Why Worry Can Be So Hard to Stop

Why Worry Can be So Hard to Stop

Written by: Kat Harris, PhD, LCP

Most people I see for worry have already tried to stop on their own. They have read about it, tried apps, and made real attempts to reason themselves out of their fears. The worry comes back anyway. Worry in Generalized Anxiety Disorder (GAD) can be self-sustaining. It is maintained by a set of beliefs and behaviors that are understandable from the inside and that keep the cycle going.

Positive Beliefs About Worry
Worry does not always feel entirely negative to the person doing it. For many of my clients it can instead feel like the responsible thing to do or like preparation. The implicit assumption is that thinking through everything that could go wrong will keep them ready, keep the people they love safe, or at least prevent them from being caught off guard. In some instances, clients will even believe that worrying about something will reduce the actual likelihood of what they fear coming true. These are called positive beliefs about worry, and they are common in GAD (Borkovec, Hazlett-Stevens, & Diaz, 1999). 

The difficulty is that most of what people worry about does not happen, or resolves differently than feared. When the feared outcome does not occur, worry gets the credit, and a behavior that provides no actual protection is reinforced anyway. Worry is also a largely verbal process rather than a sensory or image-based one, and that verbal quality appears to suppress the physical experience of fear in the moment (Borkovec, Alcaine, & Behar, 2004). For that reason, worry functions in part as avoidance. It feels like engaging with a problem while actually keeping the emotional core of the fear at a distance, which is one reason it is so persistent.

Negative Beliefs About Worry
A second factor is what the person comes to believe about the worry itself. Wells, in the metacognitive model of GAD, distinguished ordinary worry about external problems from worry about worrying (Wells, 1995). Two beliefs carry most of the weight. The first is that the worry is uncontrollable, that once it begins the person has no influence over whether it continues. The second is that the worry is dangerous, that it will harm their health or eventually cause them to break down. Both raise the stakes of an ordinary worried thought. If worry is believed to be both unstoppable and harmful, each instance becomes something to manage urgently, and the person responds with more monitoring and more attempts to suppress it. The belief that worry cannot be controlled tends to confirm itself, since deliberate attempts not to think about something reliably produce more of the thought.​

Safety Behaviors
People with GAD work hard to manage their fear, and the strategies are understandable. They seek reassurance from themselves and others, check, search symptoms online, contact loved ones to confirm they are safe, over-prepare, keep extensive lists, and rehearse conversations in advance. Some delay the thing they are dreading, and some avoid it completely. Each of these produces brief relief, and the relief is the problem. It teaches the brain that the situation was in fact dangerous and was narrowly managed, so the original estimate of threat is never revised. Most of these behaviors rest on a low tolerance for uncertainty, a difficulty remaining in a state of not knowing how something will turn out (Dugas, Gagnon, Ladouceur, & Freeston, 1998). Safety behaviors are attempts to produce certainty, and because certainty is not available, the behaviors do not end.

What Changes Worry
If worry is maintained by beliefs and behaviors, those are what treatment addresses. This matters, because the intuitive strategy, arguing with each worry until the anxiety settles, generally does not work. A process whose function is to generate the next "what if" cannot be reasoned with directly. The more effective approach is to test the beliefs rather than accept them, for example by setting up situations to see whether worry is genuinely uncontrollable or whether uncertainty can be tolerated longer than expected; to reduce reassurance, checking, and over-preparation so the brain can gather evidence of safety without them; and to allow a thought to remain a thought rather than a directive to act. It also means approaching the feared outcome directly instead of circling it in words. Because worry keeps fear at a verbal distance, treatment often uses imaginal exposure, in which the person deliberately holds the feared outcome in mind, in image form, and stays with it long enough for the emotional response to rise and settle on its own. This allows the fear to be processed emotionally rather than only verbally, which is precisely the processing that worry has been preventing (Borkovec, Alcaine, & Behar, 2004). Cognitive behavioral therapy does this in a structured way, and the evidence for its effectiveness in GAD is strong (Cuijpers, Sijbrandij, Koole, Huibers, Berking, & Andersson, 2014).

This does not mean the worries are unreasonable or that what a person cares about does not matter. The aim is not to care less about health, work, or family. It is to reduce the cost that chronic worry adds on top of those concerns and to recover the time and attention it consumes. When worry reaches the point of organizing a person's day, it is treatable. If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.​