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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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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

Information handouts

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

Information handouts

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

Information handouts

Cognitive Behavioral Model Of Intolerance Of Uncertainty (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-hebert-dugas-2019

Information handouts

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

Exercises

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

Information handouts

Mastery Of Your Anxiety And Worry: 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

Treatments That Work®

Mastery Of Your Anxiety And Worry: 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

Treatments That Work®

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

Worksheets

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

Exercises

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

Information handouts

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

Worksheets

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

Worksheets

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

Guides

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

Guides

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

Worksheets

Worry Decision Tree

Worry is a cognitive process that involves thinking about problems that might happen in a way that can leave you feeling anxious or apprehensive. Not ... https://www.psychologytools.com/resource/worry-decision-tree

Exercises

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

Archived

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

Exercises

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

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Assessment

Intervention

Presentation

  • The how and why of rumination and worry | Watkins | 2012 download archived copy
  • Targeting rumination by changing processing style: experiential and Imagery exercises | Watkins | 2011 download   archived copy
  • Unwanted intrusive thoughts | David Clark | 2019 view

Recommended Reading

  • Watkins, E. R. (2008). Constructive and unconstructive repetitive thought. Psychological Bulletin, 134(2), 163-206  download
  • 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  download
  • 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.