The following is not intended to be a substitute for treatment by a qualified health professional, but rather a general overview of metacognitive therapy for worry and rumination.
What is worry?
Worry is a repetitive self-talk activity concerning possible, future calamities. Worrying is an attempt at solving a problem via thinking. Effective problem-solving is often a different type of affair, requiring action or other activities which exist outside thinking in the echo chamber of one's mind.
Worry tends to have a circular, snow-balling quality, as the person rehashes a question or problem. Worry thoughts often begin in a 'what if?' form and then spiral as follows:
What if I lose my job?
I won't be able to support my family.
My family will be so disappointed in me.
They may leave me.
I'll have no one.
I'll lose everything.
I can't lose my job.
But there are so many cut backs going on!
What if I'm next?
Everyone likely experiences worry thoughts from time to time. For people who do not struggle with worry, the thoughts are probably short-lived and either transition to another topic or are put to bed via active problem-solving.
What maintains worry in people who struggle with it?
Chronic worriers (likely people with generalized anxiety disorder) often get stuck in excessive worry due to four maintaining factors which re-trigger the original 'what if?' thought:
1. Pro-worry beliefs, such as:
Worrying helps me find better or perfect solutions
Worrying helps me understand problems
Worrying motivates me to do things
Worrying prepares me for the worst
Worrying prevents bad things from happening/if I don't worry enough, I'll be letting my guard down and more bad things will happen that I could have prevented
Worrying shows I care
It is unlikely someone will stop worrying as long as one believes that it is helpful or necessary on some level; these beliefs much be processed and challenged as part of therapy.
2. Phobic beliefs about worry, such as:
Worrying is dangerous and will cause either physical or mental harm
Worrying is uncontrollable
These beliefs risk making worry more distressing. They also tend to fuel avoidance and suppression strategies, discussed below.
3. Difficulties in re-allocating attention
Worriers tend to 'chase' initial worry thoughts, struggle to avoid 'taking the bait', and otherwise actively focus their attention on the spiral. "Attention training' and building a capacity to tolerate uncertainty are possible solutions.
4. Avoidance or thought suppression strategies, such as:
telling oneself to 'stop worrying'
trying to reason with worry thoughts
attempts at distraction
trying to nullify worries with overly positive thinking - "Everything will work out just fine!"
reassurance-seeking
excessive research/information-seeking
numbing strategies, such as those involving substances or food
avoiding situations which might trigger worry
Research suggests thought-control strategies rarely work and tend to have the opposite-of-intended effect by generating more worry thoughts, intensifying any beliefs that worry is uncontrollable. Try not to think about a pink elephant for the next 60 seconds!
How can worry be better managed?
The meat and potatoes of reigning in worry/treating generalized anxiety disorder is the "worry time technique", which works as follows:
Set a worry time. Consolidate all of your worrying to this time period, not to exceed one hour per day. Worry mindfully during this time, if there is something you need to worry about.
Delay worrying outside of your scheduled worry time.
When you notice an initial worry thought, try not to 'chase' it.
Note and accept it's presence, but avoid 'taking the bait'.
Write it down on a list of worry thoughts you will address later during your worry time.
Attempt to bring your attention back to the current task.
If/when the initial worry thought recurs, remember that we cannot control our automatic thoughts. Essentially, what one must delay is the more active process of pursuing a worry thought beyond its initial appearance.
Worry well during worry time.
Only worry about items on your list which you feel you must address.
If items on your list no longer bother you, simply cross them off the list. [And perhaps consider how much time you would have spent on them had you chased the worry thought in the moment.]
Worry using a pencil and paper and try to emphasize productive problem-solving,.
If an item on the list is solvable, consider what the problem is, what options you have, how you could take some action, etc.
If you notice you may be overreacting to a specific issue, consider how to think about it in a more realistic, nuanced, and helpful manner. What would you tell a friend in a similar predicament?
If you can't take action or reframe your thinking, consider accepting that the problem may not be solvable right now, even with continued worry, and defer the issue until a subsequent worry time.
The strategy requires practice, but can yield significant insights about the role and utility of worry.
Troubleshooting common challenges with the worry time technique:
Try to avoid a worry-suppressing or non-accepting attitude. Anger at worry tends to make it worse. Recall that delaying worry is different than suppressing.
Trouble with delaying worry often relates to pro-worry beliefs. Consider coupling efforts to delay with a reminder of why you no longer see worry as useful, such as, "I won't come up with a better solution just by thinking about this more, so, I'm going to address this during worry time."
Expect and accept repetitious worry thoughts; it is normal and does not necessarily represent a failure to delay. You can use tally marks to indicate how many times a specific worry though recurs on your list. Especially initially, certain thoughts may need to be delayed several times.
Remember to avoid reasoning with or rationalizing worry thoughts. If this worked, your worry would have already resolved. Reasoning with thoughts likely represents 'chasing' them and thus inviting them to persist.
If you find that you avoid worry time, you may need to identify and address phobic beliefs about worry. In such cases, worry time also functions as an exposure.
Source: Metacognitive Therapy for Anxiety and Depression by Adrian Wells
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