Robert L. Leahy, Ph.D., is clinical professor in psychiatry at Weill Medical College of Cornell University and the editor and author of 25 books. He is the director of the American Institute for Cognitive Therapy in New York City, a founding fellow--and served as the president-elect--of the Academy of Cognitive Therapy, and was the president of the International Association of Cognitive Psychotherapy.
Excerpt. © Reprinted by permission. All rights reserved.
1: Understanding Worry
Worry is everywhere. All of us worry, including me. You are not alone. In fact, 38 percent of people worry every day. And many people describe themselves as chronic worriers—they say, “I’ve been a worrier all my life.” But that’s only a modest indication of how worry has come to impact every aspect of our lives, limiting our enjoyment and satisfaction. Worry is the central component of all the anxiety disorders and depression. Research shows that worry precedes the onset of depression—you literally worry yourself into depression. Fifty percent of the people in the United States have had serious problems with depression, anxiety, or substance abuse at some time.1 Depression, anxiety, and substance abuse have increased during the past fifty years.2
The problem of worry is one that urgently needs a solution. To find one, we first need to understand it.
The Different Kinds of Worry
Let’s consider three people who worry.
•Jane is thirty-two years old and single. She and Roger just broke up after a two-year relationship. They had been talking about getting married, but Roger got cold feet, and Jane got fed up with him. She felt she didn’t want to wait forever for Roger to get his act together, so she broke it off. She knows she did the right thing, but now she worries: “Will I ever find a guy who can make a commitment?” and “Will I ever be able to have kids?” She sits in her apartment at night eating cookies and watching sitcoms.
•Brian is forty-five. He hasn’t filed his taxes for two years. He is sitting at home alone—just like Jane—thinking that he’s a loser for being so stupid not to file his taxes. He imagines the feds coming to his home and taking him away in handcuffs. Brian knows, in his rational mind, that he hasn’t committed a crime—his employer withheld the taxes, and he’s only late in filing. The worst case would probably be some kind of fine. But every time he sits down to start his taxes, his stomach clenches, his mind races, and he’s overcome by an overwhelming sense of dread. To avoid this feeling, he turns on ESPN and thinks, “I’ll wait for a better time.”
•Diane turns forty next month. She just had a complete medical exam two weeks ago, and everything is fine. But she feels a slight irregularity in her breast and begins to think, “Is this cancer?” Even though the doctor assured her she is healthy, Diane knows you can never be too careful. Just six months ago she thought she had Lou Gehrig’s disease. Diane was relieved to learn she didn’t have a serious neurological problem—only a bad case of nerves. Diane knows her fears are real—even though everyone else tells her to see a therapist.
I could fill several volumes with stories about people who worry. One of the volumes could probably be written by you! We worry about everything—getting rejected, ending up alone, doing badly on an exam, not looking that good, what someone thinks of us, getting sick, falling off cliffs, crashing in airplanes, losing our money, being late, going crazy, having weird thoughts and feelings, being humiliated.
You find yourself puzzled with thoughts like these:
•I know that I keep predicting the worst, but I can’t help myself.
•Even when people tell me it’s going to be OK, I still can’t stop worrying.
•I try to put these thoughts out of my mind, but they just keep coming back.
•I know it’s not likely to happen, but what if I’m the one?
•Why can’t I get control of my thoughts?
•Why am I driving myself crazy with these worries?
For example, Greg worries that things at work might go badly if he doesn’t get this project done on time. Even if he gets it done, he thinks it might not be up to par. The boss could get angry at him. What if he gets so angry he decides to fire him? After all, three people were laid off last month. And then what would his wife think? She’d be disappointed. Now Greg notices that he’s worrying again, and he thinks, “I’m worried all the time, and I can’t get any control over this worry. I’ll never get any sleep tonight, and then I’ll be tired, and then I won’t be able to get this project done.” And so on in a vicious circle.
Greg has generalized anxiety disorder (GAD), or what I call the “what-if disease.” A lot of what we will discuss in this book relates directly to this particular kind of worry. If you have this problem, then you worry about a number of different things—money, health, relationships, safety, or performance. And you worry you don’t have control of your worries. This is one of the longest-lasting anxiety disorders. You jump from one worry to another, predicting one catastrophe after another. Plus you worry about the fact that you are worrying so much. Not only are you worried, but you also have difficulty sleeping, are irritable and tense and tired, have indigestion, sweat a lot, and just feel nervous a good deal of the time. It’s hard to relax. No wonder you are often depressed or have physical problems such as irritable bowel syndrome.3
About 7 percent of us have GAD. Women are twice as likely as men to have this problem. This is a chronic condition, with many people saying that they have been worriers all their lives.4 The first severe worry tends to begin during late adolescence or early adulthood. Most people with GAD never seek out psychotherapy; they generally see their doctor and complain about vague physical symptoms, such as fatigue, aches and pains, irritable bowel, and sleep problems. Those who do eventually go to therapy wait a long time before doing so—an average of ten years. In fact, worry is such a widespread problem that it may not even seem like a problem. That’s because you think, “Oh, I’m just a worrier” and believe that there’s nothing you can do about it. You think, “I’ve always been a worrier—and I always will be.”
Worry is not limited to GAD. In addition to this general what-if disease, others confront more specific types of worry—a fear of a specific situation, for example. These more targeted worries are part of every anxiety disorder and a central component of depression. This is important for two reasons. First, if you have GAD—or if you are a chronic worrier—then you probably have some problems with another anxiety disorder or depression. Second, if we cure your worry, your anxiety and depression should dramatically improve.
If you have social anxiety, then you worry that people will see you as weak, vulnerable, and anxious. You are shy, intimidated, afraid to speak in public, and worried that people will see that you are anxious. If you have post-traumatic stress disorder, then you worry that the intrusive images and frightening nightmares will never go away and that something terrible will happen. If you have specific fears, such as a fear of flying, then you worry that you will be injured or killed. And if you have obsessive-compulsive disorder, you worry you may have left something undone, or that you are contaminated, or that your thoughts will lead to dangerous impulses.
Now that you have evaluated the different kinds of worries you have for these different anxiety problems, let’s take a closer look at why your worry persists—no matter how many times things turn out OK.
Why You Keep Worrying
You have mixed feelings about your worries. On one hand, your worries are bothering you—you can’t sleep, and you can’t get these pessimistic thoughts out of your head. But there is a way that these worries make sense to you. For example, you 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.
You have a hard time giving up on your worries because, in a sense, your worries have been working for you.
