Compulsive Worry

Worry is common and normal – most people worry sometimes. In other words, they anticipate what could go wrong, imagine a range of possible negative scenarios, speculate “What if...” in every possible variety. But most people usually snap out of it after a while (at least until the next time...)

Worrying is not pleasant, and most people could probably benefit from doing less of it, but it doesn’t destroy their lives. Other people, however, develop a major worry problem – they become compulsive worriers. Autistic people, in particular, often seem to be vulnerable to this tendency, perhaps for reasons connected both to the innate nature of the autistic mind (intense/rapid thinking, detailed perceptiveness, high pattern-recognition, emotional sensitivity, etc) and to learning experiences that tend to foster a worry-focused attitude to life (extra levels of struggle with mainstream life challenges, being bullied, pressure to conform, confusion & uncertainty, etc).

Worry becomes a serious problem when it becomes

• ·       compulsive

• ·       hard to control

• ·       excessive

• ·       inappropriate (i.e. usually about minor things)

• ·       circling around the same anxious predictions again and again

then we have a real mental health issue. This type of compulsive worry is formally (but somewhat vaguely) called Generalized Anxiety Disorder (GAD). People with GAD worry excessively about a variety of things (e.g., job, money, family, health), and as the problem develops, more and more of the worry is about hypothetical scenarios, rather than about real challenges. Along with persistent feelings of anxiety, physical symptoms also tend to develop, such as muscle tension, headaches, and difficulty sleeping.

One approach that can be of some help is Cognitive Behavioural Therapy (CBT). From a Cognitive-Behavioural perspective, compulsive worry is driven by the following four underlying processes:
1. Intolerance of uncertainty
2. Positive beliefs about worry
3. Negative problem orientation
4. Cognitive avoidance.


1. Intolerance of uncertainty

Understandably, we mostly worry about things where the outcome is uncertain (and important). Worry is a natural reaction to uncertainty and it can be seen as a way of trying to predict the future and manage the experience of uncertainty. People with a worry problem tend to be especially uncomfortable with uncertainty (and this is a common theme for autistic people). Some would even prefer bad things to happen rather than live with the sense of not knowing what will happen next. However, worrying generates more uncertainty, which in turn fuels more worry.

Behavioural experiments are one Cognitive-Behavioural technique for working to increase tolerance of uncertainty; here the worrier deliberately does something (something small, initially) in a way that is more uncertain than usual, to test if it is actually as intolerable as they believe, for example:
• Going to see a film they know nothing about
• Going to a different supermarket than usual
• Ordering something they have never had before in a restaurant
• Making opportunities to meet new people
• Breaking daily routines

(Some of the above examples have of course been largely irrelevant for most of the past year due to COVID restrictions, but under more normal circumstances they are commonly used experiments).

2. Positive beliefs about worry

Compulsive worriers tend to believe that worry helps in some ways (and up to a point there is a grain of truth in this way of thinking), though they are not fully conscious of this belief. Some common beliefs they may have are:
• Worry finds solutions to problems
• Worry motivates me to do things
• Worry protects me from possible dangers
• Worry prevents possible dangers from happening
• Worry shows I care

Once people become fully aware of these beliefs, they usually begin to see that there is little evidence to support them, except to a very limited extent.


3. Negative problem orientation

Worriers tend to use unhelpful strategies to try to solve problems, for example:

• Seeking reassurance for decisions (which keeps worry going, as the worrier never learns to trust their own judgement)
• Seeking out excessive information before making a decision
• Making lists as a substitute for actions
• Being overly busy, throwing oneself into activity rather than solving problems (e.g. cleaning)
• Procrastination
• Post-mortem worry: “What if I have made the wrong decision?”

GAD sufferers need to be taught more helpful strategies of problem-solving and decision-making, such as realistic risk-assessment, cost-benefit analysis, trial-and-review, etc. This a potentially strong area for many autistic people, despite their reputation for “poor executive functioning”.


4. Cognitive avoidance

Because excessive worry is distressing, many GAD sufferers become worried about their worrying, so they try to go to the other extreme, and push all upsetting ideas out of their mind. This is not a helpful strategy either, as real concerns and issues do need to be faced, and “fearing fear itself” does not improve the situation.

Worriers are often invited to write down their worries so that they can be faced squarely (or dropped), and even to set aside a specific “Worry Time” every day, for which they save all their worries. This helps them learn to postpone worries, rather than indulge in them or avoid them. During the specified Worry Time, they are encouraged to worry as hard as they possibly can – this tends to change their relationship with worry as a habit, and can sometimes even be a strangely amusing experience.

 

There is useful information on all of this in:

Freeston, M. & Meares, K. (2015) Overcoming Worry & Generalised Anxiety Disorder: A self-help guide using cognitive behavioural techniques, 2nd Ed. London: Robinson.