In order for human beings to manage their lives, they have to accommodate to constantly changing circumstances. They have to adapt to the demands of daily life. So constant is this process that it goes unnoticed unless something goes wrong. When the car breaks down, or the children go missing for fifteen minutes, or a boss seems threatening, we have to respond. This is the warp and woof of life. Throughout most of human history we lived in caves and small settlements. Every day there were dangers to consider and to avoid. If there were individuals who were oblivious to all the mishaps and mistakes one could possibly make, they would not have survived long enough to reproduce. We are all the products of men and women who evolved to be wary.

There is nothing remarkable about this. We plan our days and our years. From the time we are children, we are told to watch out for strangers, for speeding cars, and for being caught outside in bad weather. We are instructed to eat and sleep properly and take care of ourselves. Doing the right thing becomes automatic—most of the time. We do not worry about these matters. We plan for them. We schedule them.

But even as children, and forever after, we also worry about things. What distinguishes those problems we plan for from those we worry about?

We plan—what we are going to have for dinner. What movie we are going to see. What college our children are going to apply to, what our next vacation will be—and so on. We can plan for our retirement.

We worry, typically—about our children hanging out with the wrong crowd, about a family member getting sick, about not having enough money to pay our bills, about getting fired—and many other things. These worries do not necessarily have to be about important matters. We can worry about whether we can get to an airport on time, or whether our children are eating enough, or about whether a close friend may be angry at us. We can, in fact, under certain circumstances, worry about those things that we might ordinarily plan for. We can plan for our retirement, but if it is fast approaching and we do not have enough money, we will start to worry about retiring.

What distinguishes planning from worrying?

We plan every day for all those things we need to accomplish during the day. We worry about those things that are very difficult or impossible to plan for. Worrying is frustrated planning. For instance, we can plan for who will pick up the children from school. We worry when we find out that no one has picked them up and we have no way of picking them up. If a parent does not concern herself in the first place with her children being picked up, she will not worry about them. So, being reckless is one way to avoid worry. Certainly, there are people who sail blithely throughout life without worrying but who are courting disaster a lot of the time. For instance, just as there are hypochondriacs who are at a doctor’s office for the slightest reason, there are others who may be in the middle of a heart attack, but who put off going to the hospital because they expect every medical problem to go away spontaneously.

To put it another way, we can plan for something important and not worry, if it seems to us we are in control. We worry about things we cannot control. So, we worry if a biopsy will come back showing an abnormal growth, we worry about our children using drugs, we worry about not having enough money to pay the mortgage, we may worry about a spouse being unfaithful. These matters seem to be out of our control. They defy out ability to plan for them. Worry is, therefore, an inevitable consequence of the inability to plan successfully. It is as if we our searching our minds for a plan to confront these problems and cannot find one. If we could find one, we would not worry!

Besides these concerns, which everyone has to some degree or another, there are worries—irrational (unreasonable) worries—which bedevil especially anxious individuals. Men and women with Generalized Anxiety Disorder, for example, spend most of their time worrying about dangers that are very unlikely, or entirely nonexistent. So, I have patients who worry about:

Excessive radiation in their homes.

The possibility of someone setting off a nuclear bomb in a nearby city.

Their daughter being raped if her car should become disabled on a highway.

Getting sick if they miss a good night’s sleep, or a regular bowel movement, or if they go out on a cold day.

Catching germs from a doorknob.

And so on.  These individuals cannot plan to avoid danger because it is everywhere. So, they worry.

It is sometimes said to worriers that they should stop worrying because “what good does it do?” You might as well tell them to stop planning. It is important to plan!  Sometimes a reasonable plan will occur to someone in the midst of worrying. But persistent and painful worrying has the quality of mulling over the same “what if…” conjectures over and over again without ever discovering a plan of action. Still, It is impossible to stop worrying simply by deciding to stop.

The Treatment of a Worry.

 A specific worry—let’s say a worry of having developed cancer—should always be thought of in two ways: what is the chance of that awful thing actually happening (in this case cancer) And second, what would happen next if that awful thing did happen? There is a “well, then…” that comes after the “what if…?” If someone develops cancer, there are different plans one can engage in: seeing a specialist, undergoing different treatments, arranging for family members to help. Probably about 50% of cancers are now treatable. And many others are not fatal. Too many people get to the “what if…?” stage and never go beyond it. Often, someone who does get cancer gets so caught up in making arrangements for treatment, there is no time for worrying. The antidote to worry is action. Chronic worriers are simply people who are not good at making plans.

A general strategy for dealing with worry.

No matter how out of control a situation may seem to be, worrying about it can be dispelled by developing a plan of action. The trick, then, for the affected person—or his/her therapist—is to try to find some plan for dealing with that situation. Sometimes a simple exploration of the problem immediately suggests a reassuring response. I worried one time that my daughter would miss a connecting flight. She pointed out to me that the airlines have a way of dealing with that situation.

“They will just put me on the next flight,” she told me.

One more example, a patient of mine has been scolded at work and feels he has reason to think he may be fired. He recently bought a house and is worrying about being unable to meet his financial obligations. This worry preoccupies him.

I do not recommend to him that he sit on the porch and warm himself in the sun and try to remain “in the moment.”  This man has a real concern and should not be encouraged to engage in foolishness. He needs a plan.

Some things to do:

Try to determine the real risk of being fired. There are ways of doing this. Not every employee who is scolded is in danger of being fired.

If, in fact, his boss thinks he is performing inadequately, he may be able to talk to his boss and address his dissatisfaction.

He may need to speak to others in the company to see if there is a chance for an internal transfer to avoid this particular boss.

He should explore his finances to determine just how long he can go without a job. He can consider other short-term emergency measures he can take if he has to, such as borrowing money from a family member. In any case, he should talk to friends and family for emotional support.

He should bring his resume up to date.

He should network, which means talking to friends and former colleagues to see if there is job somewhere that they may know about. They may be able to refer him further on to other people who may be in a position to help. He should interview for other jobs as soon and as frequently as possible.

He should try to find a headhunter, that is, someone whose job is placing employees.

And there is more. The more detailed the plan, the less likely he will continue worrying. Even starting to implement a plan will make him feel better. © Fredric Neuman M.D.

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