We all worry on occasion. But what makes worrying so debilitating? A good place to start is differentiating between thinking, worrying, and obsessing. Each of these is a private event—the occurrence of the action is only observable to the person performing the act. They also represent a continuum of helpful to unhelpful cognitive activity. When we think about something we are analyzing an event, situation, or condition. We are attempting to describe it and possibly generate a solution or a better way to manage a problem situation. For example, I am thinking about what to eat this evening. We have a situation, and evening mealtime, and I start thinking (an action) about possible solutions----what I can prepare and place on the table to eat. The act of thinking results in neutral or positive outcomes. In this case, I will be preparing a sandwich. I have a solution to the problem of what to have for dinner.
Worrying is also an active behavioral process. When a person worries, they are thinking about future potential negative outcomes about past or future events or actions. The future situation that we are worrying about is fear provoking or we assume that our actions will produce negative outcomes. We worry about what will occur. Worrying is different from thinking in another way. When a person engages in worrying two things occur. First, your thoughts are about a hypothetical unpleasant event that may occur. Second, as you worry about this potential future event, you become increasingly tense, nervous, on edge, and restless. This is anxious arousal. The more you worry the more anxious arousal you experience. As the anxious arousal increases, the person becomes increasingly overwhelmed and effective action is less likely to occur. People who worry say that trying to predict and be certain of every possible negative outcome prepares for the worst. What they are neglecting is that for every new potential negative outcome they come up with, they feel more distressed. Individuals who worry become distressed when there is uncertainty. Worrying provides false hope that they have prepared themselves for whatever will happen. But nothing is certain. You keep worrying and feel incapacitated. When none of those potential negative outcomes occurs, you have relief. Now worry has you on the hook. It looks like worrying about “what if” paid off because the bad stuff didn’t happen. But worrying about whatever did not change anything, except that you now will worry more. And you will be miserable.
Obsessing occurs when a thought pushes into your awareness produces anxious arousal and fear and prevents other thoughts from occurring. The obsessive thought is unwanted in contrast to worry where the person is actively analyzing events. The obsessive thought is related to a fear such as losing control, contamination, or harming others. Because the obsessive thought produces anxiety, individuals learn maladaptive actions that lessen the anxiety or neutralizes the “effect of the thought.” These actions are called compulsions or rituals. Obsession and compulsion go hand in hand, but obsessing is not worrying. Worrying and obsessing are related in that each is related to intolerance of uncertainty.
Widespread worry (generalized anxiety disorder; GAD) and obsession and compulsion (obsessive compulsive disorder; OCD) can have serious negative psychological impacts affecting the person relationships, and work. Clinical research has shown that specific cognitive behavior therapy (CBT) procedures are needed to help manage generalized worry (problem solving, relaxation training, cognitive restructuring) and OCD (exposure response prevention). Treatment procedures are not the same. Use of inappropriate methods worsens both disorders.
By:
Duane Lundervold, PhD, LPC, BCBA-D
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