Functional Worry

I’ve decided to organize the categories of repetitive negative thinking into types so that I can also organize interventions that will be most helpful for each type. You won’t find this in any textbook, scholarly articles, or elsewhere on the internet. I’m using these types for us to have shared language without unhelpful interpretations that come with the current label of each type of thinking pattern. (For instance, “I have anxiety, not OCD,” which may or may not be true in any given person.) Refer back to my previous post for a review of the dimensions.

Type 1 – Functional worry

  • Ego-orientation: Ego-syntonic, meaning that worries seem reasonable to worrier.
  • Time orientation: Past and future
  • Content: Can be anything
  • Beliefs that maintain it: “I don’t feel as upset by everything when I worry.” “I worry because I care.” “Worrying helps me problem solve.”
  • The function that maintains it:  Suppresses all feelings (examples: uncertainty, not-just-right  feeling, guilt, disgust, embarrassment)

Worry as a function is a cognitive form of experiential avoidance, similar to thought control or thought suppression. In thought control and thought suppression, individuals make active attempts to stop thinking about the stimulating topic and distract themselves. When worrying as a cognitive avoidance, you might feel like you are thinking a lot about the topic and even feel completely preoccupied with it. This form of worry is problematic when you don’t feel like you get to choose to think about it and when the thinking you are doing is not becoming problem-solving. If you have fallen into the habit of worrying as experiential avoidance, you probably don’t know what you feel about the content that preoccupies you. Another clue is that you can’t stop thinking about it, but you don’t want to talk about it. You feel an aversion to anyone asking you about it, you don’t want to discuss it in psychotherapy, and if you were to try to write out what you are worried about, it would either be very hard to do or feel very uncomfortable for you.

Here are some questions to ask yourself if you are experiencing worry as experiential avoidance:

  • If I didn’t feel anxiety, what would I feel? (examples: sadness, anger, guilt, fear, regret, jealousy, embarrassment, NJR)
  • If I was going to take action on this topic, rather than worrying about it, what is my next step?
  • Is there anything I can actually do differently?

Scheduled worry time is the most of effective intervention for worry as a function. When the main function of your worry is to avoid or suppress uncomfortable sensations and feelings (that is, experiential avoidance), the best thing you can do is go towards it until it is boring. Write out all of your fears and then say them over and over until it is no longer distressing.

Notice the dimensions above. Scheduled worry time should challenge the idea that worrying is reasonable. The time orientation and content don’t matter. If your worry is not also maintained by actual problems to solve or beliefs about the utility of worry, scheduled worry time should challenge the function of your worrying and break your habit.

The main intervention for functional worry: Scheduled worry time

Scheduled worry time involves setting aside 10 minutes per day twice per day to worry aloud. During this exercise, you should plan what you will worry ahead of time, writing down everything you worry about in the format:

“What if _(catastrophic thought)__?”

Do not problem solve or answer the question, just write a list of the things you worry about. As an example, the list might include:

  • What if I don’t get where I need to be on time?
  • What if my car breaks down?
  • What if my child gets sick?
  • What if something terrible happens to me?
  • What if there’s something wrong with my mind?
  • What if I feel embarrassed at the upcoming event?
  • What if I’m not prepared for the thing I need to prepare for?
  • What if ____ is mad at me?
  • What if I do something that causes people to dislike me?
  • What if I fail?
  • What if I make a mistake at the thing I’m trying and maybe I don’t fail but it has some other catastrophic consequence?
  • What if worrying so much means something bad about me?
  • What if anxiety isn’t my problem?
  • What if I’m anxious forever?
  • What if this technique doesn’t work?

Your list can be as short or long as you want it to be and you can add to it over time. It’s important that you continue to worry out loud, in a mirror for 10 full minutes, even if you only have a minute or two of worries. By repeating the worries over and over you will likely start by feeling anxious, but finish the task feeling bored.

The point is four-fold:

  • Contain the worries to one part of the day and have a place to “put” worries that pop up in the middle of the day, thinking “Oh. Let me get back to whatever I’m doing. I’ll worry about that later.”
  • Desensitize yourself to the thoughts themselves, by hearing them out loud in your own voice.
  • Learn to see your worries as chatter, that just pops up when you feel anxious, not as content that is important to respond to.
  • Cue yourself to respond to the thoughts as worry when they intrude in your mind at other times, not as content that is important to respond to.

To learn more about scheduled worry time, read Dr. David Carbonell’s book The Worry Trick.

If you give scheduled worry time a fair shot and you still worry a lot, your worry is not primarily maintained by functional cognitive avoidance.

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