The difficulty is with chronic, repetitive worries, the kind that recycle on and on and never get any nearer a positive solution. A close analysis of chronic worry suggests that it has all the attributes of a low-grade emotional hijacking: the worries seem to come from nowhere, are uncontrollable, generate a steady hum of anxiety, are impervious to reason, and lock the worrier into a single, inflexible view of the worrisome topic. When this same cycle of worry intensifies and persists, it shades over the line into full-blown neural hijackings, the anxiety disorders: phobias, obsessions and compulsions, panic attacks. In each of these disorders worry fixates in a distinct fashion; for the phobic, anxieties rivet on the feared situation; for the obsessive, they fixate on preventing some feared calamity; in panic attacks, the worries can focus on a fear of dying or on the prospect of having the attack itself.
In all these conditions the common denominator is worry run amok. For example, a woman being treated for obsessive-compulsive disorder had a series of rituals that took most of her waking hours: forty-five-minute showers several times daily, washing her hands for five minutes twenty or more times a day. She would not sit down unless she first swabbed the seat with rubbing alcohol to sterilize it. Nor would she touch a child or an animal—both were "too dirty." All these compulsions were stirred by her underlying morbid fear of germs; she worried constantly that without her washing and sterilizing she would catch a disease and die.11
A woman being treated for "generalized anxiety disorder"—the psychiatric nomenclature for being a constant worrier—responded to the request to worry aloud for one minute this way:
I might not do this right. This may be so artificial that it won't be an indication of the real thing and we need to get at the real thing. . . . Because if we don't get at the real thing, I won't get well. And if I don't get well I'll never be happy. 12
In this virtuoso display of worrying about worrying, the very request to worry for one minute had, within a few short seconds, escalated to contemplation of a lifelong catastrophe: "I'll never be happy." Worries typically follow such lines, a narrative to oneself that jumps from concern to concern and more often than not includes catastrophizing, imagining some terrible tragedy. Worries are almost always expressed in the mind's ear, not its eye—that is, in words, not images—a fact that has significance for controlling worry.
Borkovec and his colleagues began to study worrying per se when they were trying to come up with a treatment for insomnia. Anxiety, other researchers have observed, comes in two forms: cognitive, or worrisome thoughts, and somatic, the physiological symptoms of anxiety, such as sweating, a racing heart, or muscle tension. The main trouble with insomniacs, Borkovec found, was not the somatic arousal. What kept them up were intrusive thoughts. They were chronic worriers, and could not stop worrying, no matter how sleepy they were. The one thing that worked in helping them get to sleep was getting their minds off their worries, focusing instead on the sensations produced by a relaxation method. In short, the worries could be stopped by shifting attention away.
Most worriers, however, can't seem to do this. The reason, Borkovec believes, has to do with a partial payoff from worrying that is highly reinforcing to the habit. There is, it seems, something positive in worries: worries are ways to deal with potential threats, with clangers that may come one's way. The work of worrying—when it succeeds—is to rehearse what those dangers are, and to reflect on ways to deal with them. But worry doesn't work all that well. New solutions and fresh ways of seeing a problem do not typically come from worrying, especially chronic worry. Instead of coming up with solutions to these potential problems, worriers typically simply ruminate on the danger itself, immersing themselves in a low-key way in the dread associated with it while staying in the same rut of thought. Chronic worriers worry about a wide range of things, most of which have almost no chance of happening; they read dangers into life's journey that others never notice.
Yet chronic worriers tell Borkovec that worrying helps them, and that their worries are self-perpetuating, an endless loop of angst-ridden thought. Why should worry become what seems to amount to a mental addiction? Oddly, as Borkovec points out, the worry habit is reinforcing in the same sense that superstitions are. Since people worry about many things that have a very low probability of actually occurring—a loved one dying in a plane crash, going bankrupt, and the like—there is, to the primitive limbic brain at least, something magical about it. Like an amulet that wards off some anticipated evil, the worry psychologically gets the credit for preventing the danger it obsesses about.
The Work of Worrying
She had moved to Los Angeles from the Midwest, lured by a job with a publisher. But the publisher was bought by another soon after, and she was left without a job. Turning to freelance writing, an erratic marketplace, she found herself either swamped with work or unable to pay her rent. She often had to ration phone calls, and for the first time was without health insurance. This lack of coverage was particularly distressing: she found herself catastrophizing about her health, sure every headache signaled a brain tumor, picturing herself in an accident whenever she had to drive somewhere. She often found herself lost in a long reverie of worry, a medley of distress. But, she said, she found her worries almost addictive.
Borkovec discovered another unexpected benefit to worrying. While people are immersed in their worried thoughts, they do not seem to notice the subjective sensations of the anxiety those worries stir—the speedy heartbeat, the beads of sweat, the shakiness—and as the worry proceeds it actually seems to suppress some of that anxiety, at least as reflected in heart rate. The sequence presumably goes something like this: The worrier notices something that triggers the image of some potential threat or danger; that imagined catastrophe in turn triggers a mild attack of anxiety. The worrier then plunges into a long series of distressed thoughts, each of which primes yet another topic for worry; as attention continues to be carried along by this train of worry, focusing on these very thoughts takes the mind off the original catastrophic image that triggered the anxiety. Images, Borkovec found, are more powerful triggers for physiological anxiety than are thoughts, so immersion in thoughts, to the exclusion of catastrophic images, partially alleviates the experience of being anxious. And, to that extent, the worry is also reinforced, as a halfway antidote to the very anxiety it evoked.
But chronic worries are self-defeating too in that they take the form of stereotyped, rigid ideas, not creative breakthroughs that actually move toward solving the problem. This rigidity shows up not just in the manifest content of worried thought, which simply repeats more or less the same ideas over and over. But at a neurological level there seems to be a cortical rigidity, a deficit in the emotional brain's ability to respond flexibly to changing circumstance. In short, chronic worry works in some ways, but not in other, more consequential ones: it eases some anxiety, but never solves the problem.