Oh, No! Now What Could Go Wrong? : Behavior: Once we viewed chronic worriers as people who could stop, if only they would. Now experts think extreme worry is an addictive pattern with serious consequences.

Gia was the matriarch of a large family, the beloved “Grammy.” But she was more than that. Her children and grandchildren recall her as the Official Family Worrier.

“I can’t remember a time when Grammy wasn’t worried about something,” says Charles, a grandson who lives in Los Angeles. “She was always worried about one of us, that we were sick too much or that we would get in some kind of trouble. And she always worried about her health, although she was relatively well her whole life. Until, of course, she worried herself to death.”

We all know them: the walking worried. The worry warts of the world. The woe-is-me, hand-wringing . . . well, you get the idea.

Generally, chronic worriers have been considered somewhat annoying people who could stop worrying if they wanted but who instead get a perverse pleasure from it.

That view may be unsympathetic. In recent years, chronic worriers have attracted greater interest among psychologists, who now believe that extreme worrying is an addictive thought pattern that can lead to serious mental and physical consequences. But they also say it is something that can be successfully “treated” with hard work.

“In therapy it has always been considered as not very serious and that there was not much you could do about it,” says Dr. Gary Emery, a worry expert and director of the Los Angeles Center for Cognitive Therapy. “Surprisingly, for how prevalent it is and how much suffering it causes, it hasn’t been studied much.”

Experts’ efforts over the last decade have been devoted to defining chronic or obsessive worrying. After all, everyone worries. But what is the difference between worrying a little and worrying a lot?

A chronic worrier, Emery says, is “someone who has a morbid preoccupation with what can go wrong. Chronic worrying is unrealistic in the sense that it’s unhelpful and it’s counterproductive. It’s realistic in the sense that what you’re worried about could actually happen. It’s not paranoia like, ‘The CIA is after me.’ ”

Terry Sandbeck, a worry expert in Sacramento, calls chronic worrying a destructive thought process. An anxiety disorder, by contrast, occurs when chronic worrying begins to interfere with daily living and leads people to believe they are incapable of dealing with their fears.

“If an individual is in a situation where they have no control over what is happening, then to continue thinking about it, it’s called worry. To think about it and then drop it is concern,” he says.

Although researchers believe there may be a genetic component, at least some of the habit seems to be learned. Says Emery: “In some families it’s almost like someone had to have the role to worry.”

It’s clear that excessive worrying can begin as soon as a child is old enough to anticipate the future, says Michael Vasey, an assistant professor of psychology at Ohio State University.

Although little is known about chronic worry in children, Vasey and others have found that in adults, worriers seem to latch on to a thought and ruminate about it. Non-worriers, however, get concerned about something and either take some action or forget about it.

In a recent study, Vasey looked at 48 college students, half of whom were found to be chronic worriers. When asked what worried them, both groups gave similar responses: academic success, relationships and health.

The students were then asked, “What is it about getting good grades that worries you?” And this is where the difference stood out. Worriers produced much longer lists of possible consequences.

For example, chronic worriers saw a stronger likelihood that not getting good grades would eventually result in pain, physical deterioration and death. To a non-worrier, the result might be unhappiness and strain, but nothing beyond that.

“Worriers start to think about what can go wrong. It makes them anxious, and they seek to stop thinking about it,” Vasey says. “The problem is they never resolve anything. The next time their attention isn’t taken up by something else, here comes the thought again.”

Worriers, it seems, can’t get beyond worrying. And that can lead to big trouble.

Mental health experts have only recently started to investigate whether chronic worry is the underlying factor in cases of anxiety or depression.

In Vasey’s study, he was stunned to see how large a role worrying seemed to play in some people’s lives. The worriers in his group said they spent at least half of their waking hours worrying. In contrast, the others said they worry less than 10% of each day.

“I find it mind-boggling to think that people worry that much,” he says. “I doubt that they really spend that much time worrying. But it suggests how salient worrying is to these people, how distracting it is.”

Moreover, the worriers said their anxious thoughts caused them great discomfort. In some people, chronic worry can turn into depression, guilt, helplessness, resentment and anxiety, says Sandbeck. The ability to cope, make decisions and understand what is wrong in their lives begins to crumble.

“I have yet to meet someone who comes in for therapy who is not an excessive worry wart,” he says. “It’s at the heart of all therapy.”

Generally, people who worry excessively should seek professional help if they find themselves distressed a good deal of the time or if the worrying interferes with their lives, Vasey says.

But worriers can learn to break the habit, experts point out.

“There are a lot of techniques” to help worriers, Sandbeck says. “It’s very hard work. We give homework assignments: reading, writing, record-keeping. If a person is doing the assignments and working hard in therapy, they can do significantly better in 10 to 20 visits. To completely break the old habit takes much longer.”

He prescribes a full year of devoting one hour each day to worry-busting techniques.

Pioneer researcher Thomas Borkovec of Penn State University created a widely used technique in which worriers devote half an hour each day--in a specific place and time--to focus solely on their worries, says Vasey, who co-authored his recent study with Borkovec. At all other times, they are to remind themselves that they can think about their worries later.

“The problem is that people worry any place and every place, but . . . never get past that initial stage of thinking about what may go wrong,” Vasey says. “But if you devote enough time to it (in one sitting), then maybe you can begin to come up with solutions.”

Emery also advises therapy for chronic worriers. But he has also seen people give up worrying spontaneously.

“A lot of times you just stop worrying as you get older,” he says. “This has a lot to do with the degree to which you can tolerate uncertainty. As you get wiser, you can tolerate uncertainty. And for some people, once something really bad happens to them, they quit worrying. All of a sudden they decide not to worry any more. It puts things in perspective.”

The key to giving up the worry habit is realizing that worrying doesn’t help, Emery says.

“It comes from the insight that it’s a waste of time. . . . It doesn’t solve things. It’s a substitute for action. When people realize this, they can let go of it.”

Try this, Emery says: When you start to worry, ask yourself, “Is this something I can take action on? Is there something I’m avoiding? How will I feel if I can approach it, as opposed to avoiding it?”

However, if you can’t do anything about the worry, ask yourself if you can drop the thought and tolerate the uncertainty, Emery says.

“If you drop the thought as soon as it comes in, then gradually it will fade away,” he explains.

Some people find it helps to ask themselves, “What is the worst thing that can happen?” he says--and to realize that almost none of those “worst things” happen.

According to Vasey, people who cope well with worries often do so because they ask other people, “Do you think I should be worried about this?”

“When someone says, ‘I think you’re overreacting,’ most people can use this information to stop worrying,” he says. “But serious worriers are probably going to need more help than that.”

The ability to let things unfold is a crucial ingredient to healthy, joyful living, Emery says. “Real freedom is freedom from worry. If you worry, you are living in the future. You are living in thought rather than reality.”

Emery says he likes the story of John F. Kennedy’s response to people who asked him to describe his toddler son’s potential for success. The President would smile and reply: “We’ll know more later.”

The attitude?

Don’t worry. Be happy.

For a Worrier, Ending Up in Hell Is a Real Fear

In a study, worriers seemed to latch on to a worry and exaggerate it, thinking up more and more ideas of what can go wrong.

Here are some responses to the question: “If you didn’t get good grades, what would happen?”

* WORRIER

I wouldn’t live up to my expectations.

I’d lose my self-confidence.

My loss of self-confidence would spread to other areas of my life.

I’d be afraid of facing the unknown.

I’d become very anxious.

Anxiety would lead to further loss of self-confidence.

I’d feel like I wouldn’t have any control over my life.

I’d become more and more anxious.

I’d have no control at all, and I’d become mentally ill.

I’d become dependent on drugs and therapy.

I’d always remain dependent on drugs.

I’d be in pain.

I’d die.

I’d end up in hell.

(Worrier was truly afraid these things would happen, citing an 80% likelihood of ending up in hell.)

* NON-WORRIER

I might do poorly on a test.

I’d get a bad grade in class.

That would lower my grade-point average.

I’d have less of a chance of getting a good job.

I’d end up in a bad job.

I’d get a low salary.

I’d have less money to spend on what I want.

I’d be unhappy.

It would be a strain on me.

I’d worry more.

(Non-worrier didn’t really think these things would happen, citing only a 20% likelihood of doing poorly on a test.)