The Washington Post - 05.11.2019

TUESDAY, NOVEMBER 5 , 2019. THE WASHINGTON POST EZ EE E5

Robichaud said intolerance of

uncertainty is like a psychologi-

cal allergy, and that just as gradu-

al exposure to a small amount of

allergen can cure an allergy, grad-

ual and small exposure to uncer-

tain situations can significantly

reduce the fear of uncertainty

and consequent worry.

Sticking with bad behaviors

Safety behaviors are actions

that help us feel better in the

moment, but exacerbate worry

and can even lead to GAD.

One type consists of “approach

strategies,” which include exces-

sive information- and reassur-

ance-seeking, double-checking,

hypervigilance and failing to del-

egate. Another type includes

“avoidance strategies,” attempts

to stop worry through procrasti-

nation, evading uncertain, novel

or worry-provoking situations,

and failing to commit to people or

events.

Instead of checking your teen-

ager’s location for the seventh

time, for example, try abstaining

and see what happens. Try the

same technique the next time you

feel an urge to ask your partner to

ease your worries. If that sounds

like a tall order, at least delay the

behavior.

When sensing an urge to pro-

crastinate on a hard project at

work, take a first step as soon as

possible. Or push yourself gently

to do what your irrational worries

tell you not to.

You might be surprised to dis-

cover that, although you feel

quite anxious, you can avoid rely-

ing on safety behaviors, Mennin

said.

The more you are willing to

reduce safety behaviors, the more

likely you will become worry-free.

So, don’t worry: The factors

that turn worry into GAD and the

strategies that can help alleviate

them are part of a standard

cognitive behavioral therapy ap-

proach. Following self-help

books, videos, and apps can be

beneficial.

For those who need or prefer

professional guidance and help,

cognitive behavior therapists are

recommended. The Association

for Behavioral and Cognitive

Therapies (abct.org) is a good

place to start.

[email protected]

relationships, children, health
and money. When worrying be-
comes persistent, long-lasting
and difficult to control, it can
seriously affect daily life. And if
the unrelenting worry is accom-
panied by anxiety symptoms such
as irritability, difficulty concen-
trating, muscle tension, fatigue
and poor sleep, that person may
be suffering from something
called generalized anxiety disor-
der (GAD).
GAD is one of the newer anxi-
ety diagnoses, appearing in the
American Psychiatric Associa-
tion’s manual of mental disorders
for the first time in 1980. Re-
search and recognition of exces-
sive worry and GAD have lagged
behind other disorders that have
been acknowledged longer, such
as depression, or have captured
the public’s attention more, such
as obsessive-compulsive disorder
and post-traumatic stress disor-
der.
Worriers often suffer in si-
lence. Melisa Robichaud, co-
founder of the Vancouver CBT
(Cognitive Behavior Therapy)
Centre and co-author of “The
Generalized Anxiety Disorder
Workbook,” said many of her
patients are concerned that seek-
ing help for GAD is self-indulgent
because they’ve been told that
worry is just a part of life.
And many people suffer for a
long time.
“I often see people who have
struggled with it for 10, 20, 30
years,” said Robert L. Leahy,
founding director of the Ameri-
can Institute for Cognitive Thera-
py in New York and author of
“The Worry Cure.”
How does it feel to have GAD?
One of my patients told me: “I am
frustrated by my mind always
moving 100 miles per hour and
going down a rabbit hole. I feel
constantly on edge and unable to
relax.” Another said, “I am ex-
hausted and unable to enjoy life.”
Studies show that between
5.7 percent and 11.9 percent of
U.S. adults experience GAD at
some point, yet less than half get
treatment. Many people with
GAD also have other anxiety dis-
orders and depression, as well as
significant work and interper-
sonal problems. GAD also repre-
sents a significant risk factor for

ANXIETY FROM E1 cardiovascular problems.
Recent decades have brought
new understanding about the
factors that make worry turn into
GAD and those that perpetuate
GAD.
Targeting these negative fac-
tors directly can help people who
worry too much.

Holding erroneous views

People with GAD hold more

positive beliefs about the useful-

ness of worry than the general

population. They frequently view

worry as motivating, as helpful in

preparing them for bad out-

comes. They even see it as a

positive personality trait. Some

believe that worry shows to oth-

ers how much they care.

White said she and her bosses

loved that she worried about

every detail when organizing

work events, and always had a

Plan B — and C and D. Two

frequent manifestations of GAD,

perfectionism and workaholism,

often are rewarded in our culture.

But research shows that worry-

ing does not help people better

prepare for the future, nor does it

inoculate them from feeling bad

when negative events come to

pass.

Moreover, worriers are often

not good problem-solvers. They

frequently procrastinate, and

that, as well as having perfection-

istic tendencies, has been linked

to worse performance. When

tackling excessive worry, it is

important to acknowledge a per-

son’s positive beliefs about it and

a possible ambivalence toward

change.

By modifying those beliefs, a

path toward less worrying often

can be cleared.

Catastrophizing

Worriers tend to predict that

things will turn out worse than

they actually do.

A recent study found that

91 percent of worries held by

people with GAD did not come

true. Psychologists Daniel Gilbert

from Harvard and Timothy Wil-

son from the University of Virgin-

ia have found that humans gener-

ally are bad at predicting how we

will be affected by future events.

Their research shows that people

tend to overestimate the emo-

tional effect of bad events and

underestimate their ability to

cope with those events.

“When negative outcomes ma-

terialize, most people — at least

70 percent — handle it okay,”

Leahy said.

One way to minimize catastro-

phizing is by distinguishing be-

tween worrying and problem-

solving — and then improving the

latter.

Everything that you have con-

trol over calls for problem-solv-

ing. Worriers often view prob-

lems as threatening, doubt their

ability to solve them and distrust

potential solutions. Being aware

of potential problems allows for

early detection, which allows

worriers to tackle those problems

before procrastination sets in.

Basic problem-solving steps, laid

out in many worry self-help

books and cognitive behavior

training protocols, include defin-

ing a problem, generating multi-

ple solutions, choosing the best

one, implementing it and assess-

ing the result.

Not being ‘mindful’

Worry is by definition a cogni-

tive activity, meaning it’s happen-

ing in the mind. When we are

preoccupied by worry, we are

unable to focus on what is in front

of us. Habitual worriers have a

hard time being mindful of what

is happening in their present

moment and shifting attention

away from recurrent thoughts.

Extensive research suggests

mindfulness training can help

reduce problematic worry. In a

small study of 40 worriers pre-

sented at a recent conference,

University of Pittsburgh profes-

sor Lauren Hallion and col-

leagues investigated the useful-

ness of various mindfulness ap-

proaches. They found that the

“focused attention” approach, in

which the participants redirected

attention from their worries to an

external sound, decreased worry-

ing the most. In comparison,

accepting thoughts without try-

ing to change them helped less.

Engaging in regular guided

mindfulness mediations more in-

formally or practicing a mindful

way of being can also be benefi-

cial.

‘Choosing the devil you know’

Intolerance of uncertainty has

been shown to be one of the most

powerful drivers of worry. Worri-

ers have an extreme dislike and

fear of uncertainty, and the act of

worrying is an attempt to reduce

it. They also tend to avoid uncer-

tain situations whenever possible

— even when it means missing

out on life.

Douglas Mennin, a professor at

Teachers College, Columbia Uni-

versity who has researched wor-

ry, said people with GAD are

more fearful of and distressed by

negative emotions. Consequent-

ly, he said, “they tend to organize

their lives in very predictable,

routinized and structured ways,

effectively choosing the devil

they know [worry] over opening

up to new possibilities.”

Taking chances on new possi-

bilities might bring about more

anxiety in the short run. But joy

and vitality are also likely to

increase as someone engages in a

richer, more meaningful exis-

tence. Eventually, worry and anx-

iety will decrease, as well.

Expert’s tips on tackling unrelenting worrying

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