We’ve talked about the Worry Loop, and how it plays a critical role in our ability to carry out the sequence Worry, Plan, and Act, which we each need to use to make it through the day. We also learned that the Worry Loop is a tract of brain cells that goes through three different areas of the brain. And we’ve discussed that there is both a genetic and environmental component to how much we worry. Now we’re going to look at the problem of worrying too much and what to do about it.
When to Worry About Worry
I get asked, “When should I worry about my worry?” As we’ve seen, the Worry Loop has its purpose. It helps us make plans and act on them. A little bit of worry energizes us, helps us pay attention, and motivates us to prepare for the future. But clearly there is such a thing as too much worry – when it’s all-consuming and you can’t enjoy anything anymore, and you are frozen by your worry. At that point it’s gone way too far.
So, what is the line that separates too much worry from normal amounts of worry? See if you can listen to your gut for a moment. Turn your attention inward and ask yourself if you believe your worry has gotten out of hand. Listen to the answer. Give it a lot of weight. No one else can necessarily see your worry or the effect it’s having on you, so if you feel that your worry is out of control, trust that and find some help.
Another sign is whether multiple people around you are telling you to stop worrying. If they are, think about why they are telling you that. Do they have a good point? Next, look at how much time worry is taking from you. What would you be doing if you weren’t worrying? If it’s a significant amount of time or activities, you may be worrying more than is productive. Is it making you miserable? Are you having trouble enjoying things, feeling present for things, or getting around to doing things because you’re spending your energy worrying? If so, it may be time to find something else to do with that energy.
If you’re still on the fence about it, or if you are dismissing your gut and your friends as biased, try the Patient Stress Questionnaire. It combines four common screening tools for depression, anxiety, PTSD, and alcohol problems. Taken together with other information, the screening tools may help determine when it’s time to get professional help.
Taking Action
Before jumping to the conclusion that your worry is irrational, think about whether there is something in that Worry -> Plan -> Act sequence you can act on. Maybe some of your worry won’t go away because there is the nagging sensation you need to do something specific you don’t want to do.
Maybe you need to make an appointment with a dentist about that tooth pain instead of worrying about what might be wrong. Maybe you need to end a relationship you know deep down isn’t good for you. Maybe you need to take the risk of starting a relationship with someone you find interesting, even though it might not work out. Or maybe you need to go ahead and clean out that closet instead of worrying about how much time and effort it’s going to take.
A lot of the things we worry about can be addressed by taking action. We’re quick to just want to get rid of the worry. Maybe the action is hard and scary. But when possible, the best course to ending worry can be taking action, if it’s something within your control.
Taming Worry
That said, there are plenty of worries that taking action doesn’t work for. If you’re worried you’ve left the stove on, and you’ve checked it twice already, checking again is not going to make you feel better. If you’re worried about a parent or grandparent catching COVID, there’s very little in your power you can do to protect them that you haven’t already been doing. If you’re worried about an asteroid hitting the earth, you know you’re catastrophizing and that worrying isn’t going to do a damn thing to stop it.
So, what do we do with these kinds of worries? What works for you may be a matter of trial and error, but here are three basic strategies. Note that medication is an important tool, but we’re going to give it its own set of posts later in this series. Today we’re going to focus on these three:
- Cognitive Behavioral Therapy
- Mindfulness Practices
- Engaging the body
Cognitive Behavioral Therapy
One of the most well-known forms of therapy practiced today is Cognitive Behavioral Therapy, or CBT. Nearly every licensed therapist is trained in CBT, usually along with other approaches. And if you don’t have the time, money, or need for professional help, there are quite a few self-help CBT books out there. Not only is CBT popular, but there is a version of CBT tailored to almost every kind of psychological ailment.
There are books you read straight through like Cognitive Behavioral Therapy Made Simple by Seth Gillihan, Ph.D., and workbooks like The Anxiety and Phobia Workbook by Edmund Bourne or The Cognitive Behavioral Workbook for Anxiety by William Knaus, Ed.D.
You can also find endless YouTube videos on the topic. Emma McAdam, LMFT, has a great channel called “Therapy in a Nutshell,” and she has an entire series centering on cognitive distortions.
And there’s even an app for that. I’m hesitant to recommend a specific one because they change so quickly, but there are thought diary tracker apps and all sorts of CBT apps to help you tame your worry, whether you decide to go it alone or find professional help.
CBT is based on a combination of Behavioral Therapy and Cognitive Therapy. Behavioral Therapy is modeled on the idea that simple – but not always easy – changes in a person’s behavior can bring relief from symptoms.
Cognitive Therapy was developed out of the theory that thoughts have strong effects on both our behaviors and our feelings, so if we could change the way we think to have more accurate thoughts, we can change our emotions and actions.
Combining Behavioral Therapy with Cognitive Therapy created what we know as CBT. This is the triangle familiar to anyone who has done formal CBT. Our thoughts, feelings, and actions affect each other, so a change in one will change the others and lead to progress in all areas.
Some of the key features of CBT are that it is goal-oriented and focuses on a specific problem or problems. It’s present-focused, so you’re not revisiting the past as much as you are changing the way you interact with the present. One of the goals is to teach self-reliance, so that you are independently able to address your own worries and aren’t dependent on staying in therapy forever. CBT teaches you how to identify and correct your negative automatic thoughts. It teaches you to address anxiety by breaking it down into a number of feelings, thoughts, and behaviors in the present, and addressing those systematically and in a structured way.
Over the years, many evidence-based techniques have been brought under the CBT umbrella, including cognitive restructuring, progressive relaxation, behavior activation, meditation, and exposure. Even mindfulness has been brought into CBT, but I consider it so important we’re going to look at it on its own. The goal is to find the techniques that work best for you and your situation.
CBT is perfect for cognitive-based, Worry Loop anxiety. It’s almost tailor-made for it. But some parts of CBT don’t work very well for amygdala-based, Fear Circuit anxiety.
For example, changing your negative automatic thoughts is unproductive if your negative thoughts are also accurate and based on evidence and personal experience. If you live in a war zone, it’s not going to reduce your anxiety to come up with a percent estimate of how likely it is you will lose a family member to violence.
But if you are worried about getting struck by lightning and you’ve never known anyone struck by lightning, looking up the statistics and reminding yourself of them when panic creeps in during a thunderstorm will help put things in perspective.
If you’ve tried CBT for your anxiety and it hasn’t worked, that’s okay. We’ll get to the Fear Circuit soon. Consider mindfulness and engaging the body in the meantime.
Mindfulness
One of the best ways to manage worry is mindfulness. Jon Kabat-Zinn is a name you’ll hear if you read about mindfulness. He has been instrumental in bringing it into the mainstream, and he defines mindfulness as, “the awareness that arises through paying attention on purpose, in the present moment, and nonjudgmentally.” His seminal book is Full Catastrophe Living, which is a thorough tome, and he has also written Mindfulness for Beginners, which is a approachable book that comes with a CD.
Mindfulness is the practice of going, “Oh, that’s just a thought going through my head,” observing it, and then gentling bringing your attention back to the present moment – often to the breath – not to the anxious thoughts, not to the future, not to the past. Teaching mindfulness is a little outside of the scope of this post, but a good place to start is mindful.org/mindfulness-meditation-anxiety/.
You don’t have to become a great yogi to benefit from mindfulness. It would be ideal to set aside twenty minutes first thing every morning for mindfulness meditation. And the more worry consumes you, the more strongly I recommend this. That said, I’m not consistent at taking even five or ten minutes at the same time every day to practice mindfulness. Instead, I’ve found that I can incorporate it into everyday tasks.
Whenever I wash my hands, I intentionally slow myself down. I pay attention to the sink handle’s feel, temperature, and resistance. Then I give my whole attention to the sound of the water, the feel of it. Same with the soap, the movements of my hands, and the towel at the end. After that I’m back to my normal train of thoughts and onto whatever I was doing.
It’s just twenty seconds or so of something I was already going to do, but with practice I’ve trained myself to recenter automatically every time I go to the sink. And that little bit of centeredness goes with me through the rest of my day.
Engage the Body
Either in conjunction with mindfulness, or as a practice on its own, engaging the reptilian brainstem can be very powerful against worry. Focusing on the breath, doing counted breathing exercises, progressive muscle relaxation, taking a walk with a change of scenery, dancing, and doing aerobic exercise are all ways to fully engage your body. Using the body is a good way to get out of your head. Simply feeling your feet against your shoes and the floor and noting the sensation of the ground will make you “grounded.”
Another option is to get your emotional limbic system directed toward something else. Music is a good outlet for a lot of people. Turn on music in the mood you want to feel and really let yourself get lost in it. German metal might not be a good choice, even it’s your favorite. Choose something with a slower beat and soothing tone. It could be as quiet as choosing the “Relaxing Reading” instrumental playlist in Spotify, or it could be simply calmer than you currently feel. If you have a habit of worrying while going about your daily routine, consider whether anyone will even notice if you keep an earbud in and listen to some good music.
Another thing to try, particularly if you have difficulty with anxious thoughts while you’re trying to get to sleep, is binaural beats. It can also be helpful, relaxing background noise if you are studying or working.
Shows and podcasts can have similar results of engaging your thoughts and changing your mood. Just be careful to pick something that isn’t intense and anxiety-provoking. Even if they’re things you enjoy, the news and political podcasts don’t count as calming. Find something uplifting and engaging, like a good novel. Look to engage your limbic system in something fun and positive.
The key is to break out of the Worry Loop and then stay out. Engage your body, change your emotions, or distract your mind long enough to break the cycle.
Worry has its reasons. It’s there to help us make plans and carry them out. If it’s doing that, great, let yourself worry a little and decide what you’re going to do. But once you’ve made the decision, or if you’re no longer making progress, it’s time to change the internal channel. Take action and explore CBT, mindfulness, and engaging the body to develop strategies that work for you.