New Harbinger Publications (NHP): What is worry, and how does it differ from anxiety?
Chad LeJeune (CL): Anxiety involves fight-or-flight arousal. This is a natural, "hard-wired" response that all animals have. Its purpose is to help us to respond to a crisis or problem that is right in front of us, an immediate threat. Worry is a verbal process, unique to humans, where we use our minds as a time machine, traveling into the future to encounter problems and threats that are not here yet. What makes worry different from simply planning for the future is that we are triggering this fight-or-flight response. Since the crisis has not yet arrived, and may never actually show up, this arousal can hang around for long periods of time. This can lead to health problems, difficulty getting things done, relationship stress, and other troubles.
NHP: What is the difference between worrying and caring?
CL: While worrying about someone or something may indicate that we care, worrying and caring are not the same thing. Worriers often confuse the two. For example, consider a mother who worries about her adult daughter, and expresses this by calling her several times a day. She might explain her behavior by saying something like "I only call because I care about you." However, if the primary function of the calls is to reduce the anxiety that the mother is feeling, this is worrying, not caring. When we are caring for someone or something, we are doing the things that support or advance the best interests of the person or thing that we care about. Caring has an impact on the outside that may or may not reduce the anxiety on the inside of the worrier.
Consider the difference between worrying about your houseplants and caring for your houseplants. If you are away from home for a week, you can worry about your houseplants every single day and still return home to find them brown and wilted. Worrying is not watering. Similarly, the mother who calls her daughter several times a day, even when the constant calls interfere with the daughter's ability to get things done and cause friction in her marriage, is worrying about her daughter, but failing to care for her as well as she might.
NHP: It is natural to worry about certain things. At what point does worry become excessive?
CL: Yes, occasional worry is natural. This is especially true when we are undergoing major life events or transitions. Worry only becomes a serious problem when it becomes a way of life, causes health problems, or interferes with our relationships or ability to get things done.
Some people find that much of their waking life is consumed by thoughts of all the things that could go wrong. The result of all the fight-or-flight arousal that accompanies these thoughts can include muscle aches and pains, stomach problems, fatigue, difficulty concentrating, and trouble sleeping. The irritability and edginess that come with frequent worry can have a negative impact on relationships, too. Excessive "checking in" or reassurance-seeking can become a problem in relationships. Constant worry can leave you feeling emotionally depleted and depressed. For some, these problems are compounded by drinking or the use of other drugs in an attempt to "turn off" the worry.
Worry can also affect how productive and effective you are in pursuing your goals. Worry about the future interferes with problem-solving and decision-making in the present, and often leads to a pattern of avoidance and procrastination. Worriers may be active, engaging in nervous or "antsy" behavior, but they are often not very productive.
NHP: What causes chronic worry?
CL: Worry involves two things, both of which are natural and helpful in the proper context, which come together in the worrier to wreak havoc. The first is our ability to imagine the future and plan ahead. This is a marvelous gift to mankind and has allowed us to accomplish amazing things. The second, is our ability to take control of and respond to our environment. We do this with the help of the fight-or-flight response. This too is an amazing benefit that has helped us to survive as a species. When these two things come together, however, and we are trying to control and respond to imaginary events in the future, we get into trouble. For the chronic worrier, there is often limited awareness that this is what is happening. Because they believe that the worry is helpful or productive (despite evidence to the contrary), it becomes a habitual response.
NHP: In chapter one you talk about some of the ways that worry helps us. What are some positive functions that worry serves?
CL: Actually, that chapter is about some of the ways that we believe worry helps us. It's this belief in the helpfulness of worry that is the problem. The Worry Trap defines worry as non-productive thinking that is in fact not helpful by nature. Worriers often confuse worry with more helpful processes like planning or problem-solving. If we are indeed planning or problem-solving, we are coming up with actions that we can take. When we are engaged in worry, the only outcome is more anxiety.
When we confuse worry with planning, we are like a small child in the kitchen with a mixing bowl. The child throws some flour into the bowl, tosses in a few eggs. He adds water and some sugar and stirs it all up. If we ask him what he's up to, he'll say "I'm making cookies." It looks like he's making cookies, but if no cookies come out of this process, is he really making cookies? Similarly, the worrier says "I'm planning", and much of what she does looks like planning. But if no plan comes out of this process, is she really planning? Or is she worrying?
NHP: Could you explain what acceptance and commitment therapy (ACT) is and how it can be used to treat chronic worry?
CL: ACT is a treatment approach developed by psychologist Steven Hayes and his colleagues that is gaining recognition as an effective treatment for a wide range of problems. Emerging evidence from both mental health and basic psychology research suggests that treatment approaches that primarily emphasize changing our internal experience may not only have limited effects, but may even make some problems worse. ACT is one of several new approaches based on acceptance and mindfulness of the present moment. These approaches have been shown to be useful in treating anxiety, depression, substance abuse, eating disorders, trauma, couples' distress, and personality disorders.
The essential components of ACT include letting go of the struggle to control unwanted thoughts and feelings, being mindfully aware of the present moment, and committing to a course of action that is consistent with what you value most in life. In this way, ACT is about both acceptance and change. It is the acceptance of the thoughts and emotions that accompany a difficult but valuable act that allow you to take that action. As applied to the problem of chronic worry, acceptance of the uncertainty of the future and anxious thoughts and feelings about that uncertainty, allow you to focus more clearly on the present and to take the steps that move you closer to the life you truly want to live.
NHP: In chapter six you discuss the concepts of "content" and "context." Could you explain those concepts and the distinction between the two?
CL: When we experience strong emotions, there is a tendency to respond as though we are our emotions. This is even reflected in our language when we say things like "I am anxious." The truth is, even at its strongest, anxiety is just one aspect of your experience. As such, it is something separate from the "You" that is experiencing it. You are not anxiety any more than you are the screen of this computer. The anxiety, the computer, and the words on the screen are all the "content" of your experience. As the experiencer, you are the larger "context" for this experience. An increased awareness of the separate nature of your self (context) and your experience (content) can make it easier to accept whatever the content is at a given time. While content is constantly changing, the context (you) endures.
This is like the difference between a movie theater and the movie that is playing there. You may not like the movie that you're watching, but next week there will be a different feature. The theatre remains the same, no matter what is on the screen. The Worry Trap uses mindfulness training as well as other techniques to help you to move toward perceiving anxiety as just another aspect of your experience. The exercises help you to shift from operating at the content level of awareness to the context level, recognizing that you are the theater, not the feature film.
NHP: What is the LLAMP approach and how can it help a chronic worrier?
CL: The Worry Trap presents a five-step model to guide you through learning the component skills of acceptance and commitment therapy and applying them to the problem of worry. It starts by interrupting the fight-or-flight response and the accompanying impulse toward controlling your thoughts and feelings, and goes on to help you accept your thoughts and feelings and focus more on the present-moment. Finally, it guides you in taking actions directed by your values rather than by worry.
The five steps are contained in the acronym LLAMP:
- Label "anxious thoughts"
- Let go of control
- Accept and observe thoughts and feelings
- Mindfulness of the present moment
- Proceed in the right direction
The step-by-step instruction and exercises allow you to practice and develop each component as an individual skill. With practice, the steps begin to flow one into another, so that applying LLAMP becomes a fluid process. Labeling certain thoughts as "anxious thoughts" is a cue to Let go of the control response, which makes room for Acceptance and Mindfulness of your thoughts, feelings, and experience in the present moment, which allows you to Proceed with valued, purposeful action.
Reproduced with permission by New Harbinger Publications, Inc.
The Worry Trap, Chad LeJeune, PhD
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Page last modified or reviewed on January 24, 2014