Worry

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A depiction of Rama in the Ramayana. Worried about his wife Sita, he is consoled by his brother Lakshmana. Rama became very much worried about Sita. His brother Lakshmana consoled him.jpg
A depiction of Rama in the Ramayana . Worried about his wife Sita, he is consoled by his brother Lakshmana.

Worry refers to the thoughts, images, emotions, and actions of a negative nature in a repetitive, uncontrollable manner that results from a proactive cognitive risk analysis made to avoid or solve anticipated potential threats and their potential consequences. [1]

Contents

Introduction

A young girl looking worried. Worried little girl.jpg
A young girl looking worried.

Psychologically, worry is part of Perseverative Cognition (a collective term for continuous thinking about negative events in the past or in the future). [2] As an emotion "worry" is experienced from anxiety or concern about a real or imagined issue, often personal issues such as health or finances, or external broader issues such as environmental pollution, social structure or technological change. It’s a natural response to anticipated future problems. Excessive worry is a primary diagnostic feature of generalized anxiety disorder. Most people experience short-lived periods of worry in their lives without incident; indeed, a mild amount of worrying have positive effects, if it prompts people to take precautions (e.g., fastening their seat belt or buying insurance) or avoid risky behaviors (e.g., angering dangerous animals, or binge drinking), but with excessive worrisome people they overestimate future dangers in their assessments and in its extremities tend to magnify the situation as a dead end which results stress. Overestimation happens because analytic resources are a combination of external locus of control, personal experience and belief fallacies. Chronically worried individuals are also more likely to lack confidence in their problem solving ability, perceive problems as threats, become easily frustrated when dealing with a problem, and are pessimistic about the outcome of problem-solving efforts. [3]

Seriously anxious people find it difficult to control their worry and typically experience symptoms like Restlessness, Fatigue, Difficulty in concentrating, Irritability, Muscle tension and Sleep disturbance.

Theories

AnxietyArousalFlow (psychology)Control (psychology)Relaxation (psychology)BoredomApathyWorryWorry
Mental state in terms of challenge level and skill level, according to Csikszentmihalyi's flow model. [1] (Click on a fragment of the image to go to the appropriate article)
  1. ^ Csikszentmihalyi, M., Finding Flow, 1997, p. 31.

Avoidance model

The avoidance model of worry (AMW) theorizes that worry is a verbal linguistic, thought based activity, which arises as an attempt to inhibit vivid mental imagery and associated somatic and emotional activation. [4] This inhibition precludes the emotional processing of fear that is theoretically necessary for successful habituation and extinction of feared stimuli. [5] Worry is reinforced as a coping technique due to the fact that most worries never actually occur, leaving the worrier with a feeling of having successfully controlled the feared situation, without the unpleasant sensations associated with exposure. [6]

Cognitive model

This model explains pathological worry to be an interaction between involuntary (bottom-up) processes, such as habitual biases in attention and interpretation favoring threat content, and voluntary (top-down) processes, such as attentional control. Emotional processing biases influence the probability of threat representations into the awareness as intruding negative or positive thoughts. At a pre-conscious level, these processes influence the competition among mental representations in which some correspond to the assertive power of worry with impaired cognitive process and others to the preventive power of worry with attentional control or exhaustive vigilance. The biases determine threatening degree and nature of worry content the worrier attempts to resolve the perceived threat and the redirection of anticipations, responses and coping in such situations. [7]

There are some who respond to mental representations in an uncertain or ambiguous state in regard to the stressful or upsetting event. [8] In this state the worrier is held in a perpetual state of worry. This is because availability of an overwhelming number(maybe 2 or 3, depending upon the worry-prone individual) of possibilities of outcomes which can be generated, it puts the worrier in a threatening crisis and they focus their attentional control voluntarily on the potential negative outcomes, whereas others engage in a constructive problem solving manner and in a benign approach rather than to engage with heightened anticipation on the possible negative outcome. [9]

Philosophical perspectives

Greek thinkers such as stoic philosopher Epictetus and Seneca advised against worry. Albert Ellis, the inventor of cognitive behavioural therapy, was inspired by the Stoics’ therapeutic ideas. [10]

Religious perspectives

Guido Reni's 17th-century painting of John the Baptist depicts anguish and worry. Guido Reni 040.jpg
Guido Reni's 17th-century painting of John the Baptist depicts anguish and worry.

The biblical word used in Hebrew for worry (Hebrew : דָּאַג, daag) regards worry as a combined form of fear and sorrow which affects nephesh, the totality of our being. The bible takes a fortitude-strengthening approach regarding worrying e.g. Psalm 94:

In the multitude of my anxieties within me, your comforts delight my soul. [11]

In the New Testament, the Gospel of Matthew encourages:

And can any of you by worrying add a single hour to your span of life? ... So do not worry about tomorrow, for tomorrow will bring worries of its own. Today’s trouble is enough for today. [12]

The Greek word used for worry in Matthew is "merimnaō", [13] which means to be anxious about, or to be troubled with cares.

St. Paul writes to the Philippian church, "There is no need to worry" [14] and in the pastoral epistles, 2 Timothy 1:7 emboldens:

For God did not give us a spirit of cowardice, but rather a spirit of power and of love and of self-discipline.

Similarly James 1:2-4 motivates to face trials of any kind with joy, because they produce endurance (strength and courage). Further Saint Peter reveals his understanding of healthy living in Second Peter 1:3,5-7:

We have a sure hope ... this is a cause of great joy for us. [15]

A late Indian spiritual teacher Meher Baba stated that worry is caused by desires and can be overcome through detachment:

Worry is the product of feverish imagination working under the stimulus of desires ... (It) is a necessary resultant of attachment to the past or to the anticipated future, and it always persists in some form or other until the mind is completely detached from everything. [16]

Management

Worry system is activated from exposure of a potential triggering event, traumatic experience or vulnerability, this brings worrisome thoughts and feelings which bring about physical stress reactions and response to avoid worrisome behavior, to ensure allostasis. But under the crisis this activity feeds back into the first worrisome thoughts and feelings which generates and strengthens the vicious worry cycle. Relaxation, risk assessment, worry exposure and behavior prevention have been proven effective in curbing the excessive worry, a chief feature of generalized anxiety disorder. [17] Cognitive behavioral techniques hasn't branched out enough to address the problem holistically but therapy can control or diminish worry. [18]

See also

Related Research Articles

Anxiety is an emotion characterized by an unpleasant state of inner turmoil, often accompanied by nervous behaviour such as pacing back and forth, somatic complaints, and rumination. It is the subjectively unpleasant feelings of dread over anticipated events.

Cognitive behavioral therapy psychotherapeutic approach that addresses dysfunctional emotions, behaviors and cognitions

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to improve mental health. CBT focuses on challenging and changing unhelpful cognitive distortions and behaviors, improving emotional regulation, and the development of personal coping strategies that target solving current problems. Originally, it was designed to treat depression, but its uses have been expanded to include treatment of a number of mental health conditions, including anxiety. CBT includes a number of cognitive or behaviour psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

Phobia An anxiety disorder defined by a persistent and excessive fear of an object or situation

A phobia is a type of anxiety disorder defined by a persistent and excessive fear of an object or situation. The phobia typically results in a rapid onset of fear and is present for more than six months. The affected person goes to great lengths to avoid the situation or object, to a degree greater than the actual danger posed. If the feared object or situation cannot be avoided, the affected person experiences significant distress. With blood or injury phobia, fainting may occur. Agoraphobia is often associated with panic attacks. Usually a person has phobias to a number of objects or situations.

Anxiety disorder cognitive disorder with an excessive, irrational dread of everyday situations

Anxiety disorders are a group of mental disorders characterized by significant feelings of anxiety and fear. Anxiety is a worry about future events, and fear is a reaction to current events. These feelings may cause physical symptoms, such as a fast heart rate and shakiness. There are several anxiety disorders, including generalized anxiety disorder, specific phobia, social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder, and selective mutism. The disorder differs by what results in the symptoms. People often have more than one anxiety disorder.

Generalized anxiety disorder (GAD) is an anxiety disorder characterized by excessive, uncontrollable and often irrational worry about events or activities. This excessive worry often interferes with daily functioning, and sufferers are overly concerned about everyday matters such as health issues, money, death, family problems, friendship problems, interpersonal relationship problems, or work difficulties. Symptoms may include excessive worry, restlessness, trouble sleeping, feeling tired, irritability, sweating, and trembling.

Cognitive restructuring (CR) is a psychotherapeutic process of learning to identify and dispute irrational or maladaptive thoughts known as cognitive distortions, such as all-or-nothing thinking (splitting), magical thinking, over-generalization, magnification, and emotional reasoning, which are commonly associated with many mental health disorders. CR employs many strategies, such as Socratic questioning, thought recording, and guided imagery, and is used in many types of therapies, including cognitive behavioral therapy (CBT) and rational emotive behaviour therapy (REBT). A number of studies demonstrate considerable efficacy in using CR-based therapies.

Behavior therapy or behavioral psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviorism. Those who practice behavior therapy tend to look at specific, learned behaviors and how the environment influences those behaviors. Those who practice behavior therapy are called behaviourists, or behavior analysts. They tend to look for treatment outcomes that are objectively measurable. Behavior therapy does not involve one specific method but it has a wide range of techniques that can be used to treat a person's psychological problems. Traditional behavior therapy draws from respondent conditioning and operant conditioning to solve patients problems.

Systematic desensitization, also known as graduated exposure therapy, is a type of behavior therapy developed by South African psychiatrist, Joseph Wolpe. It is used in the field of clinical psychology to help many people effectively overcome phobias and other anxiety disorders that are based on classical conditioning, and shares the same elements of both cognitive-behavioral therapy and applied behavior analysis. When used by the behavior analysts, it is based on radical behaviorism, as it incorporates counterconditioning principles, such as meditation and breathing. From the cognitive psychology perspective, however, cognitions and feelings trigger motor actions.

Exposure therapy is a technique in behavior therapy to treat anxiety disorders. Exposure therapy involves exposing the target patient to the anxiety source or its context without the intention to cause any danger. Doing so is thought to help them overcome their anxiety or distress. Procedurally, it is similar to the fear extinction paradigm developed studying laboratory rodents. Numerous studies have demonstrated its effectiveness in the treatment of disorders such as generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, PTSD, and specific phobias.

Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder. It is characterized by two main treatment procedures – imaginal and in vivo exposures. Imaginal exposure is repeated 'on-purpose' retelling of the trauma memory. In vivo exposure is gradually confronting situations, places, and things that are reminders of the trauma or feel dangerous. Additional procedures include processing of the trauma memory and breathing retraining.

Social anxiety is nervousness in social situations. Some disorders associated with the social anxiety spectrum include anxiety disorders, mood disorders, autism spectrum disorders, eating disorders, and substance use disorders. Individuals higher in social anxiety avert their gazes, show fewer facial expressions, and show difficulty with initiating and maintaining conversation. Trait social anxiety, the stable tendency to experience this nervousness, can be distinguished from state anxiety, the momentary response to a particular social stimulus. Nearly 90% of individuals report feeling symptoms of social anxiety at some point in their lives. Half of the individuals with any social fears meet criteria for social anxiety disorder. The function of social anxiety is to increase arousal and attention to social interactions, inhibit unwanted social behavior, and motivate preparation for future social situations.

Rumination (psychology)

Rumination is the focused attention on the symptoms of one's distress, and on its possible causes and consequences, as opposed to its solutions, according to the Response Styles Theory proposed by Nolen-Hoeksema (1998).

Interoceptive exposure is a cognitive behavioral therapy technique used in the treatment of panic disorder. It refers to carrying out exercises that bring about the physical sensations of a panic attack, such as hyperventilation and high muscle tension, and in the process removing the patient's conditioned response that the physical sensations will cause an attack to happen.

Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder characterized by sentiments of fear and anxiety in social situations, causing considerable distress and impaired ability to function in at least some aspects of daily life. These fears can be triggered by perceived or actual scrutiny from others. Individuals with social anxiety disorder fear negative evaluation from other people.

Fear of flying phobia of flying

Fear of flying is a fear of being on an aeroplane, or other flying vehicle, such as a helicopter, while in flight. It is also referred to as flying anxiety, flying phobia, flight phobia, aviophobia or aerophobia.

Separation anxiety disorder (SAD) is an anxiety disorder in which an individual experiences excessive anxiety regarding separation from home and/or from people to whom the individual has a strong emotional attachment. It is most common in infants and small children, typically between the ages of six to seven months to three years, although it may pathologically manifest itself in older children, adolescents and adults. Separation anxiety is a natural part of the developmental process. Unlike SAD, normal separation anxiety indicates healthy advancements in a child's cognitive maturation and should not be considered a developing behavioral problem.

Safety behaviors are coping behaviors used to reduce anxiety and fear when the user feels threatened. An example of a safety behavior in social anxiety is to think of excuses to escape a potentially uncomfortable situation. These safety behaviors, although useful for reducing anxiety in the short term, might become maladaptive over the long term by prolonging anxiety and fear of nonthreatening situations. This problem is commonly experienced in anxiety disorders. Treatments such as exposure and response prevention focus on eliminating safety behaviors due to the detrimental role safety behaviors have in mental disorders. There is a disputed claim that safety behaviors can be beneficial to use during the early stages of treatment.

Metacognitive therapy (MCT) is a psychotherapy focused on modifying metacognitive beliefs that perpetuate states of worry, rumination and attention fixation. It was created by Adrian Wells based on an information processing model by Wells and Matthews. It is supported by scientific evidence from a large number of studies.

Jonathan Abramowitz American clinical psychologist

Jonathan Stuart Abramowitz is an American clinical psychologist and Professor in the Department of Psychology and Neuroscience at the University of North Carolina at Chapel Hill (UNC-CH). He is an authority on obsessive-compulsive disorder (OCD) and anxiety disorders whose work is highly cited. He maintains a research lab and serves as the Director of the UNC-CH Anxiety and Stress Disorders Clinic. Abramowitz approaches the understanding and treatment of psychological problems from a cognitive-behavioral perspective.

Distress tolerance is an emerging construct in psychology that has been conceptualized in several different ways. Broadly, however, it refers to an individual's "perceived capacity to withstand negative emotional and/or other aversive states, and the behavioral act of withstanding distressing internal states elicited by some type of stressor." Some definitions of distress tolerance have also specified that the endurance of these negative events occur in contexts in which methods to escape the distressor exist.

References

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  10. Evans, J., Anxious? Depressed? Try Greek philosophy, The Telegraph 29 June 2013, accessed 8 October 2017
  11. Psalms 94:19
  12. Matthew 6:27,34
  13. "Is Worry a Sin?". Christianity Unfiltered. Retrieved 2019-10-29.
  14. Philippians 4:6 - Jerusalem Bible
  15. "New Revised Standard Version" Retrieved on 2015-01-17
  16. Baba, Meher (1967). Discourses. 3. Sufism Reoriented. pp. 121-22. ISBN   978-1880619094
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