Worry
Human beings experience a wide variety of repetitive thoughts about themselves and their lives, not all of them negative. Reminiscing, savoring, anticipating, problem-solving, and emotional processing are positive examples of repetitive thinking, and go some way to explaining why we have the propensity to engage in repetitive thought. Some types of repetitive thought are unhelpful, though—even harmful. Rumination and worry are two key forms of unhelpful repetitive thought and use of these can predict anxiety and depression (Watkins, 2016). We can conceptualize repetitive thinking about the future as ‘worry,’ and repetitive thinking about the past as ‘rumination.’ They are maintenance factors in conditions such as generalized anxiety disorder and depression (Harvey et al, 2004). Read more
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Intolerance Of Uncertainty
Uncertainty is a normal part of life – we can never be 100% sure about what will happen next. Many people feel good about uncertainty and live lives ...
https://www.psychologytools.com/resource/intolerance-of-uncertainty/
Worry Flowchart
Worry is a cognitive process that involves thinking about problems that might happen in a way that causes anxiety. Not all worry is problematic – we ...
https://www.psychologytools.com/resource/worry-flowchart/
Mastery Of Your Anxiety And Worry (Second Edition): Workbook
Mastery Of Your Anxiety And Worry comes in two volumes. This page is for the Workbook. Click on the following link to access the accompanying Therapis ...
https://www.psychologytools.com/resource/mastery-of-your-anxiety-and-worry-workbook/
Worry Postponement
Worry postponement ("worry time") is often prescribed as an exploratory or standalone intervention relatively early in the treatment of GAD, but ...
https://www.psychologytools.com/resource/worry-postponement/
Decatastrophizing
Catastrophic thinking (magnification) is characteristic of many anxiety problems. This CBT worksheet for decatastrophizing is a tool for cognitive res ...
https://www.psychologytools.com/resource/decatastrophizing/
Understanding Generalized Anxiety And Worry
Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ...
https://www.psychologytools.com/resource/understanding-generalized-anxiety-and-worry/
Reactions To Trauma
Traumatic events are shocking and it is normal to feel overwhelmed. Not everybody reacts in the same way though and there is no ‘right’ way to res ...
https://www.psychologytools.com/resource/reactions-to-trauma/
Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (Second Edition): Therapist Guide
The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (Second Edition) comes in two volumes. This page is for the Therapist Guide. ...
https://www.psychologytools.com/resource/unified-protocol-for-transdiagnostic-treatment-of-emotional-disorders-second-edition-therapist-guide/
Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (Second Edition): Client Workbook
The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (Second Edition) comes in two volumes. This page is for the Client Workbook. ...
https://www.psychologytools.com/resource/unified-protocol-for-transdiagnostic-treatment-of-emotional-disorders-second-edition-client-workbook/
Understanding Health Anxiety
Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ...
https://www.psychologytools.com/resource/understanding-health-anxiety/
Worry – Self-Monitoring Record
The Worry – Self-Monitoring Record worksheet is designed to help clients capture information about situations where they engaged in worry. Consisten ...
https://www.psychologytools.com/resource/worry-self-monitoring-record/
Worry Thought Record
Anxiety stems from negative predictions about the future (and also from assumptions that one will not be able to cope with the magnitude of the threat ...
https://www.psychologytools.com/resource/worry-thought-record/
Self-Monitoring Record (Universal)
Developing self-monitoring skills teaches clients to systematically observe and record specific targets such as their own thoughts, body feelings, emo ...
https://www.psychologytools.com/resource/self-monitoring-record-universal/
Cognitive Behavioral Model Of Generalized Anxiety Disorder (GAD: Dugas, Gagnon, Ladouceur, Freeston, 1998)
Individuals with generalized anxiety disorder (GAD) report significant worry which they find difficult to control and experience as distressing. Numer ...
https://www.psychologytools.com/resource/cognitive-behavioral-model-of-generalized-anxiety-disorder-gad-dugas-gagnon-ladouceur-freeston-1998/
Mastery Of Your Anxiety And Worry (Second Edition): Therapist Guide
Mastery Of Your Anxiety And Worry comes in two volumes. This page is for the Therapist Guide. Click on the following link to access the accompanying W ...
https://www.psychologytools.com/resource/mastery-of-your-anxiety-and-worry-therapist-guide/
Cognitive Behavioral Model Of Intolerance Of Uncertainty And Generalized Anxiety Disorder Symptoms (Hebert, Dugas, 2019)
Intolerance of uncertainty (IU) has been defined as “an underlying fear of the unknown”. Intolerance of uncertainty is a risk factor for the deve ...
https://www.psychologytools.com/resource/cognitive-behavioral-model-of-intolerance-of-uncertainty-and-generalized-anxiety-disorder-symptoms-hebert-dugas-2019/
Cognitive Behavioral Model Of Health Anxiety (Salkovskis, Warwick, Deale, 2003)
Health anxiety is characterized by a preoccupation with having or acquiring a serious illness, and a high level of anxiety about health. People with h ...
https://www.psychologytools.com/resource/cognitive-behavioral-model-of-health-anxiety-salkovskis-warwick-deale-2003/
Rumination - Self-Monitoring Record
Developing self-monitoring skills teaches clients to systematically observe and record specific targets such as their own thoughts, body feelings, emo ...
https://www.psychologytools.com/resource/rumination-self-monitoring-record/
What Keeps Death Anxiety Going?
The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ...
https://www.psychologytools.com/resource/what-keeps-death-anxiety-going/
Understanding Death Anxiety
Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ...
https://www.psychologytools.com/resource/understanding-death-anxiety/
Exposures For Fear Of Body Sensations
Fearful responses to physical sensations are common in several disorders. Interoceptive exposure (or ‘symptom induction’) is an effective treatmen ...
https://www.psychologytools.com/resource/exposures-for-fear-of-body-sensations/
Problem Solving (CYP)
Effective problem solving is an essential life skill and this Problem Solving worksheet is designed to guide children and adolescents through steps wh ...
https://www.psychologytools.com/resource/problem-solving-cyp/
Worry Diary (Archived)
NOTE: An improved version of this resource is available here: Worry – Self-Monitoring Record. Older versions of a resource may be archived in t ...
https://www.psychologytools.com/resource/worry-diary-archived/
Am I Experiencing Generalized Anxiety Disorder (GAD)?
Generalized anxiety disorder (GAD) is a condition characterized by problematic worry. Am I Experiencing Generalized Anxiety Disorder? is an indicative ...
https://www.psychologytools.com/resource/am-i-experiencing-generalized-anxiety-disorder-gad/
Cognitive Behavioral Model Of Insomnia (Harvey, 2002)
Insomnia is a highly prevalent sleep disorder characterized by difficulty initiating or maintaining sleep, or having non-restorative sleep for at leas ...
https://www.psychologytools.com/resource/cognitive-behavioral-model-of-insomnia-harvey-2002/
Am I Experiencing Burnout?
‘Burnout’ is characterized by feeling emotionally drained, unmotivated, and ineffective as a result of prolonged stress during work. This can impa ...
https://www.psychologytools.com/resource/am-i-experiencing-burnout/
Am I Experiencing Social Anxiety?
Social anxiety disorder is characterized by persistent fear or anxiety concerning social or performance situations that is out of proportion to the ac ...
https://www.psychologytools.com/resource/am-i-experiencing-social-anxiety/
Am I Experiencing Health Anxiety?
Health anxiety (also referred to as illness anxiety disorder and hypochondriasis) is a condition characterized by a preoccupation with, or fear about, ...
https://www.psychologytools.com/resource/am-i-experiencing-health-anxiety/
Am I Experiencing Death Anxiety?
Am I Experiencing Death Anxiety? is an indicative screening tool, designed to help clients self-assess whether their experiences might warrant further ...
https://www.psychologytools.com/resource/am-i-experiencing-death-anxiety/
Panic Attack Progress Record
Recovery often has a fluctuating course and it is important to monitor progress in cognitive behavioral therapy. Clients can use the Panic Attack Prog ...
https://www.psychologytools.com/resource/panic-attack-progress-record/
Exposures For Fear Of Breathlessness
Fearful responses to benign physical sensations such as breathlessness are common in several disorders, most notably panic disorder (with and without ...
https://www.psychologytools.com/resource/exposures-for-fear-of-breathlessness/
Am I Experiencing Panic Attacks?
Panic attacks are discrete episodes of intense fear or apprehension. They are accompanied by the rapid and concurrent onset of characteristic symptoms ...
https://www.psychologytools.com/resource/am-i-experiencing-panic-attacks/
Am I Experiencing Panic Disorder?
Panic attacks are discrete episodes of intense fear or apprehension, accompanied by the rapid and concurrent onset of several physiological and psycho ...
https://www.psychologytools.com/resource/am-i-experiencing-panic-disorder/
Links to external resources
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Guides and workbooks
- Dealing with worry in low intensity CBT | Chellingsworth, Farrand, Rayson | 2013
Information Handouts
- 11 Steps To Stop Ruminating | Jay Uhdinger
-
Generalised anxiety and worry - information sheets
| Centre For Clinical Interventions
- What Is Generalised Anxiety?
- What Is Mindfulness?
- Mindfulness and Letting Go
- How Worry Works
- Postpone Your Worry
- Accepting Uncertainty
Information (Professional)
- Get out of the TRAP and back on TRAC (for rumination and worry) | GoodMedicine
Presentations
- The how and why of rumination and worry | Watkins | 2012
- Targeting rumination by changing processing style: experiential and Imagery exercises | Watkins | 2011
- Unwanted intrusive thoughts | David Clark | 2019
Video
- Stopping spam from going bad | Blake Stobie | 2016
Worksheets
- Ruminating thought worksheet: What to do when thoughts are unhelpful
-
Generalised Anxiety And Worry (Worksheets)
| Centre For Clinical Interventions
- Postpone Your Worry
- Letting Go With Mindfulness
- Accepting Uncertainty
- Challenging Intolerance of Uncertainty
Recommended Reading
- Watkins, E. R. (2008). Constructive and unconstructive repetitive thought. Psychological Bulletin, 134(2), 163-206
- Watkins, E. R. (2009). Depressive Rumination and Co-Morbidity: Evidence for Brooding as a Transdiagnostic Process. Journal of Rational-Emotive Cognitive Behaviour Therapy, 27, 160-175
- Watkins, E. R. (2016). Rumination-focused cognitive-behavioral therapy for depression. Guilford Publications.
What Are Rumination And Worry?
Disorders That Are Associated with Rumination and Worry
- generalized anxiety disorder (GAD)
- depression
- social anxiety
- post-traumatic stress disorder (PTSD)
- pain
- eating disorders
- insomnia
- psychosis
Helpful Questions for Assessing Rumination and Worry
- How often do you find yourself ruminating or dwelling on your problems?
- When do you tend to do most of your worrying or ruminating?
- What are the consequences of ruminating and worrying for you? How does it make you feel?
- Are there any particular feelings that are warning signs that you might worry?
- What tends to stop your ruminating?
Treatment Approaches That Target Rumination and Worry
A variety of treatment approaches have been identified that target rumination and worry. These include:
- approaching uncomfortable thoughts and feelings rather than avoiding them;
- imaginal exposure to a ‘worry script’ or ‘worry story’;
- problem-solving training;
- processing information at a more concrete and less abstract level;
- identifying and challenging positive and negative metacognitive beliefs that may contribute to repetitive thinking.
References
- Harvey, A. G., Watkins, E., Mansell, W., & Shafran, R. (2004). Cognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatment. New York: Oxford University Press.
- Watkins, E. R. (2016). Rumination-focused cognitive-behavioral therapy for depression. New York: Guilford Press.