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Excerpt of "The Worry Cure"

Here is an excerpt of "The Worry Cure: Seven Steps to Stop Worry from Stopping You," by Robert L. Leahy.

It is the introduction.

The Seven Rules of Highly Worried People

WORRYING IS SECOND NATURE to you, but imagine that someone who has been raised in the jungle and knows nothing about conventional modern life approached you and asked, "How do I go about learning how to worry?" Of course, you've been worrying spontaneously for years, but how would you teach someone to worry? How would you come up with a rule book for worry?
First, you'd have to come up with some good reasons why you need to worry. What could they be? How about "Worry motivates me" or "Worry helps me solve my problems" or "Worry keeps me from being surprised"? Those sound like excellent reasons to worry.

Then you can come up with some ideas about when to start worrying. What is going to trigger this experience for you? You might say, "When something bad happens," but that's not really the case, because you worry about bad things that haven't happened yet. Or you might say, "When something bad is about to happen." But how would you know if it's about to happen? It hasn't happened yet, and almost everything that you worry about happening never has happened. You could say, "Worry about things that you can imagine happening that are really bad." You can now imagine a million bad things that never have to happen. It's an unlimited supply of worries.

Now that you have some potential material to work with, you will have to focus on your worries. There are so many other things to distract you: work, friends, family, hobbies, aches and pains, even sleep. How will you keep your mind on your worries?

That's easy. Tell yourself some stories about all the bad things that could happen. Embellish them with details. Start each sentence, where possible, with "what if" and then come up with every possible horrible outcome. Keep telling yourself these bad stories, each time trying to figure out if you left out something important. You can't trust your memory. Come up with all of the possibilities—and then dwell on them. Remember, if it's possible, it's probable.

And don't forget, keep thinking that if something bad could happen—if you can simply imagine it—then it's your responsibility to worry about it. That's the first rule of worry.

But if something bad could happen, what does it have to do with you? Well, the second rule is, don't accept any uncertainty—you need to know for sure.
So solve every problem that you can think of right now. You'll feel better. You'll finally be able to relax once you've eliminated uncertainty from your life. If you had absolute certainty, you wouldn't be worried, would you? You have to go out and get that perfection, that certainty.

Now, let's start with your health. You can't be completely certain that this discoloration isn't cancer. You just saw the doctor—but haven't doctors been wrong before? Moving along, you can't be sure that all of your money won't run out. Or that you won't lose your job. If you did lose your job, you can't be absolutely, 100 percent sure that you would get another job. Or that people who respect you now won't lose all of their respect if you don't keep things going at the highest level possible.

Let's face it—is there anything that you are really certain of?

Maybe you can get some certainty by getting other people to reassure you. Maybe someone else is a better judge than you are. Go to the doctor as many times as you can afford to and ask her if she can tell you absolutely for sure that there is nothing wrong with you, or if she can tell you that you will never get sick and die. Ask your friends if they think you still look as good as you did last year. Maybe you can catch things before they slide too far. Maybe, before you completely fall apart—get sick and lose your money, job, friends, and your looks—you can catch it all and reverse it in a heroic effort of self-help. Maybe it's not too late. That's the great thing about demanding certainty. You will eliminate any oversights. You won't be naive. You won't be caught by surprise.

But simply being motivated and not accepting uncertainty is not enough to be a worrier. You need evidence that things can go badly. So the third rule is, treat all of your negative thoughts as if they are really true.

If you think someone doesn't like you, it's probably true. If you think you'll get fired, count on it. If you think that someone else is upset, then it's all about you. The more you treat your thoughts as if they are reality, the more you will be able to worry.

But why should you care what people think about you or how you do on your job? Why should it matter to you?

The fourth rule solves this problem: anything bad that could happen is a reflection of who you are as a person.

If you don't do well on the exam, you are incompetent. If someone doesn't like you, you must be a loser. If your partner is angry, it must mean you'll end up alone and miserable. It's all about who you really are.

But some things are just not a big deal. Why should a loss or a failure be so important? Why worry if it's a small loss or a small failure?

Because the fifth rule of highly worried people is: failure is unacceptable.
You can think of everything as your responsibility, and if you fail, you think about how everyone will know and how this is entirely the final test of who you are. You can make your worries as powerful as possible by thinking, "I can never handle any failure."

Now your worries are really important.

You know they are really important because you feel how powerfully they affect you: knots in your stomach, rapid heart rate, whirring in your ears, headaches, cold sweats, sleepless nights. Now that you notice you have all of these feelings, you need to get rid of them right away. And that's rule six: get rid of any negative feelings immediately.

But wait. You can't get rid of them? They're not going away? That's a bad sign. You should be able to get rid of bad feelings right now. Who knows what they'll turn into if left to fester? Maybe the fact that you can't get rid of those bad feelings means something really awful is going to happen. Maybe there are terrible things you haven't thought of. Maybe you're losing control. And that's unacceptable. That's something that needs to be addressed as soon as possible. Therefore, the seventh rule is, treat everything like an emergency.

Don't kid yourself by thinking you can wait to get around to handling these things. Everything has to be solved right now—all of your problems, all of your worries, everything. You can lie in bed and go over every single problem that you will face tomorrow or next year and say to yourself, "I need the answers immediately."

So far, we are imagining bad stories and treating them like facts to motivate you to be responsible and worry. You're not going to accept any uncertainty; you'll put yourself in the center of every situation and see yourself as a failure. You realize that your emotions have to be completely controlled, and so you will treat everything like an emergency to get rid of any bad thoughts or feelings.

Now you can go back to the guy who came out of the jungle and tell him that you have the Seven Rules of Highly Worried People. Let's take a close look at them and make sure we have everything:

1.If something bad could happen—if you can simply imagine it—then it's your responsibility to worry about it.
2. Don't accept any uncertainty—you need to know for sure.
3. Treat all of your negative thoughts as if they are really true.
4. Anything bad that could happen is a reflection of who you are as a person.
5. Failure is unacceptable.
6. Get rid of any negative feelings immediately.
7. Treat everything like an emergency.

But wait. Didn't you leave out something? Isn't there something you overlooked? Can you really trust your memory? You forgot the most important thing. You forgot to worry about worrying. You forgot to tell him, "All of this worrying is going to drive you crazy, give you a heart attack, and ruin your life completely." How could you forget the eighth rule—the rule that says, "Now that you're worried, you've got to stop worrying completely or you'll go crazy and die"?

But maybe you didn't worry enough about the assignment. Isn't that why you worry, anyway? To be prepared? So you won't overlook anything? If you had worried about getting the assignment right, you would have seen that teaching your new friend to worry would ultimately drive him mad— or kill him.

Well, you're probably saying to yourself, "Very funny. It sounds just like me. But what does this have to do with helping me get rid of my worries?"

It's really quite simple. You worry because you follow a rule book that you think will actually help you. You think that you will catch things before they get out of hand, get rid of any unpleasant emotion immediately, and solve all your problems. You think that following these rules will make you feel more secure. But so far it hasn't worked.

In fact, your solutions are the problem. Your rule book makes you worry.

There Is Good News

For the past twenty years I have helped people suffering from depression and anxiety through cognitive therapy. Cognitive therapy addresses the biases in your thinking (cognitions are your thoughts) that are causing your anxiety and depression. Anxiety disorders are really problems in the way you think. The relevance of cognitive therapy is that it helps you understand and modify these biases to effectively diminish your anxiety.

For many years chronic worriers had to suffer without any significant hope of getting better. Occasionally they would seek out help with antianxiety medications or antidepressants, which can help reduce some of the unpleasantness. Traditional forms of psychotherapy might be helpful in about 20 percent of cases, but the other 80 percent would not improve. Fortunately, though, we now have very good news for people who are chronic worriers.

There have been significant advances in the last ten years in new approaches that expand far beyond what cognitive therapists used to do. For example, we now know:

  • People are actually less anxious when they are worrying.
  • Intolerance of uncertainty is the most important element in worry.
  • Worriers fear emotions and do not process the meaning of events because they are "too much in their heads."

    Worry is not simply pessimism; it's a reflection of many different parts of who you are. Once you understand why you worry and why your worry makes sense to you, you can begin to explore some things that you can do—or not do—to help yourself:

  • We now have a much greater understanding of how worry works.
  • We can use this new understanding to reverse these troublesome worries.
  • Three-quarters of people with this problem can be significantly helped with newer forms of therapy.

    Based on the new research, I've developed a seven-step program to help you understand your own "theory" about worry, how your mind works, how your personality affects your worry, and the most effective techniques for defeating your worry and breaking those rules once and for all:

    1. Identify productive and unproductive worry.
    2. Accept reality and commit to change.
    3. Challenge your worried thinking.
    4. Focus on the deeper threat.
    5. Turn "failure" into opportunity.
    6. Use your emotions rather than worry about them.
    7. Take control of time.

    Let's briefly examine each step.

    1. Identify productive and unproductive worry. Most worriers are of two minds: "My worry is driving me crazy" and "I need to worry to be prepared." Thus, you may be worried about giving up your worry, since you think it prepares and protects you. You will learn that you have mixed feelings about giving up on your worry, which is why you persist even when it makes you miserable. Your worry is a strategy that you think helps you. Until you give up this belief, you will continue to worry. You will learn how to get the motivation you need to stop and challenge your worries rather than think of your worries as a sign of how responsible and conscientious you are. Without the motivation to change your worry, all the advice in the world will be useless.

    You will learn how to use productive worry by identifying problems that you can address immediately, such as getting a road map for your trip from New York to Boston. Unproductive worry involves imaginary what-ifs, such as "What if I get there and no one wants to talk with me?" Once you make this distinction you will learn how to use effective problem-solving strategies for real problems.

    2. Accept reality and commit to change. You are unwilling to accept certain realities or possibilities that you might not like. Your worry is like a protest against reality. Acceptance of something doesn't mean that you like it or that you think it's fair. Acceptance doesn't mean that you can't do anything to change certain things. But before you can change anything you will have to learn to accept that real problems exist. You will also learn to accept your limitations. Your worries are always about something that you should be doing—you should make more money, make sure you don't get sick, help someone else who hasn't asked you for help. Worry puts you in the middle of the universe. In this step, you will learn that you can become more of an observer of reality and less of the determining force of the universe.

    3. Challenge your worried thinking. You are constantly making predictions about the future ("I might fail"), reading people's minds ("He thinks I'm a loser"), or thinking negative thoughts ("It would be awful if I didn't get what I want"). I will give you ten ways to defeat these irrational and extreme thoughts so that your life can be more balanced. In this step, you will also learn how to identify what triggers your worry, common themes of your worry, and several techniques, such as how to practice worrying, in order to reduce your anxiety level.

    4. Focus on the deeper threat. You worry about some things but not others. Why? Your core belief is the source of the worry. It may be your concern about being imperfect, being abandoned, feeling helpless, looking like a fool, or acting irresponsibly. Here you'll find out how to identify and challenge these core beliefs about yourself that are causing you so much stress.

    5. Turn "failure" into opportunity. Your worries are attempts to prepare for, prevent, and anticipate failure. Failure to you may seem like a catastrophic eventuality—something that can happen any minute unless you keep your guard up and worry. I will give you twenty things to say to yourself to overcome your fear of failure. Once you know how to handle failure, what would you have to worry about?

    6. Use your emotions rather than worry about them. Worry is actually a strategy for avoiding unpleasant emotions. You are afraid of your feelings because you think you should be rational, in control, never upset, always clear in how you feel, and on top of things. Even though you recognize that you're a nervous wreck, your fear of your feelings drives you into more worry. Rather than trying to worry your emotions away, you will learn to experience them and use them to your advantage.

    7. Take control of time. You feel controlled by a constant sense of urgency, the need to know everything right now. Here you will learn how to turn the urgency off and improve on the present moment so that you can get more out of life right now.

    Part 3, "Special Worries and How to Challenge Them," addresses the five most common areas of worry—approval, relationships, health, finances, and work—and uses the seven-step approach to deal with them. Although each area of worry draws on the seven-step program, we will also examine specific issues involved in each area. For example, when we describe relationship worries, we will look at how your childhood experiences affected your view of relationships. When we discuss your health worries, we will evaluate your perfectionistic ideas about appearance and physical functioning. And when we evaluate your money worries, we will also examine specific distortions in thinking that lead you to become obsessed with losing money.

    Now, let's begin by looking at why you worry—and why you keep worrying.

    Copyright 2005, Harmony Books, and Randhom House. All rights reserved.

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