Detecting and dealing with worrying as a secondary problem
In an earlier blog, I described how I deal with mood that has become lowered, secondary to the client’s main issue, such as an anxiety state. Similarly, clients who are primarily depressed may also be worrying a lot, with the worrying maintaining their lowered mood. I therefore proactively keep an ear out for thoughts and feelings that may be suggestive of worrying.
Interestingly, some clients can find it really difficult to recognise that they are indeed worrying. My script for explaining worrying is:
‘If you have a thought and it makes you feel apprehensive, you’re probably worrying! Many people are so used to worrying that they actually find it hard to recognise or name it as worrying!’
I will then name ‘worrying’ if the client describes a thought that has a worry content. Again some clients will say ‘Oh but I wasn’t really worrying’ or ‘It didn’t worry me as such’, to which I reply ‘Did you feel apprehensive immediately after you had that thought?’ If the answer is ‘Yes’ (and it frequently is), I suggest that that she was indeed therefore worrying. Most people catch on quickly after one or two such instances. This is one of my high yield questions in CBT and hence the pink highlighting!
Here’s the micro-formulation detailed in the earlier blog on dealing with low mood. I share this with the client once it has become apparent that worrying is one of her significant behavioural responses.
Micro-formulation linking low mood and worrying
You may detect my deliberate use of the symptoms terms ‘low mood’ and ‘worry’ rather than the diagnostic terms ‘depression’ and ‘anxiety’. This is because some clients feel even worse if they’ve come in expecting to get one diagnosis and then feel like they’ve ended up being given two! Sticking to describing symptoms in this instance can feel less threatening and more manageable.
The micro-formulation also shows how the problematic behaviours of ruminating and worrying maintain the low mood/depression. This identification of rumination and worrying as maintaining processes links us back into the formulation and indicates that we have to target these behaviours in order to make the client feel better.
At this point, I usually ask the client to name and monitor worrying as one of her behavioural responses for homework i.e. use the Mood or Thought Diary to specifically look out for and monitor worrying.
Once she understands this link through her own experience, I will introduce her to the mainstay of worry management, the Worry Tree (see later blogs).
Summary points
2. Clients may not recognise that they are ‘worrying’. A helpful question to ask is: ‘Did you feel apprehensive immediately after you had that thought?’
3. Clients may not understand that ‘worrying’ is in itself a type of behaviour. Moreover it maintains lowered mood and will therefore to be addressed in its own right
4. Micro-formulate the link between low mood and worrying
5. Use the Mood or Thought Diary homework to help the client name and monitor her behavioural response of ‘worrying’