June 16, 2010

What? Me Worry?

Borrowing a line from Mad Magazine’s Alfred E. Newman might bring a laugh, but of course most of us DO worry from time to time.  It’s only natural to have moments of concern and uncertainty when a child is late getting home, while awaiting the outcome of medical tests, or in times of great financial upheaval such as those we’ve seen in the past couple of years.

Is it natural to worry? Yes.  Comfortable? No.  Effective? Probably not.   When patients come into my practice describing worry that wrings the pleasure out of life, it does them no good for me to say, “Relax! Don’t worry!”  The cycle of thinking and emotion driving the experience we call “worry” is not so easily disassembled as all that, but with new skills the intensity of worry can be much reduced.

So, while it is natural to have occasional thoughts about the damages, negative outcomes and genuine horrors that might conceivably befall us, the real danger is in allowing our cognitive and emotional mechanisms to develop a habit of doing so.  And, yes, such a cycle of thinking and feeling can become habitual and actually hard-wired into the brain.

To completely explain this phenomenon of habit-building is impossible here, but it’s worth stating that much of our thinking is done by mental shortcuts called “schemas”.  For example, if I announce, “I have a new pet at home,” you are likely to have immediate mental images of cats, dogs, and maybe tropical fish.  Those are representative of common household pets.  My own pet might be a 12-foot boa constrictor, a mountain beaver, or a gnu, for that matter, but it’s unlikely that those would be your first mental images.

These shortcut schemas help us communicate more quickly—and usually with a fair amount of effectiveness—because our shortcuts are created out of representative mental images.  For example, when you tell me you are moving to a new home, I don’t picture an igloo, a thatched hut or a wigwam, I picture houses and apartments that are very typical in the climate and geographical location where you live.  In casual communication about household pets or potential housing arrangements these schematic shortcuts seem to do little harm, and errors in them can even provide a lot of humor.  In too many situations however, taking a shortcut creates a cognitive path to distress.

Because, in the same way we take shortcuts in our thinking, it often happens that our emotions are triggered to get involved.  So, if I arrive home tonight and find that my doctor has left a message on the answering device saying results from my recent tests are back, and I need to come in right away… What thoughts and emotions might be triggered?  And the word “triggered” is used intentionally here because it is often quite automatic.  Our cognitions and our emotions interact together so fluidly that thinking triggers emotion (sadness, anxiety, anger) which in turn triggers more thinking (remember when cousin Alice had medical tests?  She was dead within the week!) which triggers more emotion, and leads to physical experiences of distress as well.

It’s easy to see how this cycle of mental shortcuts and emotional involvement—this triggering of higher and higher levels of worry—could be very upsetting.  It can also become somewhat habit-forming!

Given what we know about shortcut schemas and their tie-in to emotional states, it is useful to have tools to stop or slow the process even while it is happening.  Renowned cognitive psychologists from Aaron Beck and Albert Ellis, to Donald Meichenbaum and Christine Padesky, advocate that we learn methods to “vigorously challenge” the negative thoughts that are the distressing basis for worry.  (Those interested in more information on the research of these psychologists can find references in the book lists of this website).

Using the example of the doctor’s message on the answering machine for illustration, a vigorous challenge to spiraling thought-emotion cycles might go something like the following.

The actual message was: Your tests are back, let’s get you in to talk about results as soon as possible.

I think to myself: If the doctor wants to see me right away it must be terrible news.

My emotional response is: Fear.

If I continue going down this mental and emotional path, I will probably worry all night, be irritable and upset with my family, and will be unable to do anything productive because of the distress such worry creates.  To avoid that, I will need to develop challenges to my first thoughts and emotions about the message:

Challenge #1: My doctor is getting back to me quickly and getting me in for follow-up quickly.  That’s a sign that my doctor is both caring and competent.

Challenge #2: Whatever my tests showed must be quite treatable if my doctor wants to get me in so quickly.

Challenge #3: It might not be bad news at all.  The doctor may simply want to share test information so that I don’t wonder or worry about it over the coming weekend.

Challenge #4 (my personal favorite): Maybe the urgency has to do with my doctor’s vacation or conference schedule.  It could be that she wants to follow up with everyone who had tests before she goes out of town.

As you can see, the challenges range from tentative to vigorous disputing of the negative mental and emotional shortcuts taken when I first hear my doctor’s recorded message.  Using a combination of all four challenges might be most effective in disputing my initial worried response.  And, of course, this is a situation in which I am unable to do anything more effective in the interim, so worrying is not going to be helpful in any case.

Humans are creatures of habit, certainly.  Challenging worrisome thoughts that trigger upsetting emotions can become more habitual, too. Practicing the skills needed to create a habit of challenging thoughts that might create a worry has many benefits for us as individuals, and the advantages extend to our family and friends as well.

Individually, the ability to challenge a concerning thought before it builds into a distressing cycle of worry is helpful to our physical well-being.  Worry increases the levels of stress chemicals that can do damage throughout the body, so it’s a good idea to learn how to short-circuit the worry cycle whenever possible.  The cycle can be somewhat self-perpetuating, too, meaning that the more we worry, the more likely it is that our schemas contain worrisome thoughts, leading to even more worry, so putting a stop to worried thinking is for my own good!

For the extended circle of family and friends, my ability to vigorously challenge my own negative thoughts means that I’ll have more energy to be a good partner, a better friend, or simply a neighborly member of the community.  I will be more capable of delivering solace or to be a good listener when others have concerns.  I won’t necessarily be able to do their challenging FOR them in the same way that I might do it for myself, but when asked, I can often open the door to an alternate thought which is the beginning of a challenge.