Don't worry, be happy:
overcoming worry may be
key to mental health Worry plays a role in causing a wide range of
psychological problems. But don't fret – there's
a simple, effective treatment
      A tendency to excessive worry has been linked to eating disorders, paranoid thinking, drug dependence
and post-traumatic stress disorder....,,,,Are you weary of "new year, new you" positive
thinking exercises? Tired of trying to feel
Tiggerish in the cold, dark, midwinter mornings?
Why not try this quick experiment to redress the
balance. All you have to do is imagine that
something great has happened in your life: maybe you've run into an old friend; perhaps
you've been promoted at work; or you're about
to head off on holiday. Now ask yourself what
could go wrong. In what awful ways could it all
fall apart? What disastrous chain of events
might unfold? Don't think solutions, think problems. Open the worry floodgates and allow
yourself to be swept away. As you're likely to discover when you attempt this depressing little exercise, with a
sufficiently negative outlook even the happiest
moments in life can become a source of anxiety
and stress. When we worry, we become
preoccupied with an aspect of our lives,
desperately trying to anticipate what might go wrong and what might happen if it does.
Although we might believe worry is constructive,
actually all it usually does is lower our mood.
And when we start worrying it can be difficult to
stop. So worry can be an immensely powerful psychological mechanism, but might it also be a
defining factor in the development of mental
illness? Can studying it deepen our
understanding of what mental illness is, how it
comes about, and how it differs from
psychological health? As you'll know if you read about the hoo-ha following publication of the latest edition of the Diagnostic and Statistical Manual of Mental
Disorders, the number of officially recognised psychiatric disorders has mushroomed in recent
years, and now stands at around three hundred.
That giant total has attracted a lot of criticism –
and with some justification – but in fact many of
these conditions are pretty similar. It is better to
think instead of three main groupings of disorders: internalising (most commonly,
depression and anxiety); externalising
(addiction, for instance, or anti-social behaviour
problems); and psychosis (with its characteristic
symptoms often bracketed under the label of
schizophrenia). However, even these three broad groupings share many of their causes,
which has led some researchers to speculate that
underlying and unifying all mental illness may be
a single cause: the so-called "p factor of psychopathology". At the social level, we know that poverty, isolation, and negative life events all elevate the
risk of mental health problems. But when it comes to the psychological p factor, there is
increasing evidence that it may be excessive
worry. When worry gets out of hand, it now
appears, a very wide range of mental health
problems can follow in its wake. This kind of "transdiagnostic" approach represents a major shift in the way we think
about worry. Traditionally, problematic
worrying has been demarcated as a specific
condition: generalised anxiety disorder. And in
that box it has remained. (The exception to this
rule is depression, for which persistent worry about the past is a recognised symptom. But it's
not called worry: it's called "rumination".
"Worry" is defined as anxious thinking about the
future.) Yet real life seems to show a lamentable lack of respect for systems of psychiatric
classification. Rather than being a separate
disorder, excessive worry has been shown to
play a significant role in the development and persistence of paranoid thinking, post-traumatic stress disorder, alcohol and drug dependence and insomnia. It has also been linked to the incidence of eating disorders. The idea that many psychological problems have excessive worry in common seems
plausible. As most of us know from bitter
experience, worry brings the most unlikely – and
unpleasant – ideas to mind, keeps them there no
matter how hard we try to shake them off, and
convinces us that the events we dread really may happen. If persistent worry is potentially so damaging to our mental health, what can be
done to combat it? Interestingly, we tend to
worry less as we grow older. People aged 65-85,
for example, report fewer worries than those aged 16-29. But besides simply waiting for the years to pass, the evidence is strongest for an
adapted form of cognitive behavioural therapy. This relatively brief, one-to-one treatment is
based on a detailed model showing
how problematic worry is caused, maintained
and overcome. Patients are helped to notice
when they're worrying, to interrupt this
habitual thinking style, and then try alternative ways of reacting to life's problems. So far this kind of CBT has mostly been used with people suffering from generalised anxiety
disorder. A recent meta-analysis of 15 studies, for example, showed that CBT was far more
effective than other therapies (or than a non-
treatment control) at helping people recover
from generalised anxiety disorder and stay well. But it is now beginning to be piloted for other conditions – the Oxford Cognitive Approaches to Psychosis Group, for example, is testing its efficacy in severe paranoia. How does CBT tackle worry? For one thing, it helps people to re-evaluate their beliefs about
its benefits. Like many of us, individuals who are
prone to excessive worry tend to assume that it
helps them. They may believe, for instance, that
worrying helps them to anticipate and solve
problems; that it provides the motivation necessary to tackle those problems; or that it
prepares them for the worst if a solution can't be
found. They may even feel that by worrying
about an event they can prevent it occurring –
despite realising that it's pure superstition.
Learning to challenge these kinds of beliefs can be a huge step forward. CBT also teaches us to confine our worrying to a regular set period of 15 minutes or so each
day. When worrying thoughts arise at other
times, the trick is to save them for later and let
them go. "Expressive writing" can be effective
too: you describe your worries in as much detail
as you can, focusing on what it feels like, and resisting the temptation to analyse what's
causing your thoughts. And don't underestimate
the power of distraction: work out when you're
most likely to worry and plan a pleasurable,
absorbing activity you can do instead. Many of CBT's techniques for tackling worry are not rocket science: with the right guidance
we can all put them into practice. By doing so
we're not merely sparing ourselves hours of
futile fretting. If excessive worry is truly the p
factor it seems to be, we'll also be addressing
one of the key determinants of our mental health. Daniel Freeman is a professor of clinical psychology and a Medical Research