II. Pathophysiology
- Worry is a normal short-term response to uncertainty
- If Worry persists it becomes maladaptive, dysfunctional
- Provoked by sense that worry prevents serious events
- Also may be coping mechanism, blocking other emotions
III. Symptoms: Presentations
- Presentation for worry itself is uncommon
- Patients will admit to worry if asked
- Patients usually present for other secondary concerns
IV. Signs: Distorted assumptions
- Belief that over-thinking issue offers benefits
- Certainty or sureness
- Relief of pain or discomfort
- Prevents bad events
- Worry shows that I care
- Sense of guilt, lack of control that led to mistakes
- Feels need to be hypervigilant about every thought
V. Differential Diagnosis
VI. Management
- Medications (start at half dose and increase slowly)
- Cognitive Behavioral Strategies
- Worry is not an effective warning or control method
- Re-evaluate: What is the real risk of bad events?
- Re-frame: Will this matter to me in a month?
- Perspective: I do not have control over most events
- Frequent search for reassurance is temporary relief
- Ask others to withhold reassurance and break cycle
- Worry does not need constant and immediate attention
- Set appointments to deal with worry and concerns
- Do not try to suppress worries or emotions
- Spend 20 minutes focusing on concern
- Follow appointment with Exercise or social time
- Learn strategies to handle over-powering episodes
- See Relaxation Training
- Meditation
- Breathing Exercises
- Relaxation Techniques
- Write down worry, address at "worry appointment"
- Set appointments to deal with worry and concerns
- Recognize worry as a problem to resolve
- Worry causes tension, stress, and somatic symptoms
- Worry is an unhealthy habit
- Worry is not an effective warning or control method