Tuesday, April 28, 2009

Steps to Stop Worrying

Mark Twain said, “I’ve had a lot of problems in my day - most of which never happened.” It has also been said that worry is interest paid in advance on a debt you may never owe. Worry is a significant problem for many people. It is the major component of all anxiety disorders. It is also something that all of us do, to varying degrees.

Some talk about "good" and "bad" worry. I feel that a clearer conceptualization is between concern and worry. I differentiate between the two in that concern reflects realistic attention to things in our lives and leads to constructive efforts to deal with them. It is certainly in one's best interest to be concerned enough to watch a young child when they are around traffic, pay your taxes, exercise, etc. It is NOT in one's best interests to incessantly dwell on all the possible dangers in the world for a child, incessantly worry about tax issues, incessantly be hyper-focused on what is going on in one' s body, etc. Worry almost always leads to catastrophizing about dire potential outcomes and generally assuming those outcomes WILL occur, especially if one does not worry about them.

Dr. Robert Leahy points out that worriers usually have mixed feelings about their worries. On the one hand, worries are bothersome and difficult to get out of your head. But there is a way that these worries make sense. For example, many think:

Maybe I'll find a solution.
I don't want to overlook anything.
If I keep thinking a little longer, maybe I'll figure it out.
I don't want to be surprised.
I want to be responsible.

Many also feel that worrying gives them a feeling of being in control. Many have a hard time giving up on their worries because the worries are perceived to have been working.

There has been an increasing recognition that worriers generally have an intolerance of uncertainty. Ask yourself the following questions and write down your responses. See if you can come to an understanding of the disadvantages and problems of being intolerant of uncertainty.

Is it possible to be certain about everything in life?
What are the advantages of requiring certainty, versus the disadvantages? Or, how is needing certainty in life helpful and unhelpful?
Do you tend to predict bad things will happen just because they are uncertain? Is this a reasonable thing to do? What is the likelihood of positive or neutral outcomes?
Is it possible to live with the small chance that something negative may happen, given its likelihood is very low?

At the cognitive level, all worry will begin with a "What if," followed by a catastrophic thought. An example is “What if there is a traffic delay and I'm late? I just KNOW that I will get fired!” Monitoring for and recognizing the exaggerated negative possibilities is the first step. Ask yourself:

What’s the evidence that the thought is true? That it’s not true?
Is there a more positive, realistic way of looking at the situation?
What’s the probability that what I’m scared of will actually happen?
If the probability is low, what are some more likely outcomes?
Is the thought helpful? How will worrying about it help me and how will it hurt me?
What would I say to a friend who had this worry?

Frequently, worry also is strongly shaped by “Emotional Reasoning,” i.e., I FEEL so strongly that I will fail the test, therefore I KNOW I will fail the test. This may be in spite of having a strong command of the material, aced the quizes, put in the study time, etc. When this is a frequent event, it is extremely helpful to monitor for this, as well as to remind yourself that, “Feelings are NOT facts!”

Monitoring your "What ifs" can be a powerful and necessary tool in getting increasing control over your thoughts. This is one way to nip the worry in the bud. It is also easier to tell yourself, "STOP!!!", “SHUT UP!!!,” or to shift your focus," at this point. This is referred to as “thought stopping.” Someone once told me, "It's easier to stop when you are going 5 mph than when you are going 60 mph." The thoughts will often come back, but each time you use such interventions, you are becoming stronger and the worry becomes weaker.

Another powerful intervention is to schedule a “Worry time.” This may sound silly, but when worries come to mind, refuse to think about them until the time scheduled to do so. If a worry comes to mind at 3 PM and the worry time is at 6:30 PM, you tell yourself you will not think about that matter until 6:30 and continue to chase the thought out of your mind.

Exercise is often helpful. It generally shifts one focus off the worries. It can also give release to some of the tension most worriers carry. Yoga, relaxation exercises, guided imagery, and meditation can also be beneficial.

Regardless, in order to decrease worries, one must monitor themselves for worry. If one remains passive, the worries will win every time. With increased awareness and effort, YOU CAN beat worry.

Best wishes,

Wednesday, April 15, 2009

Long-term (6-year) follow-up of children and adolescents who received Cognitive-Behavioral Therapy (CBT) for anxiety disorders.

A six year (6.17 average) follow-up was reported from Queensland Australia for anxious children and teens who were treated with CBT. Fifty-two clients (aged 14 to 21 years) who had completed treatment an average of 6.17 years earlier were reassessed, using diagnostic interviews, clinician ratings, and self- and parent-report measures. After receiving CBT, 85.7% no longer had any anxiety disorder. These gains held at both 1 year follow-up, as well as after 6 years. Both CBT, as well as CBT plus family management were equally effective at the follow-ups.

This study strongly supports the long-term effectiveness of using CBT in treating children and adolescents with anxiety disorders. As other research shows that most anxious adults were first anxious children, this is very good news. Further, treating these conditions early on would prevent years of misery and often, medical treatment.

Two excellent books written FOR kids are What to Do When You Worry Too Much: A Kid's Guide to Overcoming Anxiety by Dawn Huebner and Bonnie Matthews and What to Do When You're Scared and Worried: A Guide for Kids by James J. Crist. An excellent book for parents is If your Adolescent has an Anxiety Disorder by Edna Foa and Linda Wasmer Andrews. These books are recommended whether or not the child is receiving counseling.

Many kids respond quickly to CBT counseling. When presented in a more concrete way than to most adults, kids can understand which thought makes them “feel bad” and which thought makes them “feel good,” as an eight year old boy said to me today. Helping them develop mastery over their emotions can be powerful, to all involved.

The original study was by Barrett PM, Duffy AL, Dadds MR, Rapee RM and was titled “Cognitive-behavioral treatment of anxiety disorders in children: long-term (6-year) follow-up.” It was reported in the Journal of Consulting and Clinical Psychology, 2001 Feb; 69 (1): pp. 135-41.

Best wishes,
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