Worry and Chronic Illness

Katie Willard Virant

Those of us living with chronic illness tend to experience a great deal of worry over our health. It makes sense: Our bodies have been the site of pain, and we dread re-experiencing the suffering we have already known. As understandable as this is, however, worry harms us. The physiological effects of worry send stress hormones coursing through the body and put the nervous system in a continuously activated state. It’s also emotionally painful to be consumed with worry: We’re not able to feel safe and connected when we are dwelling on adverse events that haven’t yet happened.

Given that worry is such an unpleasant experience, why do so many of us continue to engage in it? Some theories opine that we worry because we want to be prepared for the worst-case scenario, running through all options in our minds. Perhaps this works up to a point—but our worried minds don’t stop once we’ve sorted through the various possible scenarios. Rather, we continue to ruminate, unable to pull ourselves out of imagining the worst.

Other theories note that worry is an attempt to manage uncertainty. Again, though, it doesn’t really work. Uncertainty is a part of life, and worrying about what may occur doesn’t eliminate the reality that we cannot know the future.

One theory of worry—the contrast avoidance model—posits that we worry in an attempt to avoid the feeling of contrast that occurs when a positive state of being is changed by a negative occurrence. That is, people use worry as a coping strategy “because they prefer to feel chronically distressed in order to prepare for the worst outcome, rather than to experience a shift from a positive or euthymic state to a negative emotion” (Newman & Llera, 2011). Researchers have found that worry actually does work to cushion the blow of an adverse outcome. However, the cost—staying in distress in order to avoid the awful that feeling of downshifting into distress—is high.

If you recognize yourself as someone who worries because you’re afraid of feeling the dreadful surprise of receiving bad news, the following prompts may help you to think and feel more deeply about this coping strategy.

• Think of a time when you experienced an adverse event “out of the blue.” What was it like for you to move from a state in which everything was fine to a state in which things were very wrong? Did you feel shocked? Vulnerable? Duped? Stupid? If you can, write about this or talk it through with someone. Something about being surprised by an adverse experience was extraordinarily painful to you—so painful that you are willing to live in distress so as to avoid re-experiencing that feeling of surprise. Try to identify what it is that you’re afraid of experiencing again.
• Treat yourself gently. Many people who worry are ashamed of their reliance on this coping strategy. They know they are torturing themselves, but they can’t imagine giving up worry. Often, their loved ones roll their eyes at them, saying with exasperation, “Just stop worrying so much!” Acknowledge that your worry does serve a purpose. You are trying to keep yourself safe from being surprised by something terrible happening. Acknowledge, too, the high price you pay in an effort to stay safe. Both sides of this equation feel difficult: Living in constant distress is unpleasant, but being vulnerable to the surprise of an adverse experience feels untenable.
• Recognize that managing worry is a process. Recognize, too, that this process is best accomplished in relationships with others. We cling to worry when we feel unsupported. Find support. Every one of us is vulnerable to loss and pain. Developing relationships in which we feel seen and loved in the face of loss is crucial. If this feels challenging, therapy can help.
• Develop a mindfulness practice. Worry catapults us to an unknown future, removing us from the present moment. Find ways to connect to the present moment every day—through movement, through attention to your senses, through breath work.
• Find mantras that resonate with you, helping to calm you when you worry. Examples include: “I can’t know the future”; “I will have support and love if something awful happens—I will not be alone”; “I am making up stories in my mind right now”; “All will be well.”
• Believe that you can change. People who have relied on worry all their lives tend to see it as an immutable trait. It’s not. It’s a coping strategy that you’ve relied on too heavily, to your detriment. With support—your therapist, your family, your friends—you can develop other coping strategies that don’t have to hurt so much.