Chances are that you have tried to stop worrying but the whole endeavor turned out to be far more difficult and frustrating than originally anticipated. Worry is a tricky and complex problem.
To understand it, we can start by differentiating between worry content (what we worry about) and worry process (the thinking spirals inside our minds). The worry process can attach itself to everything from not being prepared for an exam, having possibly made a suboptimal decision, fear of a loved one becoming ill without any indications of ill health, to dealing with one’s own frightening diagnosis. No matter the scenario, it would be nice to slow down our minds, if just a little bit. Yes, even when facing real serious issues. Letting go of worrying will not make everything good, but it give us some emotional room to rest and appreciate what is still available to us.
A.P.P.L.E. acronym is a good way to summarize the principles that we can use to manage our worries. A.P.P.L.E. stands for acceptance, perspective, problem-solving, letting go and effective engagement. We will use these five principles to show you how to tackle the worry process in some very different scenarios as reflected in stories of Tamara, Adam, Nina and Reymond. In some these cases worries might seem unsubstantiated, in others the worry emerged clearly as a result of significant crisis.
Tamara is in the second-year university. She was doing quite well until the mid-terms when her grades took a hit after a particularly difficult exam in biochemistry. Tamara has lost her confidence. She still has to write a final exam in that course but cannot bring herself to study. Most students in the class got poorer grades than expected. Tamara is spending many hours with her lecture notes and reports not being able to absorb any information. A tracking sheet revealed that very little of study time is spent on studying as Tamara tends to chat with her classmates online about the unfairness of the last test and gets easily distracted by notifications from her favorite podcasters.
Adam applied for multiple jobs as a software engineer. He was lucky to get interviews and two very attractive job offers. Initially Adam was very happy with his work but then started thinking that the other job could have been better than the one that he has selected. Now Adam evaluates his current workplace against imaginary perks of the position that he has rejected and reports being highly dissatisfied with his professional life. He stated that he would be less concerned if he could know for sure that he has chosen the better option.
Nina and Alice married last year. Nina never felt happier. She says that she cannot imagine life without Alice. Once Alice woke up earlier than her partner and could not hear clear breathing from the other side of the bed. Since that time, Nina has very hard time with her sleep, least Alice stops breathing and she, Nina, won’t notice it and fails to provide the necessary assistance. The couple started arguing and Nina has been insisting that Alice takes yet another sleep apnea test despite the first test being negative and Alice’s being in good health. Nina explains that her nagging is causing a lot of problems and that she wishes to get the worries out of her head but can’t.
Reymond observed unusual trembling and tiredness for a while but generally dismissed it as a consequence of overworking. He eventually got an appointment with a family physician and then was sent to a neurologist. The news took him aback as he received diagnoses of Parkinson’s. Reymond set up to organize all his affairs and set up appointments with hopes that alternative medicine will offer a solution. He has given up on most of his activities and has very limited interactions with his family, claiming that they simply do not understand what he is going through. Most of his time is consumed by reading about Parkinson’s and trying to implement the many recommendations that he is gathering from his various providers. Reymond is clear: he is only seeing a therapist to please his wife as his behaviour is justified because his problems are real.
ACCEPTANCE
Acceptance is not endorsement. It is absence of wishful thinking. I cannot wish things away anymore than I can "worry them away". Worry is an understandable reaction to difficulties and unpredictability in our lives. The trick is not to get lost in our worries AND not to fight them.
What happens when we try to fight our thoughts? Have you ever tried not to think about something only for the thought to come back with even more force? To demonstrate what I am talking about, I need you not to think of a green apple. Look at the picture below, close your eyes and then give it all you can to ensure that an image of a green apple does not form in your head.
How did it go? Chances are that you either thought of or have seen the green apple while doing your best to suppress it[1]. Chances are that this is the main strategy that you have been using to manage your worries as well: Forcing them to stop. That is not how our minds works. Whatever we struggle becomes relevant, important and deserving of undivided attention.
If thought stopping doesn't work, how about trigger avoidance? Many people try to avoid all that could bring about their worries. Some avoid news, others avoid making decisions yet others get frustrated that their families keep them in the dark about important concerns. Trigger avoidance is neither useful nor possible. Tamara would have to avoid her classes. Adam would have to stop working. Nina would have to leave her partner while Raymond’s would have no choice but go into a denial about his illness. None of that is helpful.
So, what do we do? We acknowledge presence of worry and then decide what is relevant and what we want to focus on. We make a choice. Take a close look at the picture of the fruit stall below. Instead of trying not to see the green apples, focus on the strawberries. Apples are still there but no longer take center stage [2]
To shift our attention, we need to recognize that presence of worry does not make it immediately relevant. Having perspective is crucial.
PERSPECTIVE
Being able to redirect your attention is possible only if we determine that what we worry about does not reflect our current immediate reality. We cannot just push worries away -- not only because pushed worries have a tendency to return even more forcefully but because worries might signal problems that require attention.
It is good to write things down. Our minds can get muddled so it is easy to get confused while trying to untangle our thoughts. Questions that help us gain perspective address urgency and reasonableness of our worries.
Is what you are preoccupied with something that is urgent and in need of immediate attention? Is it happening right now? Is it even possible to act on it? Building Awareness and Effectiveness worksheet is a good tool to use to determine urgency for action.
Do your worrisome prediction make sense? What is the evidence? What is a fuller view of the situation? Use the Challenging Anxious Thoughts worksheet to help you create a reasonable view of the situation.
Perspective and problem solving go hand in hand. We cannot solve problems if we do not have a clear picture of what these problems are.
PROBLEM-SOLVING
It is best to keep a regular problem solving time of about 30 minutes to one hour daily. Spending a dedicated time working on our concerns results in:
having clearer action plans to address the problems,
reduction of the time we spend on worrying as we can refer back to our action plans instead of trying to start from scratch, and
learning to differentiate between the time to think and time to do something else, whatever it is.
Keep in mind that you will not find solutions to all your problems in one hour. Yet, if you keep the practice going, in a month, you would have spend 30 hours developing and trying out your strategies.
If we come back to our four examples, each person has a specific task that they need to practice.
Tamara needs to rebuild her ability to study and absorb information despite interference from her. To help her, she can practice accepting worrying, train her attention and perhaps even practice studying while an audio of her prerecorded worry thoughts is playing in the background. All this to help Tamara's mind not to be derailed by her thoughts[3]
Nina would practice paying attention to the conversations with her partner and refraining from questioning Alice about health despite having unpleasant intrusive thoughts about Alice’s becoming ill.
Adam would spend the problem-solving time searching for ways in which he can engage in stimulating projects at his current work instead of spending time questioning his choice of employment. He can also further his skills, streamline his resume and start applying for jobs that match his professional interests even better.
Reymond faces uncertainty of the progression of his illness. He would use his problem solving time to coordinate his appointments AND to make sure that there is some free time for non-illness related activities in his schedule. He needs to learn to tolerate uncertainty and to dare to live despite uncertainty. In circumstances like Reymond's we have no choice not to be ill, but we can have an honest look at what is possible and decide how we want to live despite the illness. A bonfire by the lake is not going to accelerate Parkinson’s. Refusing a weekend at a cottage will not slow it down.
LETTING GO
We have to deal with our problems, not worry about them. There is a difference. Studying for an exam is very different from worrying about an exam. Questioning a job choice is different from building a career. Loving a spouse is different from being preoccupied with the possibility she could die. Worrying about future progress of recently diagnosed severe illness is different from following the treatment protocol.
As applied to worry, letting go does not trivialize our concerns. Far from it. When we let go of such a useless and painful process, we are better equipped to effectively handle what matters.
Letting go of the worry process is difficult because worrying is a conditioned behaviour. Many things that we worry about do not happen. Furthermore, Tom Borkovec discovered that, however briefly, the act of worrying can reduce some physiological markers of anxiety. That is enough to trap anxious individuals in a cycle of dependency on the very process that they want to eliminate. If you consider the two diagrams below, letting go of the worry process might not seem like a very appealing idea. It is understandably difficult.
We like to have control and worry offers an illusion of control. Worry makes us believe that we are being proactive – a phenomenon known as thought-action fusion. Thought-action fusion creates a sense of helplessness as despite having expended all that mental energy, we achieve nothing. Worry is like carrying a load when you do not have to. In the end, we are just exhausted and unable to do what we have committed to doing. Worrying is the opposite of effectiveness.
Cartoons used in this blog were commissioned from Jared Mitchel. If you want Jared to sketch for you, contact him at jaredmitchellart@gmail.com
EFFECTIVE ENGAGEMENT
Effective engagement is the opposite of worry. Effective engagement requires us to accept that worries might be there, to take things in perspective, develop plans, let go of worrying as an ineffective albeit powerfully reinforced problem-solving strategy. Then we get to choose what makes sense for us to do over the next few minutes or few hours. Effective engagement implies intentionality.
If this is the time to act on the problems that you worry about, do just that. Tamara might study and write her exam. Adam might apply for a job. Nina and Alice have booked their annual appointments with family physicians but decided to go on different dates. Raymond makes sure to take his Levodopa as prescribed.
If this is not the time to take care of the problems, focus on something else that is meaningful and makes sense for you. It can be anything. Tamara might just catch a nap, practice oil painting or meet a few friends. Adam might watch an online lecture or play a game of basketball, preferably in a real court and with teammates. The foodie that she is, Nina could try new recipes and plan the next Toronto culinary adventures for her and Alice. Raymond could spend time with his grandchildren or read crime fiction by the fireplace.
IN SUMMARY
A.P.P.L.E. is a helpful acronym to remember that being able to let go requires all of the five strategies: acceptance, perspective, problem-solving, letting go and effective engagement. These are highly interdependent relatively easy to understand but difficult to implement concepts. Remember the diagrams that shows the process of letting go of worrying? We are humans, not robots, and so anxiety and worry thoughts are likely to come knocking. That's OK.
If you want to learn more about thought suppression, read D.M. Wegner’s classic: White bears and other unwanted thoughts: Suppression, obsession, and the psychology of mental control.
You can train you ability to focus despite distractions by placing a sticker on your screens while watching videos. It can be very frustrating at the beginning but after a while you should be able to get absorbed in the content of your choice. The key is to focus on what you want to watch and not on your annoyance with the sticker.
Check this post if you want to know more about application of exposure based treatment to worry.