Judith S. Beck, PhD
Worry, as defined by Clark and Beck (2012) 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.”
This certainly describes the thinking of Stacy, a client I recently treated who suffered from Generalized Anxiety Disorder. She is a 44 year old woman, the mother of three children. And she worries constantly. “What if my boss doesn’t like my work?” “What if my kids get rejected at school?” “What if my husband falls in love with someone else?” “What if this cough I have is really throat cancer?” “What if the bus I’m on crashes?”
Some amount of worry is normal and can be productive when individuals think through a potential problem and come up with a way to prevent it, cope with it if it does arise, or lessen its impact. But Stacy’s worry is pervasive and unproductive. Why does she keep worrying when it’s clearly dysfunctional? Why does she have so little control over it? A number of factors account for why she worries so incessantly (while another client of mine, an adolescent, fails to worry in situations in which at least a little anxiety is warranted and would be productive).
Stacy’s safety behaviors include the following:
- She tries as hard as she can to predict problems. “If my boss could possibly be displeased with me, I should anticipate that and know how to respond.”
- She is constantly trying to gain certainty that a given difficulty won’t occur. “If I think through every option thoroughly, I’ll be able to avoid the problem.”
- She tries to figure out the optimal solution. “If I just keep thinking about it, maybe I can figure out the perfect thing to do.”
- She avoids situations she deems risky. “The weather is bad; I better cancel my doctor’s appointment because I might get into a car accident.”
- She tries to reassure herself and frequently asks for reassurance from others. “I can only feel better if I’m 100% sure that nothing bad will happen.”
Other contributing factors include the following:
- She catastrophizes, automatically considering only the worst outcomes of a situation. “If my child is late, maybe it means she’s been in an accident.”
- She misreads her physiological arousal. “I’m so on edge. There must be something bad going on.”
- She lacks confidence about her ability to handle problems. “I won’t be able to handle it if the problem does arise.”
- She holds positive beliefs about the worry process. “It’s good to worry because worrying can keep me safe.”
- She has negative beliefs about worry. “I can’t control my worry. There’s nothing I can do about it.” “I’m going to worry so much that I’ll go crazy!”
- She tries to stop worrying. But her attempt to suppress worry-related thoughts often rebounds and leads to more unwanted thoughts, which then triggers her positive worry beliefs and the worry process begins again.
- She doesn’t realize that, most of the time, she can’t solve a given problem and therefore feel relief—because the problem hasn’t happened yet.
- At the bottom of all this are her underlying negative beliefs about threat and uncertainty, and a sense of helplessness.
Rather than evaluating Stacy’s automatic thoughts (because successfully evaluating one worry-related automatic thought will often be replaced by another worry-related automatic thought), we focused on modifying her dysfunctional beliefs about worry itself (it helps me stay safe), reducing her safety behaviors (seeking reassurance) and attempts to control her worry (thought suppression), using functional problem solving when indicated, identifying when she was thinking catastrophically and mindfully refocusing her attention, facing her worst fear, and accepting and building her tolerance for uncertainty. Although she described having been “a worrier” her whole life, she was able to overcome her excessive worry. She gained a sense of competence and much improved peace of mind.
Clark, D., & Beck, A. (2012). The Anxiety and Worry Workbook: The Cognitive Behavioral Solution. New York: Guilford Press.