426 TREATMENT OF SPECIFIC ANXIETY DISORDERS
- Worry is a normal part of life but there are two types of worry: productive worry
and unproductive or pathological worry. It is pathological worry that is associ-
ated with high anxiety and distress. - Pathological worry is caused by our attitude and the way we try to deal with
worry. Research has shown that certain types of negative thoughts and beliefs
about risk, uncertainty, and worry itself characterizes excessive or unproduc-
tive worry. You can think of these as the psychological causes of a tendency to
worr y. - This negative attitude toward worry causes individuals to adopt ways to control
their worry that in the long run make the worry even more persistent and dif-
ficult to control. - The goal of cognitive therapy is to identify the underlying thoughts and beliefs
that cause chronic worry as well as any counterproductive responses that make
the worry persistent, and then help the individual adopt a more constructive
attitude and response to worry. - The ultimate goal of cognitive therapy is to change unproductive worry into
productive worry by modifying the underlying psychological causes of chronic
worry. The elimination of pathological worry will lead to a reduction in general
anxiety level as well.
Wells (1997) noted that the cognitive therapist must shift a client’s focus from worry
content as the problem (e.g., “I don’t have much job security so that’s why I worry about
losing my job”) to the factors that underlie the tendency to worry. To assist in this
process the client could be asked, for example, “Even if you had good job security, do
you think that would stop you from worrying?” The cognitive therapist can then ask
the client why some people worry and yet are not bothered by it, whereas other people
are very upset, anxious about their worries. One could also determine if there are some
uncertainties in the person’s life that are not associated with worry (e.g., a young per-
son who does not worry about being seriously injured in a car accident), whereas other
uncertainties lead to great worry (e.g., Will I get into graduate school and be able to
pursue my chosen career?). A comparison could be made between the different “cogni-
tive sets” associated with each of these situations and how the different ways of thinking
leads to excessive worry or no worry at all. A possible homework assignment might be
to survey family or close friends who face issues similar to the client’s worry concerns
and ask how they think about or deal with the issue (e.g., work insecurity, uncertain
medical test, questionable commitment of romantic partner). In the end clients must be
socialized to accept that the problem is not worry per se but rather how they worry.
Clinician Guideline 10.17
Begin the education phase by determining each client’s personal theory of worry and then
using Socratic questioning and guided discovery to teach individuals that reduction in
chronic worry is possible by changing the maladaptive appraisals and beliefs as well as the
ineffective mental and behavioral control strategies responsible for the persistence of their
pathological worry.