Medicine:Worry

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Short description: Thoughts, images, emotions, and actions of a pessimistic nature
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A depiction of Rama in the Ramayana. Worried about his wife Sita, he is consoled by his brother Lakshmana.

Worry refers to the thoughts, images,[further explanation needed] emotions, and actions of a negative nature in a repetitive, uncontrollable[citation needed][dubious – discuss] manner that results from a proactive cognitive risk analysis made to avoid or solve anticipated potential threats and their potential consequences.[1]

Definition

A young girl looking worried

Worry is a category of perseverative cognition, i.e. a continuous thinking about negative events in the past or in the future.[2] As an emotion "worry" is experienced from anxiety or concern about a real or imagined issue, often personal issues such as health or finances, or external broader issues such as environmental pollution, social structure or technological change.[citation needed] It is a natural response to anticipated future problems. Excessive worry is a primary diagnostic feature of generalized anxiety disorder, but also is pervasive in other psychological disorders, like schizophrenia.[3]

Most people experience short-lived periods of worry in their lives without incident; indeed, a mild amount of worrying has positive effects, if it prompts people to take precautions (e.g., fastening their seat belt or buying insurance) or avoid risky behaviors (e.g., angering dangerous animals, or binge drinking), but with excessive worrisome people they overestimate future dangers in their assessments and in its extremities tend to magnify the situation as a dead end which results in stress. Overestimation happens because analytic resources are a combination of external locus of control, personal experience and belief fallacies. Chronically worried individuals are also more likely to lack confidence in their problem solving ability, perceive problems as threats, become easily frustrated when dealing with a problem, and are pessimistic about the outcome of problem-solving efforts.[4]

Seriously anxious people find it difficult to control their worry and typically experience symptoms like restlessness, fatigue, difficulty in concentrating, irritability, muscle tension and sleep disturbance.

Theories

Avoidance model

The avoidance model of worry (AMW) theorizes that worry is a verbal linguistic, thought based activity, which arises as an attempt to inhibit vivid mental imagery and associated somatic and emotional activation.[5] This inhibition precludes the emotional processing of fear that is theoretically necessary for successful habituation and extinction of feared stimuli.[6] Worry is reinforced as a coping technique due to the fact that most worries never actually occur, leaving the worrier with a feeling of having successfully controlled the feared situation, without the unpleasant sensations associated with exposure.[7] Noteworthy, studies also show that visual worry, i.e. worrying that occurs in visual modality, is also associated with increased anxiety and other psychopathology symptoms.[8]

Cognitive model

This model explains pathological worry to be an interaction between involuntary (bottom-up) processes, such as habitual biases in attention and interpretation favoring threat content, and voluntary (top-down) processes, such as attentional control. Emotional processing biases influence the probability of threat representations into the awareness as intruding negative or positive thoughts. At a pre-conscious level, these processes influence the competition among mental representations in which some correspond to the assertive power of worry with impaired cognitive process and others to the preventive power of worry with attentional control or exhaustive vigilance. The biases determine threatening degree and nature of worry content the worrier attempts to resolve the perceived threat and the redirection of anticipations, responses and coping in such situations.[9]

There are some who respond to mental representations in an uncertain or ambiguous state in regard to the stressful or upsetting event.[10] In this state the worrier is held in a perpetual state of worry. This is because availability of an overwhelming number (maybe 2 or 3, depending upon the worry-prone individual) of possibilities of outcomes which can be generated, it puts the worrier in a threatening crisis and they focus their attentional control voluntarily on the potential negative outcomes, whereas others engage in a constructive problem solving manner and in a benign approach rather than to engage with heightened anticipation on the possible negative outcome.[11]

Philosophy

Greek thinkers such as stoic philosopher Epictetus and Seneca advised against worry. Albert Ellis, the creator of Rational Emotive Behavior Therapy, was inspired by the Stoics’ therapeutic ideas.[12]

Religion

Guido Reni's 17th-century painting of John the Baptist depicts anguish and worry.

The biblical word used in Hebrew for worry (Hebrew: דָּאַג‎, daag) regards worry as a combined form of fear and sorrow which affects nephesh, the totality of our being. The bible takes a fortitude-strengthening approach regarding worrying e.g. Psalm 94:

In the multitude of my anxieties within me, your comforts delight my soul.[13]

In the New Testament, the Gospel of Matthew encourages:

And can any of you by worrying add a single hour to your span of life? ... So do not worry about tomorrow, for tomorrow will bring worries of its own. Today’s trouble is enough for today.[14]

The Greek word used for worry in Matthew is merimnaō,[15] which means to be anxious about, or to be troubled with cares.

St. Paul writes to the Philippian church, "There is no need to worry"[16] and in the pastoral epistles, 2 Timothy 1:7 emboldens:

For God did not give us a spirit of cowardice, but rather a spirit of power and of love and of self-discipline.

Similarly James 1:2-4 motivates to face trials of any kind with joy, because they produce endurance (strength and courage). Further Saint Peter reveals his understanding of healthy living in Second Peter 1:3,5–7:

We have a sure hope ... this is a cause of great joy for us.[17]

A late India n spiritual teacher Meher Baba stated that worry is caused by desires and can be overcome through detachment:

Worry is the product of feverish imagination working under the stimulus of desires ... (It) is a necessary resultant of attachment to the past or to the anticipated future, and it always persists in some form or other until the mind is completely detached from everything.[18]

Management

The worry system is activated from exposure to a potential triggering event, traumatic experience or vulnerability, this brings worrisome thoughts and feelings which bring about physical stress reactions and response to avoid worrisome behavior, to ensure allostasis. But under the crisis this activity feeds back into the first worrisome thoughts and feelings which generates and strengthens the vicious worry cycle. Relaxation, risk assessment, worry exposure, exercises such as yoga, and behavior prevention may be effective in curbing excessive worry, a chief feature of generalized anxiety disorder.[19][20] Cognitive behavioral techniques hasn't branched out enough to address the problem holistically but therapy can control or diminish worry.[21]

See also

References

  1. ↑ Borkovec TD. (2002). Clinical Psychology: Science and Practice 9, 76–80.
  2. ↑ "Expanding stress theory: prolonged activation and perseverative cognition". Psychoneuroendocrinology 30 (10): 1043–1049. November 2005. doi:10.1016/j.psyneuen.2005.04.008. PMID 15939546. 
  3. ↑ Kowalski, Joachim; Styła, Rafał (2022-09-01). "Visual worry in patients with schizophrenia" (in en). Journal of Psychiatric Research 153: 116–124. doi:10.1016/j.jpsychires.2022.07.007. ISSN 0022-3956. PMID 35810601. https://www.sciencedirect.com/science/article/pii/S0022395622003727. 
  4. ↑ "Intolerance of uncertainty and perceived threat". Behaviour Research and Therapy 46 (1): 28–38. January 2008. doi:10.1016/j.brat.2007.09.006. PMID 17983612. 
  5. ↑ Generalized Anxiety Disorder: Advances in Research and Practice. Guilford Press. 2004. pp. 77–108. 
  6. ↑ Associative Learning and Conditioning Theory. 2011. pp. 27–43. doi:10.1093/acprof:oso/9780199735969.003.0017. ISBN 9780199735969. 
  7. ↑ "Current theoretical models of generalized anxiety disorder (GAD): conceptual review and treatment implications". Journal of Anxiety Disorders 23 (8): 1011–1023. December 2009. doi:10.1016/j.janxdis.2009.07.006. PMID 19700258. 
  8. ↑ Kowalski, Joachim; Styła, Rafał (2022-09-01). "Visual worry in patients with schizophrenia" (in en). Journal of Psychiatric Research 153: 116–124. doi:10.1016/j.jpsychires.2022.07.007. ISSN 0022-3956. PMID 35810601. https://www.sciencedirect.com/science/article/pii/S0022395622003727. 
  9. ↑ "A cognitive model of pathological worry". Behaviour Research and Therapy 50 (10): 636–646. October 2012. doi:10.1016/j.brat.2012.06.007. PMID 22863541. 
  10. ↑ "A Cognitive Model of Generalized Anxiety Disorder: the Role of Intolerance of Uncertainty". Worry and its Psychological Disorders. John Wiley & Sons Ltd. 2006-01-01. pp. 201–216. doi:10.1002/9780470713143.ch12. ISBN 9780470713143. 
  11. ↑ "Generalized Anxiety Disorder: Targeting Intolerance of Uncertainty". CBT for Anxiety Disorders. John Wiley & Sons Ltd. 2013-01-01. pp. 57–85. doi:10.1002/9781118330043.ch3. ISBN 9781118330043. https://archive.org/details/cbtforanxietydis0000unse/page/57. 
  12. ↑ "Anxious? Depressed? Try Greek philosophy". The Telegraph. 29 June 2013. https://www.telegraph.co.uk/lifestyle/wellbeing/10146546/Anxious-Depressed-Try-Greek-philosophy.html. 
  13. ↑ Psalms 94:19
  14. ↑ Matthew 6:27,34
  15. ↑ "Is Worry a Sin?". https://www.christianityunfiltered.com/is-worrying-a-sin/.  Retrieved 2019-10-29.
  16. ↑ Philippians 4:6 - Jerusalem Bible
  17. ↑ "New Revised Standard Version" Retrieved on 2015-01-17
  18. ↑ Discourses. 3. Myrtle Beach, S.C., U.S.A.: Sheriar Foundation. 1995. pp. 121–122. ISBN 978-1-880619-09-4. 
  19. ↑ "The efficacy of worry control treatment in generalized anxiety disorder: A multiple baseline analysis.". Meeting of the Association for Advancement of Behavior Therapy. Boston. 1992. 
  20. ↑ Danhauer, Suzanne C.; Miller, Michael E.; Divers, Jasmin; Anderson, Andrea; Hargis, Gena; Brenes, Gretchen A. (2022). "Long-Term Effects of Cognitive-Behavioral Therapy and Yoga for Worried Older Adults" (in en). The American Journal of Geriatric Psychiatry 30 (9): 979–990. doi:10.1016/j.jagp.2022.02.002. PMID 35260292. https://linkinghub.elsevier.com/retrieve/pii/S1064748122000343. 
  21. ↑ "Cognitive-behavioral approaches to the nature and treatment of anxiety disorders". Annual Review of Psychology 43: 235–67. 1992. doi:10.1146/annurev.ps.43.020192.001315. PMID 1539944. 

Further reading

  • Kate Sweeny; Michael D. Dooley (18 April 2017). "The surprising upsides of worry". Social and Personality Psychology Compass 11 (4): e12311. doi:10.1111/spc3.12311. 

External links

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