What? Me Worry!?!
What? Me Worry!?!

What? Me Worry!?!
Module 2
Overview of Worrying
Introduction

2

Understanding Worrying

2

What Triggers Worrying?

3

What Maintains Worrying?

4

The Vicious Cycle of Worry

7

What Can Be Done About My Worrying?

8

Module Summary

11

About the Modules

12

The information provided in the document is for information purposes only. Please refer tothe full disclaimer and copyright statements available at www.cci.health.gov.au regarding theinformation on this website before making use of such information.

forCentrelinical
C Interventions• Psychotherapy • Research • Training

Module 2: Overview of Worrying

Page 1

What? Me Worry!?!
Introduction
As we discussed in Module 1, worrying is a central feature of generalised anxiety disorder. The aim of thismodule is to provide an overview of what worrying is, what triggers worrying, what keeps it going, andmost importantly, how to treat it effectively.

Understanding Worrying
You can think of worrying as a self-talk activity, where we ‘talk to ourselves'
repetitively about possible future negative events that might happen, and of which
we are afraid. We mentally discuss the event with ourselves over and over again
and think about what would happen should the event occur. As such, worrying is a
type of vigilance for threat, and an ‘attempt’ at mentally ‘solving problems’ that haven’t
yet happened. We say ‘attempt’ because often a solution doesn’t arise, and people are left thinking they
will not be able to cope should their worst fears happen. We say ‘solving problems’ because people often
think that worrying is problem-solving, when in fact effective problem-solving is a very different type ofactivity (which you will see in Module 7).
So, worrying is essentially a type of repetitive negative thinking, where we getstuck, caught, locked or trapped in our negative thoughts about future badthings. This negative thinking has a circular, spiral or snowball-like quality to it,
because the same negative stuff keeps getting rehashed over and over in ourmind, and we have trouble disengaging from these repetitive negative thoughts.
This thinking process fuels our anxious feelings and the topic we are worrying
about seems to get bigger and bigger in our mind.

“What If…” Worries

People with generalised anxiety are often having an internal conversation about things they fear might
happen. In this way, worrying often starts as “What if…” questions like:“What if I can’t get to my appointment on time?”“What if I fail my exam?”“What if I can’t do the job?”“What if I can’t provide for my family?”“What if something happens to my child?”“What if my husband/wife/partner has an accident?”“What if I get anxious during my interview?”“What if my face turns red?”“What if I get sick?”As you will have noticed, the above examples of worrisome thoughts are about external things (e.g., work,
family, etc) or internal physical things (e.g., illness).
What are the “What if…” questions you often ask yourself? (What external things or internal
physical things do you tend to worry about?).

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
forCentrelinical
C Interventions• Psychotherapy • Research • Training

Module 2: Overview of Worrying

Page 2

What? Me Worry!?!
One “What if…” question will often play in your mind like a song stuck on repeat, and the words may
sound something like this:“What if I lose my job?”“I won’t be able to support my family”“My family will be so disappointed in me”“They won’t be able to stand having me around”“They may leave me”“I’ll have no one”
“I’ll have nothing”“I can’t lose my job”
“But there are so many cut backs going on”“What if I am next?”
Can you see how this worry chain just takes you in circles, leading nowhere particularly productive?
See if you can take an issue that you were once worried about (but is no longer a bother toyou), and use it to write out one of your typical worry chains. What was the first “what if”
thought that came to mind about this issue, and then what did you think next, and next andso on…

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Normal or Problem Worry

Research shows we all worry, and we all worry about the same sorts of things. It is how much time we
spend worrying and our difficulty disengaging from worry, which determines whether our worry is
problematic or not. While most people worry and think about negative things from time to time, for themost part these worrisome thoughts are short-lived, either giving way to a different thought topic popping
into mind or being put to rest by positive problem-solving action. Worry only becomes unhelpful when it isvery frequent and becomes difficult for us to control or disengage from. When this happens we feeltrapped in our own negative thoughts.

What Triggers Worrying?
Worrying can be triggered by various things. Some triggers may be more obvious and linked to externalthings, for example:•••

Seeing a certain image (e.g., in the newspaper or on the T.V. news)
Hearing certain information (e.g., on the radio or in a conversation)
Being put in a certain situation (e.g., having to make decisions, perform a task, lead others)

Some triggers may be less obvious. These may be thoughts or images that seem to just pop into your headout of the blue. An initial “What if…” question that comes to mind for no apparent reason, can even be a
trigger for worrying. For example, the thought “What if I left the iron on?” might pop into my head. If I
then think “I probably didn’t” and decide not to worry about it, chances are I will forget about it, and thethought will slip my mind. However, if instead I start to ‘chase’ the thought further (e.g., “the ironing board
might catch fire and that will spread to the whole house”; “the house might burn down and then I will lose
everything!”), then the original “What if…” question has now triggered a worry episode.
forCentrelinical
C Interventions• Psychotherapy • Research • Training

Module 2: Overview of Worrying

Page 3

What? Me Worry!?!
Write down any external images, information, and situations, or any internal images or“What if…” thoughts, that have triggered worrying for you.

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
What Maintains Worrying?
People who describe themselves as chronic worriers are often disturbed that they seem to spend much of
their waking hours worrying excessively about a number of different things. They do not understand why
this mental activity continues. They often ask, “Why do I keeping worrying?” Well, there are three things
that keep our worrying going.

1) Unhelpful Beliefs About Worrying

There are two types of beliefs which work to keep us stuck in the vicious cycle of worry. These are positive
and negative beliefs about worrying itself.
Positive Beliefs About Worrying
Whilst worriers usually dislike the fact that they worry so much, they also often hold positive
beliefs that worrying is beneficial and helpful. It is these positive beliefs about the usefulnessof worrying that can get us worrying in the first place. Some positive beliefs may be:
Worrying helps me find solutions to problems
Worrying helps me understand problems
Worrying motivates me to do things
Worrying prepares me for the worst
Worrying helps me avoid bad things
Worrying prevents bad things
Worrying is doing something
Worrying shows I care
Because of these positive beliefs about worrying, when an issue we are concerned about pops into ourmind, we will pull the negative thoughts closer, listen intently to them, and spend time doing a lot morenegative thinking, because we believe this is a helpful thing to do.
What positive beliefs do you hold about worrying? (What are the advantages of repetitively
thinking about negative things?)______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
forCentrelinical
C Interventions• Psychotherapy • Research • Training

Module 2: Overview of Worrying

Page 4

What? Me Worry!?!
Negative Beliefs About Worrying
In addition to the specific things worriers worry about, they may also worry about the factthat they are worrying. In this case, worriers are often concerned that worrying is “bad”
and they hold negative beliefs about the activity of worrying. For example, they may believe
that:
•
•

Worrying is dangerous, and will cause either physical or mental harm (e.g., “If I keep worrying likethis I will go crazy/have a breakdown/become ill”), and that
Worrying is uncontrollable, and will take over and result in a loss of control (e.g., “I can’t control
my worrying, and it will never stop”).

Holding these negative beliefs about worrying makes the process of worrying very distressing, creating evenmore concerns and hence keeping this thinking process going. Plus holding these beliefs makes us want topush the worrisome thoughts away, which as we will see in a moment, only makes the thoughts push backmore strongly, and hence we end up worrying even more.
What negative beliefs do you hold about worrying? (What worries-about-worrying do you
have? What are the disadvantages of worrying?)______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2) Unhelpful Attention

People who worry often have difficulty drawing their attention away from their bothersome thoughts tofocus on the present task at hand, partly because they are unaware they are doing it and partly because
they think it is helpful to think more about things. Focusing attention on the negative thoughts, plus trouble
disengaging attention from these thoughts, keeps people stuck in their worry, and further fuels the belief
that they are unable to control their worry.

3) Unhelpful Strategies

People who worry will often attempt unsuccessfully to stop their bothersome thoughts in a number ofunhelpful ways, some of which are mental strategies and others are behavioural.
Mental strategies may include:• suppressing worries (i.e., telling themselves to “stop worrying”);• trying to reason with their worrisome thoughts (i.e., “the likelihood of these things happening is sosmall”);• frantically distracting themselves (i.e., trying very hard to focus on something else); or• thinking positively (i.e., “everything will be OK”).
Behavioural strategies may include:• excessive reassurance seeking from others to ease their concerns (e.g., constantly contacting a
loved one to check they are ok or to discuss the things that worry them);• excessive information seeking (e.g., using the internet to check everything they are worried about);• excessive list making to stop worries;• using drugs/alcohol/food to dull their worry; orforCentrelinical
C Interventions• Psychotherapy • Research • Training

Module 2: Overview of Worrying

Page 5

•

What? Me Worry!?!

avoiding situations that trigger episodes of worry (e.g., passing up a new job project because theyknow all they will do is worry about it, or not watching the TV news because it is usually a sourceof worry).

Mental and behavioural thought-control strategies rarely work, as ultimately they are all forms of thought
suppression. Research shows that trying to suppress a thought usually has the opposite effect of making
that thought occur more, meaning that we worry more, which also in turn fuels the belief that our worry is
uncontrollable.
For example, try not to think of a pink elephant for the next 60 seconds and see how well you
do.

Instead of not thinking about pink elephants, chances are you have noticed pink elephants a plenty!
In what ways (either mentally or behaviourally) do you try to stop your worries?

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Unfortunately, these negative and positive beliefs about worrying, how we tend to focus
our attention on our thinking, and some of the things we do to try to stop worrying, canactually increase the amount of worrying we do. In the end we get caught in a vicious
cycle of worry.

forCentrelinical
C Interventions• Psychotherapy • Research • Training

Module 2: Overview of Worrying

Page 6

The Vicious Cycle of Worry

What? Me Worry!?!

Beliefs worrying
is dangerous

Beliefs worrying is
uncontrollable
Positive beliefs aboutworrying

Initial ‘what if’ thought_______________&
Symptoms:_____________________________________________

Unhelpful strategies
Unhelpful attention

Let’s recap and put all the information we now know about worry together. You can use this worry‘flower’ to summarise some of the responses you have written on the previous pages.
Regardless of whether your worry is triggered by something external or internal, an initial ‘what if’
thought will pop into to your mind, and likely be accompanied by some uncomfortable physical andemotional symptoms (e.g., tension, butterflies, anxious feelings, etc). So far this is all normal and happens
to everyone. How much time we spend stuck on more “what if” thoughts and how intense our symptoms
get, will be determined by the following things which can turn normal worry into more problematic anddistressing worry…
•

Your positive beliefs about worrying will mean that you respond to the initial “what if” thoughtwith more worry and negative thinking because you believe it is a helpful thing to do. So you give thenegative thoughts more time and attention, snowballing them into more worrisome thinking.

•As such, your attention gets locked in on those worrisome thoughts. Your unhelpful attention iseither unaware that is caught in worry, or unable to shift to a more helpful focus, such as the presenttask at hand, which just fuels your preoccupation with your worries.

•

Now, if you keep on worrying, your worries may start to focus more on worries-about-worrying andhow uncontrollable and harmful your worrying is. This is because you also hold some negative
beliefs about worrying being both dangerous and uncontrollable.

•

And because you think worrying is bad and you hate not being in control of it, you then engage inunhelpful strategies to try to stop your worrying. But unfortunately by trying so hard to stop theworrying, it actually backfires and makes you worry even more.

forCentrelinical
C Interventions• Psychotherapy • Research • Training

Module 2: Overview of Worrying

Page 7

What? Me Worry!?!
What Can Be Done About My Worrying?
The vicious cycle of worry (or worry flower) demonstrates something that is very important to remember
as you work through these modules.

Our initial “what if” negative thoughts are not the problem.
How we respond to our negative thoughts is the problem.
Our initial “what if” negative thought(s) are not the problem because:
1) Negative thoughts are completely normal. Research shows we all have the same negative
thoughts pop up. From an evolutionary perspective our mind is meant to find bad and negative
things in our environment. Our mind was built to be a ‘threat detector’, and this is why we survived
and thrived as a species. So when our mind brings up negative thoughts, it is just doing what it was
built to do.
2) Our minds are very busy. Research shows we have 4000 thoughts a day. It makes sense thatsome of those will be negative. We simply can’t control what pops into our busy mind.
3) Many of us will be facing some real problems in our lives. It is reasonable that these
problems will be on our mind.
So those initial negative “what if” thoughts that pop into our mind are perfectly ok. They are not a problem
and not something we can control. They only become a problem when we respond to them in a way thatgives the thoughts lots of importance, time, energy, and attention, and hence they snowball or spiral into
more negative thoughts that don’t go anywhere particularly productive.

initial “what if” thought okworry spiral a problem

We tend to respond to our negative thoughts in one of two ways. We either pull the thoughts closer andlisten to them intently (because of our positive beliefs about worrying), which obviously leads to moreworrying. Or we push them away and try to get rid of them (because of our negative beliefs aboutworrying), which also inadvertently leads to more worrying.
So this tendency to respond to our worrisome thoughts by either pulling them close or pushing them away
is the real problem, getting us stuck in our thinking, and creating more worry.
With this in mind, it then makes sense that to overcome worrying and generalised
anxiety, you need to do three things: 1) address your positive and negative beliefs
about worrying; 2) focus your attention on the present rather than on yourworrisome thoughts; and 3) develop more helpful ways of actively dealing withworrisome thoughts. The modules within this information package will address thesein the following order.

forCentrelinical
C Interventions• Psychotherapy • Research • Training

Module 2: Overview of Worrying

Page 8What? Me Worry!?!
Module 3
Module 4
Module 5
Module 6
Module 7
Module 8
Module 9
Module 10

Negative Beliefs About Worrying: “Worrying Is Uncontrollable”
Attention Training
Negative Beliefs About Worrying: “Worrying Is Dangerous”
Positive Beliefs About Worrying
Problem Solving
Helpful Thinking
Accepting Uncertainty
Self-Management

Each module will ‘pluck a petal’ from our worry flower. You will notice that the next four modules (3-6)
will target your negative and positive beliefs about worrying, and help retrain your attentional focus to thepresent moment. Module 7 & 8 will teach you more helpful strategies for dealing with worries. Module 9
will teach you how to become more tolerant and accepting of uncertainty. Although this was not a specificpetal in our worry flower, your worries will often relate to this issue, and hence it may be helpful toaddress. Finally, Module 10 will put all the helpful strategies you learn throughout this information package
together in a self-management plan, which will help you maintain and improve on the gains you make.
It is important to realise that the approach taken throughout these modules is that you are not going tolook at each individual worry you have. Generally, we have a lot of negative thoughts on our mind, so if wetook that approach, it would take you a very long time to overcome your problems with worry. Also,
what can tend to happen with chronic worriers is as soon as they resolve one worry, another one justtakes its place. So you will not be focusing on the content of your worries in these modules.
Instead these modules will teach you more about the worry process, about your pattern of getting mentallystuck on negative thoughts and your trouble disengaging from these thoughts. This is the problem. The
problem is not what you worry about, but the way your mind gets trapped in those worrisome thoughts.
These modules will help you become aware of when you are worrying, challenge your beliefs aboutworrying that get you stuck, and learn how to respond differently so as not to get caught in worry.
The beliefs people hold about worrying are often what distinguishes someone with normal levels ofworrying, from someone with more problematic generalised anxiety. Therefore, changing these beliefs isvery important in overcoming your generalised anxiety.
It is also important to remember that your worries and other bothersome thoughts will still occur fromtime to time as these are completely normal. The goal of these modules is to help you respond in a more
helpful way when these negative thoughts arise, so as not to get stuck in worry.

Additional points to consider…

It is common for people using self-help materials, like this information package, to jump between sections
and complete things in whatever order they like. However, the series of modules in this information
package have been specifically designed to be completed in the order they appear. It is recommended
that you finish the modules in the order they appear in this information package, finishingeach module before moving on to the next one in the series. Doing this will maximise the benefits
you may receive from completing the “What? Me Worry!?!” information package.
It is important for you to know that the techniques you will learn throughout the modules in thisinformation package come from a type of treatment commonly called ‘metacognitive therapy’. This
type of psychological treatment has been evaluated scientifically and shown to be effective in treating a
number of psychological problems, including problematic generalised anxiety. Metacognitive therapy is
aimed at changing your beliefs about thinking itself (i.e., metacognition), as well as your style of behavingforCentrelinical
C Interventions• Psychotherapy • Research • Training

Module 2: Overview of Worrying

Page 9What? Me Worry!?!

and the things you do. This will bring about a change in how you feel and decrease your worrying andgeneralised anxiety.

Finally, worrying is repetitive negative thinking about the future. But we can also repetitively think in anegative way about the past. This is often called rumination, and the strategies we will cover throughout
these modules will be equally applicable to this thinking style too, as the strategies are applicable to any
repetitive negative thinking.

forCentrelinical
C Interventions• Psychotherapy • Research • Training

Module 2: Overview of Worrying

Page 10

What? Me Worry!?!
Module Summary•

Worrying is a primary feature of generalised anxiety•

Worrying is repetitive negative thinking dwelling on possible negative occurrences that might happen in
the future. Worrying often takes the form of “What if…” questions•

The triggers of worrying can be external (images, thoughts, situations) or internal (images, thoughts)•

Worrying keeps going because of: Positive beliefs about worrying – solves, motivates, prevents, prepares, etc.
 Negative beliefs about worrying –uncontrollable and dangerous
 Unhelpful attention –being focused on the future rather than the present task at hand
 Unhelpful strategies – suppression via various methods.

•

Your initial “what if” negative thoughts are not the problem. How you respond to your negative
thoughts, by either pulling them close (due to positive beliefs about worrying), or pushing them away
(due to negative beliefs about worrying) is the problem.

•

Suppressing or trying to stop worrisome thoughts in various ways doesn’t work and just leads to moreworrying.

•

The modules you will be completing to overcome your generalised anxiety will cover: Negative Beliefs About Worrying (“Worrying Is Uncontrollable & Dangerous”)
 Attention Training Positive Beliefs About Worrying Problem-Solving & Action
 Helpful Thinking
 Accepting Uncertainty
 Self-Management

Coming up next …
In the next module, you will learn
how to change one of your negative
beliefs about worrying – that“Worrying is uncontrollable”.

forCentrelinical
C Interventions• Psychotherapy • Research • Training

Module 2: Overview of Worrying

Page 11

About The Modules

What? Me Worry!?!

CONTRIBUTORSDr Lisa Saulsman (MPsych1; PhD2)Centre for Clinical Interventions
Paula Nathan (MPsych1)
Director, Centre for Clinical Interventions
Adjunct Senior Lecturer, School of Psychiatry and Clinical
Neuroscience, The University of Western Australia
Dr Louella Lim (DPsych3)
Centre for Clinical Interventions
1

Masters of Psychology (Clinical Psychology)

Dr Helen Correia (MApp Psych1; PhD2)Centre for Clinical Interventions
Dr Rebecca Anderson (MPsych1; PhD2)Centre for Clinical Interventions
Bruce Campbell (MPsych1)
Centre for Clinical Interventions

2

Doctor of Philosophy (Clinical Psychology)3

Doctor of Psychology (Clinical)

Some of the materials in the modules of this information package were taken from:
Saulsman, L., Anderson, R., Campbell, B., & Swan, A. (2015). Working with Worry and Rumination: A
Metacognitive Group Treatment Programme for Repetitive Negative Thinking. Perth, Western Australia:
Centre for Clinical Interventions.

BACKGROUND
The concepts and strategies in the modules have been developed from evidence based psychologicalpractice, primarily Metacognitive Therapy (MCT). MCT is a type of psychotherapy developed by Professor
Adrian Well’s at the University of Manchester. MCT is an extension of Cognitive-Behaviour Therapy(CBT) and is based on the theory that repetitive negative thinking, such as chronic worry in generalised
anxiety, is a result of problematic metacognitions (i.e., beliefs about thinking) and behaviours. There is goodscientific evidence to support that targeting metacognitions and behaviours in therapy can help many people
to overcome generalised anxiety. Examples of this evidence are reported in:
McEvoy, P. M., Erceg-Hurn, D. M., Anderson, R. A., Campbell, B. N. C., Swan, A., Saulsman, L. M., Summers,M., & Nathan, P. R. (2015). Group metacognitive therapy for repetitive negative thinking in primary andnon-primary generalized anxiety disorder: an effectiveness trial. Journal of Affective Disorders, 175, 124132.

REFERENCES
These are some of the professional references used to create the modules in this information package.
Barlow, D.H. (2002). Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic (2nd ed.).
London: Guilford Press.
Heimberg, R.G., Turk, C.L., & Mennin, D.S. (2004). Generalized Anxiety Disorder: Advances in Research andPractice. New York: Guilford Press.
Wells, A. (1997). Cognitive Therapy of Anxiety Disorders: A Practice Manual and Conceptual Guide. Chichester,
UK: John Wiley & Sons Ltd.
Wells, A. (2008). Metacognitive Therapy for Anxiety and Depression. New York: Guilford Press.

“WHAT? ME WORRY!?!”This module forms part of:Saulsman, L., Nathan, P., Lim, L., Correia, H., Anderson, R., & Campbell, B. (2015). What? Me Worry!?!
Mastering Your Worries. Perth, Western Australia: Centre for Clinical Interventions.
We would like to thank Mandy Nathan, Psychologist, Oxfordshire, England, for the suggestion of a "worry puss" forthe theme character of this Information Package
ISBN: 0-9751985-9-9
forCentrelinical
C Interventions• Psychotherapy • Research • Training

Created: June, 2015

Module 2: Overview of Worrying

Page 12