Beyond Everyday Anxiety: The Psychology Behind Chronic Worrying

“If there is no solution to the problem then don’t waste time worrying about it. If there is a solution to the problem then don’t waste time worrying about it.” ― Dalai Lama XIV

Worrying is a universal human experience. We all worry to some extent about what the future might hold. These worries can range from minor everyday concerns such as being late for a meeting, to more significant issues like health or financial stability. Despite its usefulness and ubiquitous nature, excessive worry can be a detrimental force, leading to mental health problems such as generalized anxiety disorder (GAD) (APA, 2022). The psychological underpinnings of worrying provide keys to understanding both its adaptive and maladaptive facets, as well as strategies for coping with excessive worry.

Understanding Worrying

Worrying, in essence, represents a cognitive activity wherein an individual is preoccupied with thoughts about potential negative outcomes (Borkovec, Ray, & Stöber, 1998). It has been formally defined as “a chain of thoughts and images, negatively affect-laden and relatively uncontrollable” (Borkovec, Robinson, Pruzinsky, & DePree, 1983, p. 10). In moderation, it can serve an adaptive function. Worrying can act as a problem-solving strategy, stimulating proactive behavior, planning, and goal-setting (Sweeny & Dooley, 2017). For example, a person might worry about an upcoming presentation at work, and as a result, put extra effort into preparing to ensure a positive outcome.

However, when worry becomes excessive or chronic, it ceases to be functional and can become a problem in itself. Research has indicated a link between chronic worry and various mental health disorders, particularly GAD, which is characterized by persistent and excessive worry that is hard to control (Hirsch & Mathews, 2012).

Worry and Rumination

Pathological worry shares similarities with rumination, which is frequently associated with depression (Nolen-Hoeksema, 1991). Both processes involve recurrent negative thinking about topics focused on oneself, often in a somewhat abstract manner, such as “What if something bad occurs?” (in the context of worry) or “Why do I always fail?” (in the case of rumination). While these two cognitive processes have some overlap, worries generally revolve around potential future dangers to oneself. In contrast, rumination often focuses on past negative incidents or perceived personal flaws (Watkins, Moulds, & Mackintosh, 2005).

The Cognitive Model of Worry and GAD

The cognitive model proposed by Borkovec, Ray, & Stöber (1998) provides a theoretical framework to understand worrying, particularly in the context of GAD. According to the model, worry arises as a response to perceived threat, and the individuals who worry excessively may believe that worrying helps in coping with the threat. This belief and the accompanying worry can create a cycle, leading to chronic worry or GAD. The model also suggests that worry is maintained due to negative problem orientation, cognitive avoidance, and intolerance of uncertainty (Borkovec et al., 1998).

Negative Problem Orientation (NPO) refers to a dysfunctional set of cognitive-emotional schema that includes negative beliefs and attitudes towards problems and one’s problem-solving ability (D’Zurilla, Nezu, & Maydeu-Olivares, 2002). Those with high NPO tend to worry more as they perceive situations as threatening and doubt their ability to cope.

Cognitive Avoidance is another maintaining factor. It is believed that worrying can act as a cognitive avoidance strategy, allowing individuals to avoid more distressing mental images or emotions by focusing on worry thoughts (Borkovec et al., 1998). This theory suggests that while worrying may induce stress, it is less distressing than confronting the more emotionally charged aspects of the perceived threat.

Intolerance of Uncertainty (IU) is a cognitive bias that affects how a person perceives, interprets, and responds to uncertain situations on a cognitive, emotional, and behavioral level (Dugas, Gagnon, Ladouceur, & Freeston, 1998). Research suggests a strong relationship between IU and worry, indicating that people who exhibit higher IU are more likely to engage in worry as a coping strategy (Carleton, Mulvogue, Thibodeau, McCabe, Antony, & Asmundson, 2012).

Coping with Excessive Worry

Addressing the cognitive components that maintain worry is crucial in managing excessive worry and GAD. Cognitive-Behavioral Therapy (CBT) has been found effective in this respect (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012). CBT aims at modifying dysfunctional cognitions and behaviors, which are considered to contribute to the development and maintenance of anxiety disorders, including GAD. Through CBT, individuals learn to identify and challenge their worry thoughts and beliefs, replace them with more balanced ones, and develop more effective problem-solving and coping skills.

Mindfulness-Based Cognitive Therapy (MBCT) has also been shown to be effective in managing worry and GAD. MBCT combines cognitive therapy techniques with mindfulness strategies to help individuals focus on the present moment and accept it without judgment. This approach can help individuals break the cycle of chronic worry (Hoge, Bui, Goetter, Robinaugh, Ojserkis, Fresco, & Simon, 2015).

Worrying is a complex cognitive-emotional process that, in excess, can lead to significant distress and mental health disorders. Understanding the cognitive model of worry, including the roles of negative problem orientation, cognitive avoidance, and intolerance of uncertainty, can provide valuable insights into this pervasive human experience. Therapeutic approaches like CBT and MBCT, which target these cognitive factors, can provide effective strategies for managing excessive worry.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Borkovec, T. D., Ray, W. J., & Stober, J. (1998). Worry: A cognitive phenomenon intimately linked to affective, physiological, and interpersonal behavioral processes. Cognitive Therapy and Research, 22(6), 561–576.

Borkovec, T. D., Robinson, E., Pruzinsky, T., & DePree, J. A. (1983). Preliminary exploration of worry: Some characteristics and processes. Behaviour Research and Therapy, 21(1), 9–16.

Carleton, R. N., Mulvogue, M. K., Thibodeau, M. A., McCabe, R. E., Antony, M. M., & Asmundson, G. J. (2012). Increasingly certain about uncertainty: Intolerance of uncertainty across anxiety and depression. Journal of anxiety disorders, 26(3), 468–479.

D’Zurilla, T. J., Nezu, A. M., & Maydeu-Olivares, A. (2002). Social problem-solving inventory-revised (SPSI-R): Technical manual. Multi-Health Systems.

Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: A preliminary test of a conceptual model. Behaviour Research and Therapy, 36(2), 215–226.

Hirsch, C. R., & Mathews, A. (2012). A cognitive model of pathological worry. Behaviour Research and Therapy, 50(10), 636–646.

Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy and Research, 36 (5): 427–440.

Hoge, E. A., Bui, E., Goetter, E., Robinaugh, D. J., Ojserkis, R. A., Fresco, D. M., & Simon, N. M. (2015). Change in decentering mediates improvement in anxiety in mindfulness-based stress reduction for generalized anxiety disorder. Cognitive Therapy and Research, 39, 228–235.

Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100(4), 569.

Sweeny, K., & Dooley, M. D. (2017). The surprising upsides of worry. Social and Personality Psychology Compass, 11(4), e12311.

Watkins, E. D., Moulds, M., & Mackintosh, B. (2005). Comparisons between rumination and worry in a non-clinical population. Behaviour Research and Therapy, 43(12), 1577–1585.