Monday, January 12, 2015

How to Win the War on Worry

How to Win the War on Worry
To tame your worry, ask yourself these two questions…
Published on January 2, 2015 by Noam Shpancer, Ph.D. in Insight Therapy

“Worrying,” quipped Mark Twain, “is like paying a debt you don't owe.” Worry features in many people’s lives. In mild form, occasional worry may serve a helpful coping function, getting us to think and plan ahead. At higher volume and frequency, worry can become annoying and distracting, and may undermine our productivity, concentration, and mood. At extremely high levels, chronic worry can derail a person’s life. Such worry also constitutes the central symptom of a common psychological disorder: Generalized Anxiety Disorder (GAD).
GAD runs in families and appears to have a substantial genetic component. It is often diagnosed together with depression and with other anxiety disorders. This is why some psychologists believe it represents an underlying constitutional vulnerability, a general ‘anxious apprehension’ process that may at times manifest itself through different specific fears, such as fear of certain objects (specific phobia), of social judgment (social phobia), of physiological arousal symptoms (panic disorder) or of troubling thoughts and images (OCD).

Worry is a devious foe for several reasons. First, people who worry a lot most often see their worries come to naught. In other words, most imagined catastrophic scenarios don’t actually materialize. One would think that a system (worry) that constantly fails at its job (predicting the future) would be abandoned. Instead, the opposite usually happens. This is because our brains tend to confuse correlation with causation. In this case, since worry is associated with things turning out OK, worriers begin to believe that it is the worry what made things turn out OK (which is in fact false; research shows that worry hinders rather than facilitates effective problem solving). Hence, worriers tend to increase their worrying in response to their failed predictions of catastrophe. Over time, worry morphs from a habit into a requirement born of superstition.

In addition, research has suggested that although worry is associated with health and coping problems in the long term, it tends to decrease physiological (fight-or-flight) arousal in the short term. In this way, worrying works somewhat like an addictive drug; it provides short term stress relief through avoidance and is hence experienced as rewarding. Since our brain is wired to privilege short term rewards, a worry cycle is easily established that is as difficult to break as drug addiction. Like a drug, worry itself over time becomes a bigger problem than whatever problems it ostensibly addresses.

Another difficulty is that for those who have developed the habit of continual worry, the experience of not worrying is novel and disconcerting. As such, it becomes a source of worry in itself: “Why am I not worried? Something must be wrong with me!” Old habits die hard, and even after they die, they often hang around as scary ghosts.

Still, when worry becomes chronic, frightening, and debilitating we may be moved to do something about it. In the past, thought suppression techniques were advanced as one solution. The evidence, however, suggests that thought suppression is an ineffective way to deal with constant worry, and may have the ironic effect of magnifying worry and its influence. Instead of suppressing, denying, or trying to avoid those nagging thoughts, it is more useful to engage them in conversation, where they may be more closely examined in the light of real world evidence.

In this context, research by David Barlow and others has identified two main cognitive distortions that characterize worry. First, worry tends to involve an “overestimation bias,” whereby the odds of the worried-about scenario materializing are invariably imagined to be high. In other words, the ‘voice of worry’ ignores actual probabilities and always predicts imminence. Second, worry involves a “catastrophizing bias,” whereby the consequences of the worried-about scenario are imagined to be negative in the extreme. The ‘voice of worry’ ignores gradations and always predicts the absolute worst.

While worried about scenarios tend to appear in our minds as both patently imminent and extremely bad, in real life not all scenarios are bad, and even bad scenarios are not always imminent and/or extreme. This distinction matters, because living necessarily requires taking on low probability risk, every single day. For example, when you step into the shower in the morning, you may slip and break your neck. But most people still take on the risk. Why? Because the odds of it actually happening are low. Accurately calculating whether the odds of something happening are high or low is crucial to our daily decision-making. In general, low probability risk scenarios are disregarded so that we can go about our daily business. High probability risk scenarios may be defended against, or avoided.

Similarly, not all negative eventualities in life are extreme. In fact, extreme catastrophes are rare. If they were common, then they would not in all likelihood be considered extreme. An event’s level of impact makes a difference in the real world. In the real world, for example, getting hit by a real bullet is different from being hit by a paint ball.

Given the distorted tendency of the ‘voice of worry’ to make all risks appear likely and catastrophic, and given the real life importance of estimating the actual likelihood and severity of risks, the internal conversation regarding worry should include two main questions:

1. How likely is it, really? This question addresses the error of overestimation. An honest consideration of the actual odds that the negative scenario will materialize will help us distinguish justified, useful concern (high odds) from unjustified, useless worry (low odds).

2. How bad is it really? This question addresses the error of catastrophizing. It helps us consider the evidence in distinguishing the extreme, real threat (a real bullet) from the non-extreme, benign threat (a paint ball).

Now, these two questions, considered in tandem, may be represented in a 2 x 2 matrix of the kind psychologists love to draw:
As seen in the table, three of the four cells constitute good news. Specifically, an event that is imminent but mundane (2) need not be terribly bothersome. Such events are not the end of the world; they are just the world. An event that is catastrophic but unlikely (3) may also be disregarded—as such events must be in the course of pursuing our most basic daily tasks, unless we’re willing to go without bathing forever… And clearly, an unlikely mundane event (4) is of no concern at all. Once your worries are fleshed out and evaluated, it becomes clear that, contrary to the distortions inherent in the voice of worry, most high likelihood events are not terrible, and most terrible events are not likely.

Now, it is important to emphasize that in engaging the inner conversation with our voice of worry, we are not looking to counter negative thoughts with positive thoughts. Instead, we are looking to counter inaccurate thoughts with accurate thoughts; to replace lies with truths. Therefore, we must accept the possibility that once in a long while we will face an imminent and catastrophic event (1). That’s life. But recognizing that life is fragile and fleeting is, if anything, a very good reason to forsake needless worrying and start living.

To paraphrase Charles Darwin, anyone who dares to waste one hour of time worrying has not discovered the value of life.

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