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An explanation of worry

Worry is a two-part process including an uncertain question and an attempt to answer it. Whether the attempt to answer it occurs via analysis, problem-solving, distracting, or getting reassurance, the attempt to answer is always problematic because it can never “solve” an unanswerable question and it makes the original uncertainty feel more threatening. 

We typically say that you have generalized anxiety if you struggle against thoughts that are ego-syntonic— meaning consistent with your sense of what is important. You have obsessive-compulsive disorder if you struggle against thoughts that are ego-dystonic— meaning inconsistent with your sense of what is important. Many anxious people have both.

As an example, the person with generalized anxiety fears: “what if my child doesn’t get into college?” and, in thought and action, attempts to answer that uncertain, unanswerable question.

The person with obsessive-compulsive disorder fears: “what if my child is in the freezer?” and also, in thought and action, tries to be certain about this uncertain thought.

Where worrying about your child’s future seems reasonable to most people, worrying about your child being in the freezer seems “irrational” or “unreasonable” to most people, so they have an added layer of confusion, frustration, and shame about why they keep worrying, getting reassurance, and checking. 

Some worriers are worrying so incessantly that they don’t know what it’s like to experience their minds in any other way. Planning, solving problems, and responding to important internal and external cues is mixed in with running through catastrophic scenarios of anything they can imagine going wrong. Many worriers resonate with the sentiment: “If it’s possible, I can worry about it.”

Many worriers are also very effective problem solvers, and they know it. Trying to refrain from worrying can feel like they aren’t doing something important. Worry is constructive and effective when it alerts you to a real problem on which you can take real action. I would never attempt to make you less effective. Worry is problematic when it is actually uncertainty masquerading around like a problem.

The previous post explained the two questions you should ask yourself when you notice a worry: is this a problem I can solve and can I do something about it in the present moment? The next post will explain how you can identify and contain your worries.

In addition to uncertainty masquerading around as a problem, the habit of worry due to unrecognized belief problems (see previous posts) can also keep it going. Worry reduces affect, so sometimes people worry to prevent themselves from feeling other feelings that they don’t want to feel.

Some worriers are not effective problem solvers; they just worry about problems but don’t take action. Sometimes this a skill-deficient, as in worrying about a math test when you don’t understand the material or worrying about a presentation when you haven’t written it yet. An effective worrier will use these worries to signal that they should make a plan to study or prepare for the presentation. An ineffective worrier will notice the uncomfortable thoughts and feelings and become paralyzed or preoccupied by the worry itself. At this point, the problem is now worry about worry. Some people who experience this quandary start avoiding activities they really care about, because they can’t seem to make the worry go away nor solve the problem.

If you avoid rather than solve real problems that you care about in your life, consider thinking about your problem as worry about worry.

First, you’ll need to learn to tolerate the uncomfortable thoughts and feelings that come up when you are aware of a problem.

Next, you’ll practice taking effective steps to solve the problem, in the presence of the uncomfortable thoughts and feelings.

I know this may seem daunting, but remember that your mind and body are very adaptive and what you think and feel will change as you practice.

Walking, talking, reading, and adding were all tough… until they weren’t. When you go towards problems in your life, without shame or self-criticism, you will eventually feel effective over them and confident pursuing them. The difficult thoughts and feelings won’t be so difficult.


Belief problems that contribute to worry

It is rare that the anxious person will go to a doctor and say, “My problem is that I’m afraid of my thoughts.” You are more likely to complain, “I’m always thinking… I can’t stop thinking… I can’t turn my mind off… I can’t relax… I can’t sleep… I can’t concentrate because of my worries.” This is called fear of thoughts, because of the process that got you to the point where you feel as though you can’t stop thinking. 

The more you resist what shows up in your mind, the more likely it will occur in your mind. Make sure you don’t think of a white bear right now. Are you able to do it? It is very likely that the image of a white bear popped in your mind, because of the way your mind works. When you tell your brain not to do something, it has to scan to see if the thing it should be avoiding is there. Thus, you’ll think of what you’re trying not to think of.

Worriers have of paradoxical relationship with their worries because a part of them wants to stop worrying, but another part of them thinks that worrying shows them what they care about, prevents future catastrophe, prepares them for the worse-case scenario, and keeps them from getting more anxious. Worriers want to end the incessant, intrusive flow of thoughts that pops up at unwanted times, but they frequently keep worry going on purpose, thinking that it is helpful. 

And, sometimes worry is helpful. If a catastrophic thought arrives in your mind feels important, in order to effectively act on it, you should ask yourself two questions: 

     1) Is this a problem I can solve? 

     2) Can I take action on it right now? 

If the answer is yes to both questions, stop reading! Go take action. 

If the answer is no to the first question, the distress you feel is uncertainty. It is not danger. There is nothing you can do to solve the problem. Your challenge now is to relate more effectively with uncertainty, not come up with more and more ways to try solving a problem that doesn’t exist.

If the answer is no to the second question, and the problem is bothering you, you should think through what your next step is and when you will act it. The next step might be delegating something to someone else or waiting to hear back from someone else, and just acknowledging this can provide relief. 

Sometimes people continue to worry even when they’ve made a plan. Oftentimes, this is because the feeling of uncertainty is very unpleasant, especially if the worry is very important (like, waiting to hear the results of medical tests). Labelling the uncertainty as uncertainty can disarm it a bit, and help it from gaining fuel via additional content (as in, “I have such a bad feeling about this that there must be something wrong!”). You should specifically remind yourself that the feeling of uncertainty is a feeling, not a fact or prediction. Put differently, how you feel about a potential catastrophe has no relationship to the likeliness of whether or not it will occur. Getting stuck in a feeling just causes you more suffering.

In the upcoming posts, we will go into great detail about uncertainty, the purposes worry serves, and how to manage it effectively.


Belief problem v. Workable Attitude

As I described in the section on theories of responding to psychological suffering, I belong to the school of thought that believes that it is your response to yourself and your environment that determines your sense of wellbeing. It is not your circumstances themselves, but rather your interpretation of them and your beliefs about them that determines how you think, feel, and act.

I call those thoughts that drive ineffective behavior “belief problems.”

Various psychologists throughout the years have used different terms for the same problem. They are called cognitive distortions, negative schemas, problematic scripts, and over-used defense mechanisms in other schools of thought.

I use the term belief problem because I want it to cue you to remember that your thought, feeling, sensation, or situation are not your problem. They may cause you pain but they don’t cause your suffering. If you recognize that it is human nature to experience pain and you let the moments of pain occur without resistance, your suffering will decrease over time.

I also like the term belief problem because it speaks to the foundational parts of who you are. Typically when people talk about their beliefs, they are referring to a particular set of religious, moral, political or lifestyle indicators that dictate their behavior and give them a group with whom to identify. What I am concerned with here the more set of automatic responses that individuals naturally develop as the result of unexamined assumptions about the way you should relate to your mind, your body, other people, and your values. 

Everyone has these assumptions and some assumptions are much more effective than others. Whether you have ineffective automatic assumptions because of unexamined dysfunctional styles of relating in your family of origin, traumatic experience, or a long-standing anxiety disorder at whose mercy you have been suffering, you can learn to identify and change your automatic assumptions.

The opposite of a belief problem is a workable attitude. Having a workable attitude requires your acknowledgement of how your attitude influences determines your life.

The word workable is more helpful than “good” (as in good attitude), because the word good is judgmental without being especially helpful.

The word workable should cue you to think, “When I think this way, does it help me live based on my values, or does it make it harder for me to live according to my goals?”


Example of self-monitoring for Obsessive Compulsive Disorder

1) What was the trigger? Was it internal or external? My mom told me about her friend that was diagnosed with cancer

2) What sensations do you feel? heart beating faster, tightness in chest, short of breath, light-headedness

3) What thoughts are you having? what if I have cancer?  

4) What is your reaction to the sensations and the thoughts? what if I can’t stop thinking about this? what if my anxiety doesn’t go away?  

5) What types of avoidance do you want to engage in? I knew it was OCD, but I wanted to check my symptoms on WebMD. I wanted to ask my mom about it. Then I wanted to distract myself.

6) Did you engage in avoidance/neutralization/compulsions? Yes

7) If yes, what did you do? If no, why didn’t you? Immediately after my mom told me about her friend, I told my mom I was anxious and asked her if I could possibly have cancer. She said no, but then I felt a weird sensation in my arm and looked it up online. Later in the night, I kept thinking about it and watched some movies to distract myself.


Example of self-monitoring for Social Anxiety Disorder

1) What was the trigger? Was it internal or external? Being at a social event, having critical thoughts about my competence

2) What sensations do you feel? Stomach in a knot, muscle tension, light-headed, pain in chest 

3) What thoughts are you having? “What if other people notice how anxious I am and judge me? What if my mind goes

blank when I’m trying to talk to someone? What if I don’t know what to say?” 

4) What is your reaction to the sensations and the thoughts? I remembered that I talked about this happening in therapy, but in the moment I just felt so embarrassed that I couldn’t bear it. The sensations felt out of control and I believed my thoughts. 

5) What types of avoidance do you want to engage in? Reassuring myself, getting reassurance from my friend who was there, comparing myself to other people there, leaving the party

6) Did you engage in avoidance/neutralization/compulsions? Yes

7) If yes, what did you do? If no, why didn’t you? I did all of them and it just kept getting worse. The more reassurance I tried to get from myself and my friend, the more anxious I felt. Comparing myself to others made me feel awful too.


Example of self-monitoring for Panic Disorder

1) What was the trigger? Was it internal or external or both? Driving on the highway 

2) What sensations do you feel? I’m having the sensations of heart racing, sweating, stomach in a knot, shoulders tight, arms and legs tingling, head hurts a little, dry mouth

3) What thoughts are you having? I’m having the thought, what if I panic while driving? 

4) What is your reaction to the sensations and the thoughts? Initially I didn’t like that I was having these sensations and thoughts, but then I remembered that I should practice wanting them, and I told myself, ‘Good job!’ for triggering them.

5) What types of avoidance do you want to engage in? I wanted to avoid driving.

6) Did you engage in avoidance/neutralization/compulsions? No

7) If yes, what did you do? If no, why didn’t you? I didn’t avoid driving because I remembered that I was uncomfortable, but not in danger, and that if I keep driving when I have these sensations and thoughts, they will eventually go away. Once I was a few blocks away, my sensations did in fact subside.


Using self-monitoring to start facing your anxiety

Self – Monitoring is helpful for two reasons:

#1 –  One of anxiety’s best tricks is hiding itself from you. You’ve gotten into the habit of avoiding so quickly that you don’t actually observe what’s happening. You are having a thought, the thought is arriving in your body with sensations, and your mind is interpreting the thought as important. Since the thought feels important, you are responding to it as if it is important. Whether you distract yourself, analyze them, get reassurance from others about them, or do anything else to try and make them go away, the point is that you are responding to your thoughts as if they are facts, and threatening facts at that. 

Self-monitoring is the opposite of avoidance. The act of slowing yourself down, identifying, and labeling the thought as a thought shifts you from content to process and you are on your way toward mindful observation.

If self-monitoring sounds like a good idea while you’re reading about it right now, but practicing it in your real life is a challenge, you’re in good company. It isn’t because you’re lazy, you don’t understand, or it doesn’t work. You don’t need the perfect explanation or the perfect device to practice this skill. Self – monitoring is challenging because it’s the first step toward getting distance from the content of your thoughts and it’s the opposite of your natural reaction.  

You want to get to the point where you have an anxious episode and later, rather than “why me? what’s wrong with me?”, you think,

“Oh. I know what happened. My anxiety content was triggered and I was tricked into believing my thoughts. Then, I got stuck trying to make them go away. Oops! Silly me! What a tricky mind I have!”

This type of gentle and humorous observing will disarm your anxious content and make it easier to get unstuck next time. 

#2 – Self-monitoring can also help you identify what types of thoughts you typically get stuck on. For many people it feels like they are worried about a number of different things. When they track what they actually worry about day to day, it is in fact only a couple of different themes. 

Some anxious thoughts remain concerning due to inaccurate information, as happens when an individual misinterprets a rapid heart rate as a heart attack. Other thoughts maintain their power through what I call “belief problems”. One example of a belief problems is believing that having a thought is as bad as doing something. Once I see the content of your self-monitoring, I can help you identify and challenge your belief problem. 

With is in mind, here’s the data I want you to collect while self-monitoring: 

1) What was the trigger? Was it internal or external or both? 

2) What sensations do you feel? 

3) What thoughts are you having?  

4) What is your reaction to the sensations and the thoughts? 

5) What types of avoidance do you want to engage in? 

6) Did you engage in avoidance/neutralization/compulsions?  

7) If yes, what did you do? If no, why didn’t you? 

Do this at least daily. 


Waiting to feel certain to take action

I was talking to a client filled with regret about waiting until late in his life to pursue the romantic relationships he always wanted, and I had the thought, “The belief that ‘I have to meet some arbitrary criteria in order to live my life’ is a really problematic one.

Later that day I had the presence of mind to write the title “Waiting for my life to start” as the type of problematic belief that deserves its own new entry. 

As I wrote it I had the thought, “Oh I’m looking forward to when I write that.” And then, I noticed anxiety wondering when I’d actually do it. 

Bingo! This is the problem!

And so, because I have some time I am writing the entry now and imperfectly. 

Making plans can be very seductive. You may have lots of great ideas about what you want to do and how you’ll do it and thinking about these plans can be very exciting. In addition, “planning” to do something by figuring out when you’ll do it, for how long, with whom, etc., rather than doing it, can feel like you are making progress even though you are not. Sometimes planning is an important part of starting a new project. However, if there are many projects or ideas that you have planned out, but not acted on, your planning is likely primarily functioning as an anxiety neutralizer.   

You don’t need to plan better or “make better decisions.” You (likely) don’t need coaching in organization and time management. Rather, you need to notice and label the anxiety you experience when you start to take action and learn to relate to it more effectively.

Whether it is a big thing, like getting into a romantic relationship or moving across the country, or a little thing, like jotting down some notes when you have a new ideas or emailing someone back, the process is the same.

Relating to your anxiety effectively means noticing and labeling it as anxiety, actively allowing it to be there, and doing the thing that is uncomfortable for you. You have to learn to act, in the presence of uncertainty and imperfect and learn to accept of discomfort and doubt.

Put another way, the practice is noticing the belief “I’m not ready yet,” deciding whether you want to live by it, and if you would not like to live by it, committing to a small immediate action that undermines the belief. 

Back to the arbitrary criteria… 

It may not seem arbitrary. 

“I have to feel better before I can…” 

“I have to stop feeling anxious before I can…” 

“I have to stop feeling depressed before I can…” 

“I have to lose weight before I can…” 

“My children need to grow up before I can…”

“I have to make more money before I can…” 

“I have to be confident before I can…”

Many of these scripts seem like they are speaking truth when you experience them automatically.  But, if you can get to know them: when they show up and what to say back. They don’t have to thoughts that you act on.

If this script is one that you resonate with, consider reflecting on a few short questions: 

1) What is it that I want to change in my life? 

2) What am I waiting to happen before I change this about life? 

3) What feelings am I trying to avoid by waiting for the change to occur first? 

4) How can I take a small step toward feeling what I want to avoid right now?

5) Are there any small steps toward my goal that I can take today? 

Commit to the actions related to answers 4 & 5 and repeat as often as possible.


How values relate to goals

In contrast to a goal, which is specific, measurable, attainable, relevant, and time-bound, values are aspirational traits that you’d like to embody. Your values signify your life process, the journey that you pursue during your time here on earth. Your values are not something that you can complete or check off. They are not a place where you arrive. The underlying philosophy of a person who attempts to clarify and pursue his or her values includes recognizing ongoing learning and development as a good way to live life. 

Values and goals are related. If you understand these concepts, you can use your values to inform your goals, aligning your goal-directed behavior with your personal life philosophy. 

Here are a few examples: 

Goal: Complete each homework assignment in x class and turn it in on-time

Values: Ongoing learning and skill acquisition

Goal: Research and purchase a gift for my partner’s birthday one week prior to birthday celebration

Value: Being a loving, thoughtful partner

Many anxious people become too bewildered by their anxiety to be able to clarify and pursue their values. 

If your fear of your thoughts, feelings, or sensations drive your behavior, you’ll likely be unable to see what you care about and how you’d like to act. You can’t trust yourself if you can always be potentially knocked off course by anxious thoughts, feelings, or sensations. 

One of the ways of thinking that creates, maintains, and intensifies anxiety is perfectionism, or all-or-nothing thinking. This underlying habit of mind can be especially problematic, because it not only contributes to anxiety and depression, but it also prevents the anxious or depressed person from seeing the effective way out of such states. 

A person stuck in their perfectionistic way of thinking might think, “I know how I’ll stop being anxious, I’ll make sure that I’m always a loving person.”  This is a bastardization of values-driven behavior that is still approached from a perfectionistic point of view. 

Approaching values this way does not offer the meaning and purpose that makes values-driven living so rewarding. It becomes another chance for self-criticism and judgment that will increase suffering. As you start trying to live by your values, try to let the vague principles guide your goal-directed behavior, rather than making them rigid and prescriptive.

Also, no matter how anxious you feel, you can get a hint at what you value by the content of your anxiety. Oftentimes, people value the opposite of what they fear. For instance, someone with the fear of harming themselves or others often love life and deeply value their relationships with others.

You can start to get a sense of what you value, by asking yourself, “if I didn’t feel anxious, what type of person would I want to be? How would I spend my time? What would I do?”


Setting goals to gain confidence

A helpful goal is specific, measurable, attainable, relevant, and time-bound. This is opposed to non-specific, vague, emotionally-driven, or unattainable goals.

As an example, “I’d like to be more confident” is not a helpful goal, because it is not specific, measurable, attainable, or time-bound. It is vague and unmeasurable and unattainable.

Sure, you could measure your level of confidence about a specific task one day and then measure your level of confidence using the same questionnaire at another time in the future. However, you would not actually be able to measure the nuances of confidence, because it is feeling state that changes over time. Just because you feel x amount of confidence on Monday at 4pm and y amount of confidence on Thursday at 10am, doesn’t mean that you’ve become more confident throughout every aspect of your life. 

By unattainable, I don’t mean that you could never become more confident, but rather there is no objective binary cutoff where you could say either I am confident or I am not confident. 

Other questions I have about this goal include: what does it mean to be more confident? Do you want to be more confident in every area of life or just some areas? How would you know when you completed your goal? How does this goal direct your behaviors? 

So, you can see through this one example that while a goal like this one might feel good to write, it is a wolf in sheep’s clothing, in the sense that it does not direct your behavior toward something specific and measurable that you can attain in a relevant amount of time. 

Here are some common goals that have the same problems as the examples above:

“My goal is to be happy”

“My goal is have a good romantic relationship”

“My goal is have a good career” 

“My goal is for other people to like me”

“My goal is to be attractive”

Again, problems with these goals include the fact that they are non-specific, dependent on feelings, dependent on other people’s behavior, or unattainable in a measurable way. 

Let’s talk about helpful goals. 

The interesting thing about the word confidence is that it comes from a Latin word that can either mean “a feeling of faith or believing” or “an act of faith.” This definition is helpful, because the actions of confidence often come before the feelings of confidence.  

A person with the unhelpful goal, “My goal is to be more confident,” could make it into a helpful goal with just a few more descriptors. 

An example is, “My goal is to attend two events this week and initiate a conversation with one person I don’t know at each event.”

If the person lacks the feelings of confidence during spontaneous conversations with strangers, this is a helpful goal because it is specific, attainable, measurable, relevant, and time-bound. At the end of the week, she has either completed her goal or not. The goal is based on observable actions she took with her arms and legs, not her thoughts or emotions. Most importantly, if she keeps setting and pursuing these types of goals while relating with openness to the thoughts, feelings, and sensations that arise along the way, it’s likely that she will feel more confident more often. 

Note that this was a great example for an individual who specifically feels anxious and lacks the feelings of confidence during spontaneous conversation with a stranger. This is a very specific problem with a very specific solution. 

When you are reflecting on the challenges in your life and deciding how to set goals to overcome them, you want to get as specific as possible about what the issue is and break the solution down to the smallest next step.

For instance, perhaps the intimacy of romantic relationships is what you fear and it is preventing you from getting into a long-term relationship. When you’re thinking through how to overcome this fear, it’s important to recognize all the different fears that could be wrapped up into that one big one. We’ll get into this in greater detail in a future post.