How to Stop Worrying About Worrying

The Problem

Worrying is an almost universal feature of all of the anxiety disorders and it is a frustratingly difficult issue to understand and manage effectively.  I’ve been asked many times for suggestions for ways to help stop worrying. Depending upon the exact nature of the anxiety disorder the worry might have a different focus. In social anxiety the worry might be  “What if Cathy doesn’t like me?”;  with panic disorder it might be “What if I have a panic attack?”;  with obsessive-compulsive disorder it could be “What if I get sick from having touched that doorknob and not washing my hands?”; and with health anxiety the question might be “What if this headache is actually a brain tumor?”.  For some people the worry may begin well in advance of an event, such as somebody who’s afraid of giving an upcoming speech or perhaps a person is afraid to fly and have a flight planned for a month or two in the future. For others, the worry may be a more immediate concern such as standing in line at the grocery store and fearing that they might have a panic attack. And the worry can be about something that happened in the past - “What if my boss fires me because I didn’t give a good sales presentation last week?”

Many clients have described a phenomenon they described as their mind seems to be searching for something to worry about. In the absence of something specifically in front of them to worry about, they feel like their mind is looking for something to latch onto and worry about. It’s as if their internal radar is always scanning for danger. 

Why We Have The Problem

If we understand that our mind's purpose is to protect us from danger, and that is exactly what is designed to do, then this searching/worrying makes some sense. If we take an extreme example such as a soldier in combat, he is, indeed, scanning his world looking for any possible threats because this could be for him a life or death issue. But few of us, luckily, are in combat situations but it seems that our minds operate the same way even though whatever danger we're worried about isn’t nearly as threatening as combat. I have a metaphor that I’ve evolved over the years that I used to illustrate this phenomenon. Let’s imagine that you were driving to the grocery store (and let’s make it a non-COVID – 19 situation so there are plenty of cars on the road), and you’re not paying particular attention to whatever cars are on the road alongside you. However, once you get to the grocery store here in announcement over the loudspeaker that we just announced throughout the city that they are terrorists driving around your city with guns and bombs in their car and they’re all driving yellow cars. Now when you drive home from the grocery store guess what you’ll be looking for? On the way to the grocery store I’m guessing there were other yellow cars on the road but you weren’t even noticing a paying attention to those, but now that you believe they are dangerous your radar is turned on and you’re scanning looking for the yellow cars. It’s a natural tendency to be on guard for things that we believe are dangerous and in many situations this is a very helpful and protective process. If you're out by yourself late at night walking down a dark alley you want to be scanning and looking for any potential muggers in the shadows, however, when we have an anxiety disorder we are scanning for things that aren’t nearly as dangerous as a mugger in the shadows.

This scanning can be for external threats such as a mugger in the alley or, if we have a fear/phobia of blood-borne diseases,  we might scan for any red marks that we happen to see such as a red mark on a doorknob or light switch that we fear might be blood.  We naturally scan for whatever we believe is dangerous. However, it’s also possible to scan for what we believe to be internal sensations to our safety, such as a rapid heart rate, dizziness, shortness of breath, etc. People who suffer from panic disorder and are terribly afraid of having a panic attack will be “scanning” their internal sensations looking for a “dangerous” sensation which they think predicts the potential eruption of what they fear is a life-threatening event such as a heart attack or stroke.

The Solution

The more that I work with anxiety disorders the more I become a fan of mindfulness meditation. There’s a lot I could say about mindfulness meditation and I will cover more about this topic in future blog posts, but for time being the main point is by practicing this kind of meditation you get better at noticing what your mind is doing, stepping out of the thought stream and can develop the ability to look at your thoughts rather than from your thoughts. This gives you the option of evaluating if this thought that you’re having is worth paying attention to or if you should just ignore it. I’m not suggesting that you get this option immediately, but as you understand how mindfulness works and spend some time practicing, you can get better at doing this. Choosing to ignore the thought corresponds in many ways to the kind of exposure work that we do for treating any anxiety disorder. In essence, if you decide to ignore the thought you’re taking the chance that the thing you fear might happen and this is exactly what exposure looks like. You can get better at accepting uncertainty.

Let me give a simple example. Let’s presume for a moment that you have OCD and that you’re afraid to touch a doorknob because the OCD makes you believe that this door knob could be contaminated by someone who touched the doorknob before you  (I recognize that the rules may be different now with the Covid – 19 situation, but, stay with me).  Your mind is telling you that this doorknob is dangerous and that if you touch it you (or your loved ones) could get sick and die from some sort of unknown disease. If you can stand back and recognize that this is just a thought rather than a fact, get perspective on this, you then have the option of choosing either to act as if this thought is worth listening to or decide that it’s not worth acting on and ignore it. If you can’t step back and get perspective on this thought then most likely get caught in OCD’s web and continue to avoid touching doorknobs. If you can step back, consider that this is just a thought, and look at your options, you potentially can then decide what is your best course of action. Though my example is for OCD, this process applies to treating/managing any anxiety disorder. Here’s a copy of a handout I designed to illustrate this process:

_____________________________________________________________________________________________  

Awareness allows you to disengage from the automatic pilot.

                unknown

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SOBER

1) Stop: What cues can you notice that anxiety has entered the room?

  Most clients can recognize when their anxiety has popped up.

Take a moment to notice what is happening.

2) Observe: What is going on?

What are you thinking?

What are you feeling?

3) Be Aware: Notice what your mind is telling you.

  Be aware of what the anxiety wants you to do (usually avoid).

     Be aware of what “tricks” the anxiety is using to get you to comply.

4) Expand:    Consider other options besides what your anxiety is telling you.

    Connect with what you value.

  Connect with what you want your life to be about.

Where do you want your life to be in a month, 6 months, 5 years?

5) Respond: Choose what you want to do and do that.

What choice will move your life in the direction you want it to go?

Don’t just automatically react, make an informed thoughtful choice.

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Once you recognize how your anxiety is tricking you into believing that the danger is far greater than it really is and decide to ignore what it is telling you, I have another metaphor to illustrate what the next step should be. Think of your attention as a flashlight. We don’t have complete control over where we shine our flashlight, but we have at least some degree of control over this process. So the idea is to choose to take your “flashlight” off of what your anxiety is focused on and shine it on something that is in the long run much more important and valuable to you  And expect (and be willing to tolerate) the anxiety that will come up if you don’t believe your minds anxious thoughts and avoid the doorknob. So to continue the example above, to shine the flashlight away from the anxious thought about catching some disease from the doorknob, and perhaps focus your attention on the reason you want to go through the doorway in the first place and then do that. This, of course, amounts to doing exposure for your anxiety disorder. But it’s exposure done with a greater awareness of how your mind is playing a role in your anxiety in the first place and choosing to do what you want to do and not what the anxiety is telling you you should do. 

Conclusion

Worry can be a slippery opponent, but with some perspective and better understanding of how to tackle worry you can reduce how much worry affects your everyday functioning. Remember SOBER: 

Stop

Observe

Be Aware

Expand Your Thinking

Choose Your Response

I hope you all have a good week,

DrBob

P.S. If there is anything topic you’d especially like me to write about, let me know.