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A certain amount of worrying is a normal part of life, especially these days with barely a moment passing without a disconcerting headline landing in your news feed. But for some people, their worrying reaches pathological levels. They just can’t stop wondering “What if…?”. It becomes distressing and feels out of control. In the formal jargon, they would likely be diagnosed with Generalised Anxiety Disorder, but excessive worrying is also a part of other conditions like panic disorder. There are many factors that contribute to anxiety problems in general, but a new review in Biological Psychology homes in on the cognitive and emotional factors that specifically contribute to prolonged bouts of worry. Its take-home points make an interesting read for anyone who considers themselves a worrier, and for therapists, the review highlights some approaches to help anxious clients get a hold of their excessive worrying.

The review authors, Graham Davey and Frances Meeten at the University of Sussex and the Institute of Psychiatry, Psychology and Neuroscience, explain that what gets many pathological worriers worrying in the first place is that they seem to be highly vigilant to any sources of threat and danger, and if there’s any ambiguity about whether a situation is threatening or not, they will tend to interpret it as being dangerous. If they haven’t yet heard from their daughter today, for instance, the problem worrier will not only notice this fact, they will also contemplate that it’s because she’s in trouble, rather than simply busy.

Studies have shown the causal role that these attentional biases seem to have by testing what happens when people are trained instead to pay more attention to positive aspects of situations, or to interpret ambiguous situations more positively. Asked to spend time after the training sitting quietly, focused on their breathing, worriers who’ve had the training report fewer intrusive worries compared with control participants.

Once a worry bout kicks in, one of the things that keeps it going in problem worriers is their deep held belief that worry is actually a good thing. This doesn’t make much sense at first. How can excessive worriers think worry is good when they find it so distressing? But while they find the worrying distressing and upsetting, and it feels out of control, research shows they also believe that it can help prevent bad things from happening, that it will help them be prepared for bad outcomes, and that it aids problem solving.

Related to this, problem worriers tend to have a kind of perfectionist approach to worrying. They think they can’t stop worrying until they’ve finished, in the sense of working through every eventuality and solving every problem. Less anxious people, in contrast, will tend to follow a principle of stopping worrying once they don’t feel like it anymore. Teaching pathological worriers to change their approach, to learn to stop worrying once they had enough of it, has been shown to prevent them from getting stuck in such long worry bouts.

Another key factor is low mood. Problem worriers tend to experience more negative moods, which are known to encourage a more analytical thinking style. In turn, this lays the ground for an overly zealous, perfectionist worry style that is in a sense impossible satisfy and leads to more distress and anxiety. Pathological worriers also tend to use their ongoing negative mood as a barometer for whether their worrying has been successful. The fact that they still feel down and anxious tells them that they’ve yet to anticipate or prepare for every disconcerting eventuality. Using “mood as information” in this way creates a kind of cognitive and emotional trap that propagates yet more worry.

You should seek professional help if you feel your worrying is becoming a problem, but the review offers some simple take-aways for breaking out of occasional uncontrolled worry bouts or preventing them happening in the first place. Because of the way that negative moods contribute to the perseveration of worry bouts, for instance, simply trying to combat a generally low mood is likely to help. This may be easier said that done, but if you can lift your mood (for example through going for regular walks), the evidence suggests a knock-on benefit will be less prolonged worrying.

It sounds ridiculously simple, but also thinking about the idea of stopping worrying when you’ve had enough of it, rather than when the worrying is somehow “finished” or “complete”, could be beneficial. In fact, earlier research has shown that merely learning about the cognitive and emotional factors that feed excessive worry can help some people.

From a therapeutic perspective, the review suggests that attentional training programmes (including “cognitive bias modification”) are likely to help prevent worry bouts from starting in the first place. Therapists could also consider engaging with anxious clients’ explicit beliefs about worrying, such as that it can prevent bad things happening or that they need to continue worrying until they’ve covered all the issues.

Meanwhile, acceptance- or mindfulness-based approaches could help alleviate clients’ distress about worry, which in turn would help reduce the part that negative mood plays in prolonging a worry bout. As for where our deep-seated and sometime unhelpful beliefs about worry come from in the first place, Davey and Meeten said this is something awaiting further research.

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