John's Blog

The Blog of John Gibson, PhD


Most people worry to some extent, but some people worry excessively, whether they need to or not. It’s as if their brain is a worry machine and they can’t find the “OFF” switch.

The excessive worrier jumps to worse case scenarios. If he has a headache for several days in a row, he doesn’t assume he’s having tension headaches. He’s more likely to think, “Oh my God, I must have a brain tumor.” Other explanations, if they are considered at all, are bypassed on the way to the worst possible outcome.

Worry is typically concerned with ordinary realms of life: health, finances, relationships, job, children. Worry is a form of anxiety.

Excessive worry can disrupt sleeping patterns because it increases bodily arousal. Worries can distract us, making concentration difficult, which is why it is sometimes mistaken for ADHD. Worry can also be a burden to the worrier’s spouse or significant other because the worrier may need constant reassurance that worry isn’t likely. All in all, excessive worry is exhausting.

When I work with someone who worries too much, the first thing I do is ask them to externalize their worries, i.e., talk about them in the session, in considerable detail. We unpack them one-by-one. Invariably, we’ll discover what cognitive therapists call “thinking errors.” Some these might be:

  • Confusing the possible with the probable. (Very common thinking error)
  • Failing to consider the simplest explanations first.
  • Assuming that if a worry comes true one won’t be able to cope.
  • Over-estimating the relevance of someone else’s health problems to one’s own life.
  • Confusing prevalence with salience. (e.g., plane crashes are salient but not prevalent)

What we do in therapy is try to put the worrisome thoughts
back into perspective. Just because something is theoretically possible it doesn’t make it likely. And if x should happen, well, what would you do then? You might as well answer the question. It takes courage to face your fears –– even when they are hypothetical. But this is one way you have of not letting them control you. So I might ask, “Have you ever coped with anything like this before? Has anyone else? If so, what have they done?” Or: “Objectively speaking, how bad is this fear?”

Anxious thoughts are future-oriented. It’s as if we’re scanning the road ahead of us, watching out for the threat of danger. In therapy, I ask people to identify the threat. Frequently the threat can be reduced. For example, driving defensively, sober, without looking at your smart phone, will drastically reduce the odds of getting in a car accident. Note, however, that the risk is not eliminated, just reduced to manageable proportions.

People who struggle with worry often wish that therapy will banish their anxiety and fears completely. But of course life seldom works that way. There are some things we control and many things we do not. But some threats, perhaps most, can be reduced enough so that we don’t need to stay vigilant about them.

And yet, it takes time to turn off the worry machine. It takes focused attention to practice new thinking skills and regain perspective. Which isn’t to say we should never anticipate dangers or scan the road ahead for threats. Indeed, it is probably adaptive to devote a certain amount of attention to these things. It’s just that it seldom helps us to stay stuck in this mode.