Worry: What It Is, Why It Keeps Going, and How to Manage It

About this tool

Worry is repetitive, future-focused thinking about things that might go wrong, carried mostly in words rather than pictures. Thomas Borkovec and his colleagues, whose 1983 paper is still the standard starting point, described it as a chain of thoughts and images, weighted toward the negative and hard to control, that represents an attempt to solve a problem whose outcome is uncertain. Three features in that description matter. Worry is verbal: it runs as inner talk, a stream of what-ifs. It is future-directed: it is about what could happen, not what has. And it feels like problem-solving while rarely producing a solution, which is why people can worry for hours and end up no clearer than when they started.

It helps to separate worry from two things it is often confused with. Anxiety is the feeling: the tight chest, the racing heart, the sense of dread. Worry is the thinking that usually comes with the feeling, and the two feed each other, but they are not the same. You can have a surge of anxiety with no clear thought behind it, and you can worry in a flat, exhausted way without much bodily arousal at all. Rumination is worry's past-facing twin. Susan Nolen-Hoeksema defined rumination as repetitively dwelling on distress and its causes without moving toward solutions, and the content is usually backward-looking: why did this happen, what did I do wrong, what does it say about me. Worry asks what if; rumination asks why. Both are forms of repetitive negative thinking, both predict low mood and anxiety, and the ways out of them overlap.

One influential model of why worry persists is Thomas Borkovec's avoidance theory. On this account, because worry runs in words, and verbal thought produces less bodily arousal than vivid mental imagery, worrying dampens the physical fear response in the short term. That feels like relief, and relief is a powerful reinforcer, so the mind returns to worrying the next time something threatening appears. Worry also feels like doing something, and when the feared outcome does not happen, which is most of the time, the worrying gets the credit. The cost, in this model, is that the fear never gets fully processed: the vivid image of the feared event is pushed away before the nervous system can learn that it is survivable, so the threat keeps its charge and the worry keeps its job. The model has experimental support but is not a complete explanation of all worry, and the account described next emphasizes different ingredients.

A second line of research, from Michel Dugas, Robert Ladouceur and colleagues in Quebec, explains who worries most. The core trait is intolerance of uncertainty: finding the state of not knowing itself unbearable, more than any particular bad outcome. People high in this trait experience uncertainty as unfair, stressful and something to be eliminated, and worry is the tool they reach for. The problem is that uncertainty cannot be eliminated, so the tool never finishes its work. Their model adds three maintaining beliefs: that worry is useful (it prepares me, it shows I care, it stops bad things from happening), that problems are threats rather than normal parts of life, and that thinking about a problem is safer than facing it. Treatment built on this model works on tolerating uncertainty directly, through small deliberate experiments with not knowing, rather than on talking each worry out of existence.

Not all worry is a problem, and the distinction between productive and unproductive worry, described clearly by Robert Leahy, is the most practical idea on this page. Productive worry concerns a real, current problem you can act on: the bill is due, the conversation needs to happen, the appointment needs booking. It leads to a next step, which may be something you do now or something you schedule, and then it stops. Unproductive worry concerns outcomes that are hypothetical, unlikely, distant or outside your control, and it demands a certainty that no amount of thinking can provide. The sorting question is: is this a real problem I can act on, or a prediction? If it is a real problem, decide the next step and do it or put it in the diary, even if the step is waiting for an appointment. If it is a prediction, the worry is not a task, and the work is to let it be present without feeding it. The Worry Tree on this site walks through that sort one worry at a time, and Worry Time covers what to do with the ones that are not tasks.

Several approaches have evidence behind them. Worry postponement, which Borkovec first tested in 1983, means noting a worry as it appears and deferring it to a fixed daily slot; most deferred worries have lost their urgency by the time the slot arrives. The worry tree sorts each worry into actionable or not and routes each kind to a different response. Writing out a feared scenario in full, a form of imaginal exposure, is used within treatment for worry; it has not been established as a stand-alone self-help step, and how much of it suits whom is a question for a therapist. Problem-solving training handles the real problems. Mindfulness practice teaches you to notice a worry as a mental event rather than a forecast. Cognitive behavioral therapy that combines these elements has reasonable support for generalized anxiety, with moderate average effects; a sizeable minority of people do not respond to a first course, and the benefits of any single technique used alone are smaller than the benefits of a full program.

Everyone worries, and occasional worry about real things is part of a working mind. Worry becomes a clinical concern when it is excessive, hard to control, present more days than not for months, and accompanied by restlessness, fatigue, poor concentration, irritability, muscle tension or disturbed sleep. That pattern is what clinicians call generalized anxiety disorder, and it is diagnosed by a clinician, not by a web page. The usual traps: trying to suppress worries, which makes them rebound; seeking reassurance from other people or from endless searching, which calms things for an hour and strengthens the loop; treating every what-if as a problem to be solved; and doing the day's heaviest worrying in bed.

If worry is taking up hours of most days, stopping you from sleeping or concentrating, or you have tried the techniques here for a few weeks without relief, it is worth talking with a licensed therapist. CBT for worry is a well-mapped treatment, and a therapist can tell whether what you are dealing with is generalized anxiety, health anxiety, obsessive thinking, or something else that calls for a different plan. Psychology.com's therapist directory lets you search by specialty, including anxiety, at no cost. The printable summary below gathers the distinctions and the sorting steps in one place.

Reviewed by Michael Callans, MSW
Reviewed the definitions of worry, rumination and anxiety and the account of the avoidance and intolerance-of-uncertainty models for accuracy.

References

1. Borkovec TD, Robinson E, Pruzinsky T, DePree JA. Preliminary exploration of worry: some characteristics and processes. Behav Res Ther. 1983;21(1):9-16.
2. Borkovec TD, Alcaine OM, Behar E. Avoidance theory of worry and generalized anxiety disorder. In: Heimberg RG, Turk CL, Mennin DS, eds. Generalized Anxiety Disorder: Advances in Research and Practice. Guilford Press; 2004:77-108.
3. Dugas MJ, Gagnon F, Ladouceur R, Freeston MH. Generalized anxiety disorder: a preliminary test of a conceptual model. Behav Res Ther. 1998;36(2):215-226.
4. Leahy RL. The Worry Cure: Seven Steps to Stop Worry from Stopping You. Harmony Books; 2005.
5. Nolen-Hoeksema S, Wisco BE, Lyubomirsky S. Rethinking rumination. Perspect Psychol Sci. 2008;3(5):400-424.

What Is Worry? FAQ