend to worry about things or “no” if the statement does not apply. If you circled “yes” to 5 or more of the items, you may suffer from unproductive worry (and we should talk).
- When I worry, I get stuck on the most negative possibility (what ifs) of the situation. Yes No
- When I worry, I tend to think about how upset I will feel if this situation actually happens. Yes No
- When I worry, I keep trying to figure out what I can do to prevent the worst-case scenario. Yes No
- When I worry, I keep trying to convince myself the worst-case scenario won’t happen, but I can never feel assured or convinced that everything will be all right. Yes No
- When I worry, I come up with various responses or solutions to the problem, but I end up rejecting them all because they don’t seem adequate to deal with the situation. Yes No
- When I worry, “not knowing” about the future bothers me most. Yes No
- During worry episodes, I feel so helpless and ill-prepared to deal with life’s difficulties. Yes No
- Despite my best efforts, I end up feeling frustrated and discouraged with my inability to stop worrying. Yes No
- When I worry, I keep trying to work out what is the most likely outcome of this situation, but I am always left feeling uncertain. Yes No
- I often think about how miserable my life will be if I don’t get a handle on this worry. Yes No
Ready to begin the process of overcoming worry? Help is a simple message away. Please, connect with us today.