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how to stop-worrying.pdf
1.
Danny Gagnon© PhD,
Psychologist (514) 605-7610 www.montrealcbtpsychologist.com 1 HOW TO STOP WORRYING A quote by the French philosopher Montaigne: “My life has been full of terrible misfortunes, most of which never happened.” Before getting started on helping you decrease your worrying, a brief clarification on the difference between worry and anxiety is in order. People usually state that they ‘feel worried’ about some event. However, it is important to distinguish worrying and anxiety. Worries are thoughts that usually begin like, “What if …?” The “what if” leads to anxiety, which is an emotion. The consequence of excessive worry includes a loss of energy, irritability, difficulty concentrating, decreased quality of sleep and eventual mental and physical exhaustion. This pattern of events is illustrated in the diagram below. WHEN WORRY IS USEFUL If used productively, worry can be beneficial. Here are some examples in which worry can be constructive: 1. Worry can be a ‘warning signal’ to us. For example, it can help us identify a problem or anticipate danger. If we then analyze the threat and try to solve it, the worry was productive. For example, if you hear a funny sound coming from your car tire while driving, you would probably worry that your tire is defective and could fall off. One way to solve this worry would be to go to your mechanic and have it checked out. If worries paralyze you and prevent you from action, then it is not productive. Remember that worry leads to anxiety, and anxiety is communicating that some danger or threat is present. If you haven’t consulted the toolkits on Overcoming Anxiety or Why Do We Have Emotions, now would be a good time to do so. 2. Worry can trigger action. For example, if you are worried about an exam, you would start studying. If you have a cough that won’t go away, you could have it examined by your family doctor. You feel better when things get done or get checked out. If worries prevent you from action and paralyze you, it is unproductive worry. 3. Worry can help us cope. Worrying can help us prepare or develop effective coping strategies. You can ask yourself, “What could I do if …” or “What could happen if …” In summary, if you use worries as a danger signal which sets you into action to cope or solve the worry, you are probably using your worries effectively. Event: “What if …” Leads to worry, which is a thought. Anxiety.
2.
Danny Gagnon© PhD,
Psychologist (514) 605-7610 www.montrealcbtpsychologist.com 2 WHEN WORRY IS NOT USEFUL In some cases worries are not useful. In fact, chronic worrying can become uncontrollable and set in a series of unpleasant mental and physical symptoms including: fatigue, difficulty concentrating, irritability, increased muscle tension, difficulty sleeping and restlessness or feeling keyed up or on edge. It is also common for some people to avoid thinking about their worries or developing checking behaviours. Examples of checking behaviours include: repeatedly phoning a loved one to ensure they are alright, checking your work over and over and seeking reassurance. Avoidance and safety behaviours may relieve anxiety in the short run, but in the long run they will only fuel your worries. It may be useful to consult the toolkit on Overcoming Anxiety to review how avoidance increases anxiety. HOW TO STOP WORRYING 1. How to get rid of 90% of your worries. There are two types of worries that are unproductive. These are worries that are either unimportant or unlikely. We are faced daily with real-world problems that are already hard enough, so we should minimize wasting our time and happiness on things that will never occur or that are not important. Internal or External Event: “What if …” Worry: Thoughts & Feelings. Worry: Physical Reactions Worry: Avoidance & Checking
3.
Danny Gagnon© PhD,
Psychologist (514) 605-7610 www.montrealcbtpsychologist.com 3 In order to test whether a worry applies to one of these two criteria, it is important to put the worry in perspective by asking yourself the following questions. You can also use the toolkit on Change Your Negative Thinking to help you out. • The unlikely: Ask yourself the following question: “What is the probability this will happen”. If the probability is small, it is not worth the worry. • The unimportant: Ask yourself one of the following questions: “Will I remember this worry in one-day, one-week, or one-month?”; “What is the worst outcome if this worry is true?” You could also try to place the worry in perspective by asking yourself the following variation of this question, “What is the worst, best, and most likely outcome if this worry is true?”; Place the worry on a continuum of “bad experiences”; “How much worry is this worth”. If you have trouble answering whether your worry is unlikely or unimportant, try completing a Thought Record by consulting the Change Your Negative Thinking toolkit. 2. The other 10% of worries that are more persistent or realistic/significant. Some times worries can be persistent because they are real and significant. For these worries, it is important to set an action plan and then to ‘let go’ of the worry once the plan is completed. Follow this procedure for ‘letting go’ of those worries. First, ask yourself what you are worrying about. Then: a) Ask your self if you can you do something about it? If the answer is “yes”, then get an action plan going. For example, what can you do to prepare, how do you find out the necessary information, make a list, etc. b) Can I do something right now? If the answer is a “yes”, then plan what you can do and when then go to (c). If you can’t do anything now, then go to (c). c) No. Then ‘let go’ of the worry. Do something pleasant to get your mind off of the worry. If your mind drifts back to the worry, redirect it back to the pleasurable activity. 3. Get rid of any safety behaviours. If you engage in any safety behaviours, you need to cut them out! These behaviours will simply make the worry worse! Safety behaviours are things you do to decrease the anxiety associated with the worry or that you believe gives you control over the worry. Examples of safety behaviours include: • Checking or repeating things over and over. • Repeatedly calling someone for reassurance. • Asking the same questions numerous times. • Carrying an object with you, like a cell phone to call someone. If possible, completely cut out the safety behaviour. If it is too hard to totally stop the safety behaviour, then try using the toolkit on Exposure Therapy to help you out. 4. Stop avoiding. If you are preventing yourself from thinking about certain worries, for example the death of a loved one or a catastrophe, you are avoiding, and this will simply promote further worry and anxiety. Thoughts and images, although unpleasant,
4.
Danny Gagnon© PhD,
Psychologist (514) 605-7610 www.montrealcbtpsychologist.com 4 are not harmful. You need to expose your self to these by writing a ‘worry script’. Rank all your worries from the least anxiety provoking to the most anxiety provoking to create an exposure hierarchy. Pick a worry that causes you about 30% anxiety, or what psychologists also call ‘subjective units of distress’ (SUDs). In as much detail as possible, write out your worry on paper in as much detail as possible. Be sure to include what you see, hear, smell, feel and even taste. Include experience from all your senses. Read your worry script over for about 30 minutes or until your anxiety has decreased to 10% or less. Make sure to focus on the worry and stick to the worst possible scenario. It may be beneficial to consult the Exposure Therapy toolkit to see how exposure is helpful. 5. Positive beliefs about worry. Sometimes it is hard for people to let go of their worries because they have positive beliefs about the usefulness of worrying. If you hold any of these beliefs, you need to change them in order to see a decrease in worrying. Use the Change Your Negative Thinking toolkit to help you. Here are the five positive beliefs about worry that have been identified by psychologist and how to help you change them: • Worrying helps find solutions: Does worry paralyze you rather than help you? Do you avoid finding solutions, or even worry about a solution you may have come up with? If worrying is preventing you from finding solutions, then it is a problem. For your information: There are two main types of exposure: 1) in vivo exposure; and 2) imaginal exposure. During in vivo exposure you come in direct contact with the anxiety-provoking situations in real-life. For example, if you have a fear of taking the elevator, you take the elevator. During imagined exposure patients face the anxiety-provoking situation in their imagination or by a detailed script of their fear on paper. Imaginal exposure is used when placing yourself in the feared situation is not possible. Examples of imaginal exposure include writing out what happened during a traumatic event, such as a car accident, or writing about a worry, such as the death of a loved one. Hint: Here are some final tips to help you out with your ‘worry script’. 1) Don’t imagine any alternative scenarios. 2) Make sure to read your worry script long enough for your anxiety to go down. 3) Do not purposefully distract yourself. If you do become distracted accidently, bring your attention back to your worry script. 4) Once one worry script no longer causes you anxiety, focus on a new worry in your exposure hierarchy. 5) Try to imagine being an active participant when reading your worry script and not like you are an outsider watching a movie.
5.
Danny Gagnon© PhD,
Psychologist (514) 605-7610 www.montrealcbtpsychologist.com 5 Complete a Cost Benefit Analysis Worksheet about worry to help change this belief. You can also calculate the percentage of times that worrying has helped you find a solution versus not finding a solution to help you see that excessive worrying may not be helpful to you. • Worrying increases our motivation and sets us into action: Has worrying helped you set up an action plan? If instead worrying is preventing you from making plans, worrying is not helping you. • Worrying ‘now’ means there will be less of a negative reaction if the worry occurs ‘later’: If you worry about the safety of a loved one, would you react less negatively if your fear came true in the future? • Worrying can prevent bad things from happening: This is not possible and is called ‘thought-action fusion’ by psychologists. No amount of worrying will prevent bad things from happening to us or loved ones. • Worrying means one is a responsible and caring person: Are there times in the day when you are not worrying? For example, if you worry about the health of a child, was there a time during the day when you did not, say during a 30-minute meeting at work? Does this mean you cared less during that 30 minute period? Of course not! Worrying is unrelated to being a caring or responsible person. Write down some ways that show you are a caring and responsible person besides worrying.
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