Three strategies for dealing with useless worry
– a cognitive therapy approach.

Some people find the following strategies helpful for reducing pointless and upsetting worry.

1. Thought Stopping

Thought stopping is designed to be used when you find yourself worrying about the same issue again and again. It should only be used if the worry is pointless. If your worrying is actually giving you solutions to the problem, then you might want to keep doing it.  The technique takes a fair bit of practice to learn. Here’s the sequence:

a) Pick a time when you can be undisturbed at home for a couple of hours.

b) Sit down and deliberately start worrying. This may be harder than you think. You should choose an issue that bothers you but not one that will send you into deep depression or make you think about harming yourself.

c) Once you begin to feel worried do three things: stand up, clap your hands once and shout “stop!” you will feel quite silly doing this but do it anyway. You should notice that the worry stops for a bit.

d) The moment you notice yourself worrying again (probably only a few seconds later) stand, clap and shout “stop!” again. Keep repeating this. Eventually you should notice that the worry takes longer and longer to come back. At this point clap and shout without standing.   After a while stop clapping; just shout.

e) Finally stop shouting. Instead picture a large stop sign in your head and imagine yourself shouting “STOP”. Now you can have other people around again. Over the next few weeks make a point of imagining the sign and the shout whenever you catch yourself worrying about the topic. If you like you can wear a rubber band around your wrist and snap it (gently) against the skin at the same time. Then shift your mind onto some other topic. With time you can become very effective at halting periods of pointless worry.

2. Worrying Time

Worrying time is designed to help you stop worrying about problems for most of the day by saving all of your worrying for a particular time. This can be easier than stopping the worrying altogether. As well you may have to think about some of your worries in order to decide what to do about them. Here’s the strategy;

a) Pick a time during the day or week when you will sit down and think about the things that have been worrying you. You probably don’t need to do this every day but more than once a week would be a good idea. Set aside a maximum of 30 minutes when you will not be distracted.

b) Carry a pen and paper (index cards work well) with you at all times. When you catch yourself worrying, make a note of the topic. Assure yourself that you will  think about the issue but not right now. Shift your mind onto something else.

c) When it is time to worry, take out your list of topics and consider each of them in turn. With some topics you may find that you can actually come up with a solution or a decision about how to handle them. Others you may just worry about.  This strategy may sound a bit odd but it is amazingly helpful if you are disciplined about carrying it out.

3 . Worry Inflation

We frequently try to minimize our fears. Worry inflation uses the opposite approach: making the problems as big as possible. Why? Because if you exaggerate many fears they eventually become ridiculous. You find that you can’t really believe that things will get that bad, and the problem shrinks down to realistic proportions. Here’s the strategy:

a) First identify the disturbing thought you want to deal with.

b) Next decide whether inflating the worry will make it seem silly or will only make it seem worse.

c) If it looks like a good topic for worry inflation, exaggerate the disturbing thought out of all proportion. Imagine the most extreme consequences possible. For example: “If I phone my old friend she won’t remember me. She will tell the police she has had a nuisance caller. They will trace the call and arrest me. I’ll spend the rest of my life in jail”. The more extreme the worry gets; the less you may believe in it and the less that thought will be able to bother you in the future.

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CBT (Cognitive-Behavioral Therapy), often referred to as exposure and response prevention, exposes the patient to her or his obsessional fear (for example, making a germ-obsessed person touch a dirty floor) and then delays their compulsive response (immediately washing their hands). The aim is to ease distress. Over a period of time the person learns to become less and less afraid and anxious by their fears – they learn to handle the anxiety.
This type of behavioral treatment is advocated and studied by Dr. Jeffrey Schwartz, a leading authority on OCD and the author of a book, Brain Lock. He believes that OCDers must learn NOT to give in to their gut feelings and obsessions. By resisting the rituals – no matter how hard that is to do – the OCDer is learning a proper response to normal behaviour, where as giving in to the obsession actually makes the person worse.
# Whatever the person does regularly, good or bad behavior, the brain picks up and does automatically. So, if that behavior is good behavior the brain’s chemistry will start to change. He suggests there are four basic steps which allow an OCDer to do behavior and response prevention on their own without a therapist. These are as follows:
# Step 1. Relabel

Learn to recognize obsessive thoughts and compulsive urges – and do so assertively. Start calling them “obsessions” and “compulsions.” Realize they are symptoms of your illness and not REAL problems. For example, if your hands feel dirty or contaminated, train yourself to say “I don’t really think my hands are dirty; I’m having an obsession that they are. I don’t really need to wash my hands; I’m having a compulsion to do so.” After a while the brain learns to realize that these are just false alarms – false messages caused by the imbalance. You can’t make the thoughts and urges go away because they are caused by this biological imbalance, but you can control and change your behavior response.

# Step 2. Reattribute

“It’s not me, it’s my OCD.” Learn to reattribute the cause of these thoughts and urges to their real cause. This will increase your willpower and enable you to fight off the urge to wash or check.

# Step 3. Refocus

This is where the real hard work is done. Learn to refocus your mind on something else. Choose something pleasant like a hobby – listen to music, play sport, go for a walk, whatever it takes to make your mind think of something other than the obsessions and compulsions that it WANTS to think about. Say to yourself, “I’m experiencing a symptom of OCD. I must refocus and do another behavior.” This is not easy, and a person should adopt a FIFTEEN MINUTE RULE. They should delay their response by letting some time elapse, preferably fifteen minutes, but a shorter waiting time at first.

During this time they should re-check through all the steps. Be aware that the intrusive thoughts and urges are a result of OCD and that this is an illness, a biochemical imbalance in the brain. Try to focus on something else. After the fifteen minutes, reassess the urges. Take note of any change in their intensity and this will give the person courage to wait longer next time. The longer it’s left the greater the decrease in intensity.

# Step 4. Revalue

Begin to realize that these thoughts and urges are a result of OCD, and learn to place less importance on them and less importance on the OCD. Learn to take back control, take charge. In the short term, feelings can’t be changed but behavior can be, and in time the feelings change too. Dr Schwartz, in his conclusion, says, “We who have OCD must learn to train our minds not to take intruding feelings at face value. We must learn that these feelings mislead us. In a gradual but tempered way, we must change our responses to the feelings and resist them.”
from Brain Lock by Dr. Jeffrey Schwartz.

This morning’s *New York Times* includes an article: “When Anxiety Is at
the Table” by Jeff Bell. 2/6/2008

Here’s the article:

FOR some of us the trouble starts before we even step into a restaurant.

If Carole Johnson, a retired school administrator who lives near
Sacramento, Calif., happens to have a distressing thought while passing
through a doorway, she needs to “clear” the thought by passing through
the door twice more, doing it precisely three times.

My own challenge is fighting the urge to return to my parked car and
check yet again that the parking brake is secure. If I don’t, how can I
be sure my car won’t roll into something — or worse, someone?

Ms. Johnson and I are but two of the estimated five to seven million
Americans battling obsessive-compulsive disorder, an anxiety disorder
characterized by intrusive distressing thoughts and repetitive rituals
aimed at dislodging those thoughts. We are an eclectic bunch spanning
every imaginable cross-section of society, and we battle an equally
eclectic mix of obsessions and compulsions. Some of us obsess about
contamination, others about hurting people, and still others about
symmetry. Almost all of us can find something to obsess about at a restaurant.

(more…)

Stop Obsessing! Edna, B. Foa & Reid Wilson

Getting Control. Lee Baer

The Imp of the Mind. Lee Baer

Brainlock. Jeffrey Schwartz