A whole range of mental health problems are acquired and maintained through the development of delusional beliefs about the self and the world – and I’m not just confining that statement to the obvious conditions that display delusional thinking, such as psychosis. Even the most common mental health problems, such as anxiety and depression, are underpinned by quite ingrained, strongly held delusional beliefs about the self or the world, and this led me to thinking about the role of delusional beliefs in maintaining chronic or pathological worrying.
As I’ve said before, pathological, uncontrollable worrying is extremely common, can be found in almost all the anxiety disorders, is the cardinal diagnostic feature of Generalized Anxiety Disorder, and is paralleled in depression and other conditions by perseverative ruminative thought. Chronic worrying is all about the individual’s ‘need’ to worry, the perseverative nature of worrisome thought, and the regular lack of closure or resolution to that worrying – the worrier spends hours worrying, with the usual outcome being that the topic of the worry now seems much worse than better!
So what delusional beliefs does the chronic worrier hold? There are a lot! When I came to list these, I surprised even myself with the length of the list. And they are all delusional – by that, I mean they are thoughts and beliefs that do not reflect reality. Here’s my list of 10 delusional beliefs held by chronic worriers.
1. “I’m a born worrier”. No – worriers are not born, they are made. Anxiety has a modest, nonspecific genetic component to it, but there is no evidence that worrying is inherited. True, your mother or your father may have been a worrier, but in all probability you simply learnt the habit from them. The “I’m a born worrier” plea often spoken by worriers is more of a: “I have to worry, so don’t even try to change me!” plea.
2. “If I worry about something it’s likely to happen”. No – most of the things that worriers worry about are highly unlikely to ever happen. But it is true that the more you worry about something, the more you think it’s likely to happen.
3. “Just because something I worried about in the past didn’t happen, doesn’t mean it won’t happen in the future.” No – I suspect that around 90% of what chronic worriers worry about is never likely to happen. If something you worried about in the past didn’t happen, there’s probably a reason for that, and that reason may well be around in the future. Alternatively, worriers catastrophise their worries to highly improbable ends (e.g. if a partner is 15 minutes late, the worrier will catastrophise that into the partner having an accident, being injured, being taken to hospital, etc.). The end points of catastrophized worries are highly improbable and as unlikely to happen in the future as they were in the past.
4. “Worrying will prevent bad things happening”. No – worrying alone never prevented anything from happening, only actions stop things happening. Unfortunately, chronic worriers have very poor problem-solving confidence so are usually unlikely to reach a solution to a problem that they believe is worth acting on (see No. 6).
5. “If I’m anxious about something, it must mean it’s a threat or a problem, so I should worry about it”. No – this is called the fallacy of ex consequentia reasoning. People can feel anxious for lots of reasons, such as being tired, in pain, or simply in a negative mood, and these feelings don’t mean that what you’re thinking about at the moment is a threat or problem.
6. “I’m useless at thinking up solutions to problems, so I must keep worrying”. No – chronic worriers are as good as anyone at thinking up useful solutions to social problems, they just lack confidence in the solutions they generate.
7. “I must think through all the possible things that might happen otherwise I won’t be prepared.” No – worriers are excellent at continually asking themselves “What if…?” questions that fuel their worrying. But the more potential outcomes that you generate, the less likely they are to ever happen.
8. “If I worry about others, it will show I care about them.” No – there’s nothing worse than knowing that someone else is continually worrying about you. If you do care about someone, then let them know that in more direct ways.
9. “If I let other people know what they do makes me worry, they will change their behaviour.” No – they’ll just get angry with you. Family and friends can easily see through this form of emotional blackmail, and it’s one of the major reasons why individuals with conditions like Generalized Anxiety Disorder regularly have problems with close relationships.
10. “It is better to spend a lot of time thinking about a problem than making a snap decision.” No – most people make decisions on a daily basis by the way they feel, on the advice of others, or a “gut instinct” – you don’t need to spend a long time thinking through every aspect of an issue before making a decision. This is the difference between what is known as using “heuristics” and using “systematic processing”
These are all delusional beliefs that have to be deconstructed in therapy with the chronic worrier – but like everyone who holds well-rehearsed delusional beliefs, that is not a simple process.