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

What? Me Worry!?!
Module 10
Self Management
Introduction

2

Summary of Strategies

2

Worry Flow Chart

4

Maintaining Gains

6

Worksheet: Healthy Me
Minimise Setbacks
Worksheet: Self Management Plan

78
9Module Summary

10

About the Modules

11

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.

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What? Me Worry!?!
Introduction
Congratulations on making it to the end of this information package! We’re glad
you stayed on with us. If you haven’t read all the modules, it might be good to go
back to the ones you missed. However, the most important thing for you now is
to keep practising the strategies you have learned through reading the modules inthe “What? Me Worry!?!” information package. This means continuing to apply all
the useful skills and insights about yourself you might have gained. If you continue
practising the concepts and skills you have learned, they will become like habits thathave been integrated into your lifestyle.
There are a few things to keep in mind now that you have learned some important skills
in managing your worrying. One thing is to be very clear on what you have learned about worry andhow to deal with worry from now on (i.e., a summary of strategies used throughout these modules and aworry flow chart showing how to respond to worries). Another area to think about is how to maintain thegains that you have made. A final area to consider is how to minimise setbacks that might occur.

Summary of Strategies
Remember the worry cycle we looked at in Module 2? Here it is again. Written inside each ‘petal’ are thestrategies we have covered throughout the modules to tackle each part of the vicious cycle.
Beliefs worrying is dangerous
Evidence?

Beliefs worrying is
uncontrollable
Evidence?
Postponement Experiment

Positive beliefs aboutworrying

Evidence?
Up & Down Experiment

Initial ‘what if’ thoughts&
Symptoms

Attention Training:
Mundane Task
Meditation

Postponement
Attention Training
Problem Solving
Helpful Thinking
Accept Uncertainty
Unhelpful Strategies

Unhelpful attention
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What? Me Worry!?!
In Module 3 we tackled your belief that worrying is uncontrollable, by first examining the evidence for thisbelief and then setting worry postponement as an experiment to test the accuracy of this belief.
In Module 4 we worked on retraining your attention to be more present-task focused, using mindfulnessbased techniques such as mundane task focusing and meditation.
In Module 5 we then addressed your belief that worrying is dangerous to your mental or physical health,again examining the evidence for this as a way of challenging this belief.
In Module 6 we challenged your positive beliefs that worrying is a helpful thing to do, by again looking at
the evidence and experimenting with this idea via our up & down worrying experiment.
In Module 7 we learned the difference between worrying versus problem solving, and worked through astructured way to engage in this more productive thinking style.
In Module 8 we discovered how to purposely engage in more helpful thinking when needed.
In Module 9 we focused on letting go of the need for certainty that can drive so much of our worrying,and instead accepting uncertainty as an unavoidable part of life.
From the outset we suggested that a big reason we get stuck in worrying is because of the beliefs we holdabout worrying itself. That on the one hand worrying is positive, so we want to pull the worrisome
thoughts closer, and so inevitably we worry more. On the other hand worrying is negative, so we want topush the worrisome thoughts away, which just makes them push back at us. It may be worth taking amoment to consider what you have learned about worry from completing these modules. Do you still
believe worrying is uncontrollable, dangerous and helpful? Or do you believe something else? What new
beliefs to you now hold about worrying? (Take a moment to reflect and write them down).

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Given we have covered a lot of territory over the last 9 modules, it can also be useful to clarify exactly
what it is we need to do when we notice ourselves worrying. The Worry Flow Chart on the next page
can helps us clarify how to integrate and apply the main strategies we have learned, in the moment, eachtime a worry pops up…

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What? Me Worry!?!
Worry Flow Chart
THE OLD WAY you use to respond was as soon as an initial ‘what if’ thought popped into your mind,
you pulled it close and/or pushed it away, getting very caught in the worry spiral.

initial ‘what if’ thought

Worry spiral

THE NEW WAY you can now respond to your negative ‘what if’ thoughts, given what you have learnedin these modules, is represented by the flow chart below.

Expect & Accept initial ‘what if’
thoughts

POSTPONE&PRESENT TASK FOCUS

If immediate action
can be taken – do it!

Repeat as required

THINKING TIME
If it still seems important, thenQ. Can I do something about this?
Q. Can I think about this in a more
helpful way?

No

Yes

Let it go using…
Mindfulness Attention Training
Accepting Uncertainty Strategies
Continued Postponement

Problem Solving
orHelpful Thinking

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What? Me Worry!?!
This flow chart begins with expecting and accepting that negative thoughts willenter our mind (remember we can’t control what pops into our head, but we dohave a choice in how we respond to those thoughts once they arise).
You then postpone any further thinking about the topic, redirecting your attention
back to the present task at hand. Repeat these steps as often as you need to.
Remember we aren’t changing that negative ‘what if’ thoughts will pop up, but we arechanging getting caught in the worry spiral.
It is also important to realise that postponement is not procrastinating! Remember that what we are
postponing are repetitive negative thoughts (e.g., I am worrying about my test tomorrow, so I will postpone myworrisome thoughts and re-focus on the task of studying). We are not postponing or putting off obvious
actions that we need to be taking (e.g., I am worrying about my test tomorrow, so I will just postpone studying).
Therefore, if there is some obvious immediate action that can be taken that would resolve your worry,
then by all means take action and do it (e.g., you are worrying about making a phone call, why not just make thephone call).
Having postponed your worrisome thoughts, when thinking time comes around later on, many of yourworries may no longer seem relevant or important, and if that is the case you don’t need to do anything
further with them. Only if your worries still seem important, you can then ask yourself: Can I do
something about this? That is, question if this is something that is within your control and potentiallysolvable. Or ask: Can I think about this in a more helpful way? That is, question if there is anothermore helpful perspective you could take on the situation.
If the answer to both is NO, then it indicates that this is an issue you need to ‘let go’ of. To help you letgo, you could use your mindfulness attention training strategies (i.e., mundane task focusing andmeditation) or even aspects of your accepting uncertainty strategies. Otherwise, just continue topostpone the issue, recognising that the issue may well keep popping into your mind, but repetitively
worrying about it is futile.
However, if the answer is YES I can do something about this, then problem solving is the next step. Or
YES I can think about this differently, then helpful thinking would come next. When you get to the endof problem solving or helpful thinking, you may discover that you have resolved the issue – great! Or you
may discover that it isn’t currently solvable or that you aren’t currently able to think about it in a more
helpful way. In which case, you can just switch to letting go via mindfulness, acceptance and postponement.
If at any point you are confused about what to do (i.e., postpone, be present, take obvious immediate
action, let go, mindfulness, problem solve, helpful thinking), just remember…if in doubt, postpone! And
remember, in the moment when a worry pops up, postponement is always your ‘go to’ strategy.

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What? Me Worry!?!
Maintaining Gains
In Module 1 of “What? Me Worry!?!” we got you to make a couple of ratings about your generalised
anxiety. We want you to make these ratings again and compare them to your ratings in Module 1. How
did you go? What progress have you made?
Overall, how distressing is your generalised anxiety?
(Circle the number that best describes you)0
Not at all

1

2

3

4

5
6
Moderately

7

8

9

10
Extremely

9

10
Extremely

Overall, how much of a problem is your generalised anxiety?
(Circle the number that best describes you)0
Not at all

1

2

3

4

5
6
Moderately

7

8

It is important to recognise the progress that you've made, and when you are reaching your goals it isuseful to pat yourself on the back and celebrate those milestones. This will hopefully encourage you tokeep going, to keep practising, and to keep applying the new skills you have learned. Maintaining the gains
you have made relies on you continuing to practise these skills. Remember, developing new skills that aredesigned to challenge what may be years worth of old habits takes time and persistence.
So there are some important things you will need to do in order to make the most of what you havelearned to stay well or gain that extra improvement.
The easiest way to summarise this is by looking at the “Healthy Me“ worksheet on the next page. It shows
the main areas of your life that you should give some attention to in order for you to continue maintaining
your gains. This is about being aware of what helps you to feel well and healthy, both physically andpsychologically.
You will notice that on the “Healthy Me” worksheet, each heading has spaces left blank for you to write in
the things that are important for you to devote time to, in order to maintain your sense of well being. For
example, under Self-Care you might write: “I will grocery shop every week and follow a healthy wellbalanced diet”. Under Social Activities you might write: “I will visit friends at least once each week.” You
may want to update this worksheet on a regular basis when you need to extend your goals or modify them.
We really encourage you to do this, as it will enable you to keep track of things.

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What? Me Worry!?!
Helpful Thoughts

Social Activities

Pleasant Activities

Healthy
Exercise

Self-Care

Relaxation

Me

Goals

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What? Me Worry!?!
Setbacks or slip-ups in progress can happen at any time and are to be
expected. Try not to fall into the trap of believing that you are ‘back tosquare one’ as this will only make you feel worse. Change is not a steadyprocess, it's more like the old saying: “Two steps forward, one step back“
from time to time.

ChangeMinimise Setbacks

Time

Think about how you learned to ride a bike. It probably took a few unsteady attempts and a few falls before
you gained your balance. Even when you get your balance, you might still be unsteady when travelling overnew ground, or on different surfaces. In the same way, different situations or times in your life may be
more challenging, and may require extra effort and persistence (i.e., more postponement, more attention
training, more problem-solving, more helpful thinking, more acceptance of uncertainty, etc). Even after
much practice, there may be times when you think you've slipped back and feel a little off balance.
Developing new skills is never a smooth process, you're always being faced with new challenges anddifferent situations to apply those skills.

Reasons for Setbacks

There are several reasons for setbacks occurring. There may be an increase in physical or mental stress.
Just like riding a bike over challenging terrain, physical and mental stress can be challenges to the new waysof thinking and acting that you have developed. Also, when we are physically unwell, we are less likely tohave the mental or physical energy required to deal with our worry differently and use helpful strategies.
It may help to remind yourself that most people have ‘down days’ or days where life’s hassles are harder todeal with – it’s part of being human! Use the skills you learned for dealing with worrisome thoughts to help
when this situation occurs. Also, you can use setbacks as a way of learning something new about yourself
to help avoid similar problems in the future.

Preventing Major Setbacks

As you are progressing through your goals, try not to focus too much on small setbacks. If you areexperiencing several small setbacks then there are some ways of preventing a major setback.
1. Identify Early Warning Signs
The first step is to look at your own early warning signs. Some common examples are:• Spending increased time worrying about things• Reverting back to unhelpful strategies (e.g., avoidance or thought suppression).
• An increase in physical symptoms of anxiety, expecially tension.
2. Revise Skills
Think about the skills you have learned and what has been helpful in reducing your worry (e.g.,challenging/experimenting with beliefs about worrying, postponement, mindfulness attention training,problem-solving, helpful thinking, accepting uncertainty). Have you stopped practising these skills
consistently? You may wish to revise the modules and techniques you have learned and perhaps increasepractising those skills.
3. Social Support
It is wise to find someone with whom you can sit down and have a good talk. This doesn’t mean a therapy
session where you pour out your heart, but rather just a chance to talk through what’s going on in yourlife, what your goals are, and generally just to ventilate with someone you trust. Often, problems seembigger than they really are when a person tries to deal with them on their own. Hearing yourself talkthrough something can help to put it into perspective.
On the next page is a self-management plan for you to complete. Make a note of the early
warning signs that might signal a setback then write down the strategies and tools you havelearned about that can help you to deal with a setback.
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Self Management Plan
What are the early warning signs that tell me that I might be heading for a setback and need to dosomething about it myself? (e.g., I am spending more time worrying OR I am spending more time avoiding or
trying to suppress my worries OR I have more physical symptoms of anxiety)

What are some of my negative or positive beliefs about worrying and unhelpful strategies that I need towatch out for?

What situations are potential problems for me? (e.g., deadlines, exams, social gatherings, etc)

What are my future support options? (e.g., friends, family, GP, mental health professionals, other, etc)

What strategies/techniques have I found most helpful and need to continue to practise?

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Module Summary•

It is important that you keep applying and practising the strategies you learned through reading
the modules in the “What? Me Worry!?!” information package•

Consistent and continuous practice will enable you to integrate the strategies into your lifestyle•

Setbacks are expected when we make changes to the way we think and act – postpone any
unhelpful thoughts that might get in the way of your progress and repeat the modules to remind
you of the skills you have learned•

Find some friends with whom you can be with and talk to. A group of friends can be a source ofsocial support and good company for social activities.

To finish up…
We hope that you have found thisinformation package to be of benefit
to you and that you will maintain thegains you have made. If you have any
questions about medication or
psychotherapy for generalised anxiety
disorder, do go and see your doctor
or an appropriate mental healthpractitioner. For now, it’s goodbye
from us at CCI. Take care!

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What? Me Worry!?!
About The Modules
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
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Created: June, 2015

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