In a recent post, I discussed how anxiety is always at its highest when we are anticipating events. But, I didn’t talk about worry very much, so I thought I would do it today. We can think of worry as the cognitive component of anxiety. In other words, worries are the racing thoughts we have when we are feeling anxious about the future. They usually begin with the words “what if.” “What if I don’t get that promotion?” “What if my partner is cheating on me?” “What if I become very sick?” “What if I go bankrupt?”
The catch is that we can never answer these “worry questions” with 100 percent certainty. Even the most predictable of outcomes in this world are associated with some amount of uncertainty. The future is uncertain. And worry feeds on that uncertainty.
Because our worries remind us that the future is uncertain, they can motivate us to work hard for those things we want to happen (or not happen). We might complete all of our work assignments promptly, we might spend more time listening to our partner, we might take better care of our bodies, or we might save more money. The problem with worries, however, is that because they hinge on uncertainty, it is very easy to get stuck in a vicious cycle in which no matter how much we worry and prepare, we still can’t reach 100 percent certainty. About anything. This makes us feel anxious and, in turn, we respond to that anxiety with more worry, which in turn makes us feel more anxious.
In fact, according to Borkovec’s avoidance theory, worry allows us to “get in our heads” and therefore avoid feeling the anxiety in our bodies. But because avoidance frequently results in rebounds of the same emotions we are seeking to avoid, the more we worry, the more anxious feel, and the more we worry. And so on. Physiologically, this vicious cycle of worry is usually manifested by low heart rate variability (HRV), which indicates that our cardiovascular system is having difficulties reponding flexibly to changes in the environment (see earlier post). That is, our heart rate is not going up or down as fast as it ought to. This inflexibility can interfere with our ability to replace worry with more adaptive ways of managing our emotions.
Although we all worry, some of us do it to a greater extent. In fact, some people are so prone to getting stuck in the vicious cycle of worry that they meet diagnostic criteria for generalized anxiety disorder (GAD). GAD is a debilitating condition that affects approximately 6 percent of Americans (that’s roughly 18 million people). People with GAD entertain excessive and uncontrollable worries most of the time and they also experience a series of somatic symptoms, such as difficulties sleeping (worries keep them up at night), difficulties concentrating (worries can be quite distracting), and muscle tension. Moreover, people with GAD have difficulties regulating their emotions. In particular, they are prone to perceiving most things in the environment as treatheting. They seek to control this uncertainty by worrying, which only perpetuates the vicious cycle of anxiety. They also have difficulties implementing adaptive emotion regulation strategies, such as cognitive reappraisal and acceptance. Moreover, they have chronically low HRV.
A study I conducted in graduate school with my mentor Doug Mennin sheds some light onto the relationship between worry, emotion regulation, and HRV. We recruited participants with and without a diagnosis of GAD and asked them to watch emotion-eliciting film clips while we recorded their physiological reactions (you can find more information on these procedures in this earlier post). We were interested in the extent to which participants with GAD would be able to implement adaptive emotion regulation strategies in order to manage the negative emotions elicited by those film clips. We randomly assigned them to one of three conditions: 1) try to think of the film clip in ways so as to reduce how much negative emotion you are feeling (reappraisal condition), 2) try to allow your emotions to follow their natural course (acceptance condition), and 3) try to watch the film clip as you normally would (control condition).
Interestingly, we found that when told to use either strategy, participants with GAD had lower HRV (i.e., lower flexibility) than when they were not given any specific instructions on how to regulate. In contrast, healthy participants had higher HRV when told to use these emotion regulation strategies than when not given regulation instructions. We interpreted these findings as suggesting that when people with GAD try to expand their repertoire of emotion regulation strategies beyond their use of worry, they respond with lower physiological flexibility. This might explain why they find it so difficult to break away from their worry cycles and try new ways of regulating their emotions.
In any case, it is time to wrap up today’s post. But before clicking submit, I wanted to point out that a number of treatments have been developed for treating GAD. In the past decade, several research groups have developed emotion-focused treatments for GAD (they are variant on traditional cognitive behavioral therapy, which is also effective for treating GAD). The primary goal of these emotion-focused treatments is to teach patients to respond to their anxiety in a mindful, non-judgmental way, so as to break the link between anxiety and worry. In other words, rather than trying to “think through their worries,” patients are encouraged to notice their worries as reactions to their anxiety and to practice letting go of the need to worry. This is super challenging and it takes a lot of practice, but a number of studies have shown that this type of approach might be very useful for treating GAD (see the work of Doug Mennin, Liz Roemer & Sue Orsillo).
In case you’re wondering about self-help books, there are two really good ones that I have used in the past: “The Worry Cure” by Robert Leahy and “The Mindful Way Through Anxiety” by Roemer & Orsillo (if you have found other books to be useful, please let me know and I’ll add them to the list).
As a brief, in-home exercise, try to notice how many times a day you start a thought with “what if.” How often does this happen? A few times? Dozens of times? Hundreds of times? Do you find yourself worrying about a specific topic or about a number of different issues? Does the worry interfere with your sleep? Are you having difficulties concentrating? If the answer to most of these questions is yes, you might want to talk to a mental health provider. Here is more information about GAD from the and Anxiety & Depression Association of America.