Even with this explanation, people often think it’s a pretty weird idea, setting an alarm clock for 2 a.m. because they don’t want to wake up at 2 a.m. And I guess it is. But this is a counterintuitive problem, and it requires a counterintuitive solution. When you need a counterintuitive solution, you can always turn to the Rule of Opposites. Setting the alarm for 2 a.m. is a pure application of the Rule of Opposites.
Worry on Awakening
Sometimes people experience the flip side of this problem. When they wake at the desired time in the morning, they lay in bed a while, trying to get a little more sleep. Instead of sleeping, though, they often juggle worrisome thoughts about their day as they lay there. Sometimes people even set their alarm a little earlier than they need, so they can build in an extra period of snoozing. The “snooze alarm” feature on some clocks encourages this practice.
Perhaps the best advice I can offer you about these “top of the morning” worries is this: don’t take it lying down! You’re at a big disadvantage as you lay there on your back, worrying, without anything else to do.
You’ll be better off getting out of bed once you recognize that you are awake. Lying in bed, contemplating the bad things that might happen today, is not the way to start your day! Instead, get out of bed and start your morning routine—showering, having breakfast, letting the dog out. Get your day started, and postpone, for a short period, your contemplation of the day ahead.
After you’ve finished a portion of your morning routine, about fifteen minutes’ worth, then sit down in a chair and take a few minutes to review the upcoming day. You’ll be better able to view the day when you’re fully awake and sitting up. If you “need” to worry in the morning, this is a better time and place to do it. If you have a strong habit of waking and worrying in bed, it might be a good alternative to schedule a worry appointment (chapter 10) as part of your morning routine.
Worries about Illness
Worry about possible disease and illness can be an especially challenging form of chronic worry.
Someone with “illness anxiety,” as it’s called by professionals, or someone who just has some tendencies in this regard, is going to experience lots of thoughts and concerns about the possibility that he has a disease. Sometimes this worry leads people to seek out much more medical attention than would otherwise seem necessary or desirable. Sometimes it leads people to do the opposite of that, to avoid ordinary medical checkups and procedures that would otherwise make good sense. We’ll look at both responses here.
Too Much of a Good Thing
People who experience illness anxiety usually find themselves focused on some really serious and dread diseases, like cancer, Alzheimer’s, AIDS, multiple sclerosis, heart ailments, and so on. You know what you’re supposed to do if you detect a sign or symptom of some potential ailment, right? You go see the doctor and get it checked out! That makes sense.
The doctor should listen to your concern, examine the relevant parts of your body to evaluate it, and perhaps run some tests—blood work, X-rays, or other scans of relevant areas. In some cases, a consultation with a specialist may be part of the evaluation. The doctor’s aim will be to clarify, to her satisfaction, whether or not an ailment exists; if so, to identify a course of treatment; and see any necessary treatment through to its successful conclusion.
But here’s where it gets so tricky for people with chronic worry about the subject of a possible illness. If you have this kind of chronic worry, you arrive at the doctor’s office with two goals in mind. First, you want the doctor’s professional opinion as to whether or not you have a disease. If the doctor says you do have a disease, you want the doctor’s recommendation for treatment. If the doctor says you don’t have a disease, you want to be 100 percent confident that the doctor is correct—and that’s a problem.
You Can’t Always Get What You Want
No matter how healthy you may be, no matter how skilled, thorough, kind, and persuasive the doctor may be, you won’t get the 100 percent certainty that you crave. Even if you feel that way during the visit, by the time you get home you’ll probably start doubting all over again. This is the problem of trying to prove that something doesn’t exist. It can’t be done.
A person who worries a lot about her health may develop a concern about, say, having a dangerous heart condition, or stomach cancer. She’ll notice physical sensations that seem to indicate that she has that disease—her heart occasionally changes speed or skips a beat, or her stomach produces sensations that she doesn’t expect—and she’ll consult a doctor about it.
She hopes to be able to prove that she doesn’t have a disease and listens very closely to the words the doctor uses. If the doctor says, “I don’t see any sign of this disease,” she’s unhappy with that, because it leaves open the possibility of the disease appearing in the future, maybe as soon as she leaves the office.
What she’d like the doctor to say is something more like, “You don’t have this disease now, and I guarantee you will never get it in the future.” That would sound good to her. But, it wouldn’t be long before she’d start wondering, and get back to worrying. How can the doctor be so sure?
Doubting Your Doctor and Taking the Bait
What do you do when you find yourself once again worrying about the possibility that you have a dreaded disease and that the doctor, for whatever reason, failed to find it? If you’re like most people with this concern, you respond to the doubt by engaging in a variety of anti-worry behaviors, just like the bull charges the red cape. You go back to that doctor to explain your situation again. You might have the thought that you left out an important detail the first time, or that you simply didn’t emphasize it enough; or that the doctor overlooked it for some reason; or maybe even that the lab mislabeled your blood sample and you got someone else’s report. So you go back and repeat the visit, asking the doctor to check again. You go to other doctors for other tests and opinions. You search the Internet. You ask friends and family for reassurance. But no matter how hard and thoroughly you try, there’s Uncle Argument tapping you on the shoulder—“What if… ?”
Wanting 100 Percent Certainty
It might seem to you as though this subject, a possible fatal illness, is too important to settle for less than 100 percent certainty. The fact is that no matter how important the subject seems, you can’t have 100 percent certainty that a problem doesn’t exist. The harder you try to attain it, the more painfully aware you will be that you’re still not sure.
If this is your situation, you’re not unsure because you failed to investigate your concern sufficiently. You’re unsure because no one can be as sure as you wish. You’ve already attained your first goal, getting the doctor’s opinion about your health. You’re stuck trying to achieve your second goal—being 100 percent sure—and you’re not going to achieve that goal.
You’re not focused on this problem because undiagnosed disease is the biggest threat to your survival. It’s not. There are any number of ordinary daily activities that carry more likelihood of death than undiagnosed disease, and you probably don’t pay them much mind at all. You’re stuck on this problem because it makes you feel so uncomfortable. It’s discomfort, not danger. When you treat it like danger, the problem seems to spiral further out of control.
What can you do? The problem is that you’re going to the doctor hoping to get a new opinion—from yourself. You’re hoping to come home, thoroughly convinced and satisfied that you are healthy, without the disease that you feared, and that this certainty in your new opinion will last the rest of your life. But the only reason to go to the doctor is to get an opinion from the doctor, not to change your opinion or thoughts. You go there wanting to find out if the doctor thinks you have a disease. Make it your goal to get an opinion from the doctor, knowing that you will likely continue to have worrisome thoughts about disease before, during, and after your appointment. Don’t go there for certainty, just go for the doctor’s opinion.
Why Do I Do Thi
s to Myself?
Some people get stuck on this worry because they repeatedly have physical symptoms as well as worry. Anxiety is not all in your head. You will also experience it in your body. Some of the classic physical symptoms of anxiety include feeling lightheaded or dizzy; changes in your apparent heart rhythm or speed; muscular tightness in your chest, shoulders, back and neck; digestive distress; and more. Even though these are common symptoms of anxiety, some people who experience them have a lot of trouble accepting and believing that they can have physical symptoms that are just part of anxiety and not part of a physical disease.
People who worry about potential illnesses and find it hard to let go of those concerns frequently get angry at themselves. “I do it to myself!” they often say, and blame themselves for their troubles.
If you have worries about illness, and physical symptoms of anxiety as well, it’s true that no one else is doing this to you. The worries and physical symptoms occur within your body and mind without outside cause, but this isn’t really the same thing as you doing it to yourself. These worries and physical symptoms are natural, involuntary activity within your mind and body, part of the process by which we routinely scan and watch for signs of trouble.
If you have worries like these, you’ve got overzealous watch dogs! They bark when there’s a prowler, and that’s good. But they also bark when kids run across your lawn, or when the mailman leaves your mail. It’s too much of a good thing! But they are dogs, after all, and it’s probably unhelpful to expect that they only bark when there’s an actual threat and never bark when there isn’t. They’re not doing it to bother you; they’re doing it because that’s their nature.
In the same way, it’s within all of us to watch for signs of possible trouble and seek to head it off. That’s a part of our nature, and sometimes we get more of it than we might wish. That’s a problem. But it’s not your fault.
Avoiding a Good Thing
Other people will respond to chronic worry about possible illness in a very different fashion. They avoid doctor visits like the plague. People who get caught up in this pattern go for years without seeing a doctor. They avoid annual physicals as well as the usual recommended milestones, like colonoscopies at certain intervals after age fifty, a shingles vaccination at age sixty, and so on. The necessity of a medical visit, perhaps for a chest X-ray required by a new employer, or for an actual medical emergency, often becomes a crisis for people with this kind of worry. If you’re someone with this kind of experience, your worries take a different form compared to people who constantly seek out medical evaluations.
Why does illness anxiety lead people to avoid doctors? There are several reasons.
One common pattern is that people worry not about the potential effects of a disease, but rather about the shock and anxiety they think they’ll feel if a doctor tells them of one. If you have this type of chronic worry, your chief concern is an imagined, hypothetical moment when the doctor examines you, or reads your lab report, looks up at you with a heavy sigh, and says, “I have bad news.”
People with this form of illness anxiety imagine this scenario frequently, and the thought of hearing bad news scares them so much they think they have to avoid that possibility at all costs. It’s similar to the anticipatory fear a person with panic disorder feels when they imagine getting into a situation they associate with panic attacks, perhaps an airplane or crowded elevator.
White-Coat Syndrome
A routine part of most doctor visits is a blood pressure reading. Some people hate and fear this to such an extent that it leads them to avoid the doctor. Maybe they have a pattern, called “white coat syndrome,” in which their blood pressure goes up when it’s time for the reading, and they have such an anticipatory reaction to this that they get caught up in a vicious cycle. They imagine the nurse saying something like, “Oh my God, your blood pressure is through the roof!” and causing a scene, while their blood pressure continues to mount.
People who experience anticipatory worry about the blood pressure reading, the doctor’s feedback, or any other aspect of the office visit sometimes find it intolerable to wait their turn in the waiting room, because that’s prime time for anticipatory “what if” thoughts to arise. Just like the fearful flier who gets to the gate only to turn back, sometimes people get as far as the waiting room only to leave in response to heightened anticipatory fears.
Worry About Illness Is Just…Worry
If you recognize yourself in the above descriptions, and see that chronic worry about health and illness is having a negative effect on your life, then the fact that the apparent content of the worry is about health and illness becomes much less important. Think back to chapter 6, in which we diagrammed the typical worry sentence. The content of the worry sentence is revealed to be of very little importance when we consider the meaning of the “what if” clause that precedes it. Do you remember what the “what if” part means?
It means “let’s pretend.” Whatever follows that pretend clause—cancer or the common cold—it’s still pretend! You’re still multiplying by zero!
That’s what you end up with when “what if” thoughts get you to pretend, even about topics that would be very important outside of pretending.
Don’t Hide Your Worry!
It’s very common for people who struggle with chronic worry about illness to try to deny and hide it when they visit the doctor. Do you do this? Some of this is motivated by a desire to not be hampered by this problem—you probably don’t want to “give in to it.” Some of it is from embarrassment. It’s also often motivated by a concern that, if you acknowledge to the doctor that you have some trouble with worry, all your medical concerns and complaints will be dismissed as simply “anxiety related.”
These are understandable concerns. However, to the extent that they lead you to disguise or deny your troubles with worry, they probably make your situation more difficult rather than better. If you have chronic worry about illness, you really have two problems to bring to the doctor: the symptoms you want to investigate, and your burning desire to prove, beyond a shadow of doubt, that you are not ill. If you only acknowledge the symptoms, without acknowledging how your quest for certainty complicates your life, then both you and the doctor may get diverted into unproductive areas.
Some physicians, seeing that the patient is not entirely satisfied with the diagnosis of good health, will suggest test after test and specialist after specialist, either not noticing that chronic worry is part of the issue or preferring to avoid dealing with it. You can waste a lot of time and money this way! You will also probably be disappointed to find that no amount of tests and consultations will give you the perfect reassurance you seek. In fact, the more tests you have, the more opportunities for worry will come your way.
Your internal process of worry continues to go forward whether you acknowledge it or not. If worry about possible illness is part of your lot in life, hiding that from your physician may well make the doctor-patient relationship seem more adversarial and less helpful. However, if you can acknowledge and discuss with your physician the way worry influences your thinking about your health, you may find it easier to arrive at a more satisfying working relationship with that doctor.
Some physicians probably don’t want any part of this and would prefer to have obedient, cooperative patients who accept their recommendations and don’t worry about it. If you happen to have such a physician, you may well need to change doctors and find one who is more open to working around the way worry influences your medical treatment.
Thinking It Over
Worries about sleep and health follow the general pattern of all chronic worry, and may also lead to the creation of strong habits that increase and maintain your worry. This chapter identified some characteristic behaviors that people adopt hoping to get the worry under their control, behaviors which ultimately make the worry more persistent and severe rather than less. Identifying such behaviors, and reversing them, is an important p
art of changing your relationship with chronic worry.
Chapter 14
Closing Thoughts: There’s Something Funny About Worry…
So there you have it. Chronic worry is not an intruder or a disease you have to oppose. It’s a bunch of reactions that appear in your internal world, in your mind, when you try too hard to control and oppose unwanted worrisome thoughts. Chronic worry tricks you into taking it seriously and opposing it just like a matador tricks a bull into charging men armed with swords and spikes.
A matador tricks a bull with a red cape. Chronic worry tricks you with a phrase like “What if… ?”
When you fall for the trick, you end up arguing with Uncle Argument and feeling nauseous at a banquet that you had hoped to enjoy. And the best way to defuse the situation with Uncle Argument is to playfully humor him.
This might not be as hard as it seems, because there’s something funny about worry.
I give frequent workshops on worry and anxiety at professional mental health conferences around the country. These are usually held in large hotels or conference facilities with rooms for many workshops to occur simultaneously. At break times, as participants from other meetings walk by my table, they often have an interesting reaction. When people see the sign for the meeting about worry, they frequently laugh and say something like this: “Oh, I could really use this meeting!”
The Worry Trick Page 20