Except for self-confidence (22 percent), worrying takes the second place with 20 percent on the list of priorities among participants of the online self-help program '15Minutes4Me.com'. One out of every five participants wants to start out by gaining control over their worrying. Not surprisingly, as it often is the trigger which causes panic attacks, depressed feelings, or other psychosomatic complaints. In this article, we give you some tools with which to learn to gain control over your worrying. The theme self-confidence was already taken up in this year's third Psyche&Brain. With the word 'control', we can already start to see the paradox of worrying. Oftentimes, saying 'stop worrying!' to yourself does not work, because this thought in itself is the ideal thing to worry about. You then start worrying about the fact that you cannot stop worrying. Because you keep using the same area of the brain - the one where rational thinking is located - which already is overstimulated by stress and tension, the paradox becomes hard to break through without taking a different way around the issue. That is why we recommend a 4-step plan. Each step takes about one week's time, and the time you invest each day is about fifteen minutes.
From Aristotle to therapy
Worrying is a thought (logos). The Greek philosopher Aristotle described in his Retorica that human behavior consists of three building blocks: logos, ethos, and pathos. Logos are our thoughts and beliefs. This is where worrying is situated. Ethos are our behaviors or habits, and pathos are our feelings. If you change one of the three elements, the other two will automatically be changed, too. This is the way in which psychotherapy or an online self-help program works, namely by helping people to influence one of the elements. Each form of therapy will put most emphasis on one of the elements as a way to work toward a solution. The cognitive behavioral therapy will often aim to work on thoughts and beliefs (logos), behaviorism focuses on reconditioning behavior (ethos) and hypnotherapy will relate more directly to emotions (pathos). Because the three building blocks are interconnected, each of these forms of therapy can be a good treatment. Sometimes it is said that the worrying negative thoughts are the 'cause' of anxiety, depression, or stress related complaints, which is an oversimplification of reality. We namely know that we can influence any of the three elements in order to break through negative feelings, behavior, or thoughts. It is, however, so that breaking the worrying pattern often is the simplest and quickest way toward the goal. In this sense it is pragmatically speaking okay to pretend that worrying is the cause of stress, and that to stop worrying means you can learn to overcome stress. Today, we limit ourselves to that. In the self-help program this is one of the building blocks, combined with some other methods.
The role of worrying in self-help or therapy
Worrying can be seen as a thought pattern with useless, negative, and especially unproductive thoughts. What is the difference between thinking and worrying? When you are thinking there is development. People who think go through a logical process with several steps where there is a regular arrival of new insights or links which eventually lead to a solution. With worrying there is no such development. Instead, there is a type of circle in your thought pattern, meaning you keep going through the same thoughts without moving toward a solution. When this phenomenon occurs, it is a sign that the brain is overstimulated, therefore temporarily shutting down the solution focused abilities. As an effect thereof, continuing to think is useless. First, you need to get out of the vicious cycle of stress and worrying, before your brain will once again be able to do any useful thinking. That is the reason why we will go through a number of steps in our approach, where there temporarily is no space for looking for a solution. As long as the brain is exhausted or fatigued, no creative insight will occur. The opposite actually happens: looking for solutions during this stage will worsen the worrying. Only after that you have broken out of the vicious cycle will there be space in your mind to look for - and find - solutions.
The anti-worrying plan
To prevent the abovementioned paradox, we build up the plan with four stages, each stage lasting one week. It is important to take the steps in the order they are provided in, and not to go faster than recommended. Otherwise you will paradoxically start to worry about your worrying instead of moving forward.
First week: week: Observe the worrying
In the first week we will do something paradoxical. Earlier, we mentioned that thinking about stopping the worrying in itself will lead to more worrying. This is because you continue stimulating the already overstimulated part of your brain in which you think about thoughts. This system is overstimulated during this first phase, meaning a detour is needed to make it calm down. The Dalai Lama teaches us an interesting perspective in his observations about Buddhism, which often is found in literature on hypnotherapy as well: the concept of creating distance between oneself and the undesirable thought. He does so by stopping the fight and instead simply observing the worrying behavior. This is called 'to observe with mild attention', in mindfulness-terms. The exercise we suggest for the first week, is to practise to observe yourself while you are worrying during one week. This is done without making any judgements. Choose a regular period of fifteen minutes where you 'observe' your worrying thoughts - as if you were to see yourself on a projected screen in a movie while worrying. Every time you catch yourself worrying, you observe your own worrying behavior. This way, a certain distance is created between you and the worrying. The worrying behavior is still there, but it will feel less and less like a dominating part of yourself. In this phase you do not yet try to change or stop the worrying, instead you are a neutral observer of your own worrying behavior.
Second week: observe the natural alternatives
In the second week we are going to try something else. This time, we get our inspiration from the solution focused psychotherapy, developed by Steve De Shazer at the end of the past century. This week you will be less interested in your worrying behavior, but instead you focus on the moments during which you, for some reason, were worrying less or not at all. This could be because you are fully focused on your job, your household, a conversation, a hobby, or a completely different activity, such as listening to music. Every evening you take fifteen minutes out of your day to think about your day and to observe during which moments you were not worrying a lot or even at all. You try to then look at which activities, thoughts, or feelings were combined with these moments of 'natural alternatives'. At the moment you do not do anything with this information yet: you just become aware of the alternative moments. You could possibly write them down in a diary. The questions which you ask yourself are: What was I doing during those moments? (ethos) What was I thinking during those moments? (logos)
Third week: practise the natural alternatives
During the third week we continue building on the work of the past two weeks. The first week you learned to create distance from your worrying behavior without stopping it. The second week you looked at which natural alternatives averted your thoughts from the worrying, which indirectly gave you useful information about what is helpful for you. The third week is the time in which you will start experimenting with solutions. This is done during the course of the day. When you realize that you start worrying, you ask yourself these questions:
- What can I try now to reduce or stop my worrying behavior?
- What helped me last week?
- Is there anything I observed last week which I can try now (see worksheet)
- What thought can help me now? (logos)
- What action or behavior can help me now? (ethos)
You then test his to see if it works. If something works, you keep moving in that direction. if something does not work, you just try something else.
Fourth week: the fifteen minutes of worrying
During the third week we practised diverting thought from worrying with the help o f natural alternatives. For some people this is enough, but for some people the unrest stays such an important problem that they could not solve it without worrying. To take care of this, you can make use of fifteen minutes of worrying. The technique works as follows: during the day you use the methods from the first three weeks to reduce your worrying, but each night during this week you take fifteen minutes during which you intensively and in a structured manner focus on the content of your worrying thoughts. Each time when you start to worry during the day, you decide to take care of these thoughts during your fifteen minutes of worrying in the evening. This allows you to take a break from the worrying during the day. Your fifteen minutes of worrying are preferably spent in the same space in the same chair each time, so that it becomes your 'worrying chair'. You bring pen and paper or your laptop and write down all your worrying thoughts. You structure them, prioritize some, differentiate between main problems and side problems, and eventually work out a plan of action for solving certain concrete problems. Beforehand you set an alarm, and exactly fifteen minutes later your fifteen minutes of worrying stop, knowing that you can continue with this the next evening. This way you limit your worrying in time and space and link them to the finding of concrete solutions, at least for the problems that can be solved, because unsolvable limitations in life simply have to be learned to be accepted. Extra: the thought-stopping technique by Fliegel. It sometimes happens that we are so worried that we need a more brusque technique to get a hold of our negative worrying thoughts. There is a simple technique for this, developed by Fliegel in 1998. As this technique is easiest to demonstrate with a video, we show it to you in a short video demonstration at www.15minutes5me.com/psycheandbrain. In short, the technique is based on that the worried person catches their own worrying thought, claps their hands and yells 'stop' out loud. It is a powerful technique, but it has the disadvantage that it cannot be used in every social context. Finally: Learning to stop worrying can be an important contribution to solving problems of stress, anxiety, burnout, depression, hyperventilation, anxiety disorders and other psychosomatic complaints. Sometimes it is enough, often it is a good first step. This is also th reason why we usually start both online self-help programs and therapeutic sessions with teaching techniques to stop worrying. By stopping the worrying, the participants gets more space to work on themselves with less stress, thereby enabling them to also work on other sources of stress. In the following publications of Psyche & Brain we will continue talking about problems like anxiety, depression, and burnout. To objectively follow how much you improve, you can make use of the online self-test on www.15minutes4me.com. This test measures the consequences of the worrying: tension, anxiety and depression. By doing this test once a week you can objectively measure the effect of your efforts. Note down your scores and compare them after each week. We understand that it takes a lot of commitment to follow a plan with steps like these for a long time without guidance. It, of course, is much easier to follow a structured program which takes your hand and guides you. If you know people who often worry, show them this article. It makes me glad to see how readers take matters into their own hands. Share this article with your friends on Facebook, Twitter, or Linked-In, and do our free self-test afterwards.
Paul Koeck, MD
