Managing Dread With "What if" and "So What?"

Recently, a patient in my psychotherapy practice was reflecting on her experience in therapy after what she described as three productive years of treatment. Laura* was originally referred by her family physician when no medical cause could be identified to explain her various physical complaints and disrupted sleep, among other difficulties. She struggled with depression, was frequently anxious, and described herself as a chronic worrier who essentially saw the world through a bleak lens. She reported general unease with matters of daily living and appeared to have a hard time finding joy and satisfaction in her personal life or her professional life as a museum curator.

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Fortunately, Laura’s psychotherapy accomplished many things, as she happily recounted in our final session together. She felt “stronger, more like the trunk of the tree than the fragile twig I was three years ago.” She felt as though she had earned her “adult card” to go along with the other credit cards in her wallet. She believed that she had developed a more solid ability to cope with life’s demands and expectations with less anxiety, and she generally felt more capable and competent, which for Laura included feeling better able to engage in a romantic partnership that survived beyond the initial dating phase.

Laura identified two particular accomplishments: something she relinquished during the course of her treatment and something she acquired as a tool that helped improve her coping skills. Laura believed that these were the two most important achievements of her course of psychotherapy.

At the beginning of her treatment, Laura would describe events in her life that she felt were “overwhelming,” “stressful,” “upsetting,” or worse. Initially, she would be startled when, often, she would hear me react to a tale of woe by saying, “So what?” or words to that effect. While not at all insensitive or without compassion for Laura’s unfortunate suffering, I was able to help her achieve perspective and appropriately diminish the negative impact of many everyday occurrences that had been so terribly unsettling for her. Laura claimed that her newly acquired ability to say, “So what?” helped ease her anxiety and enabled her to take more things in stride than she had been able to three years earlier. The difficult and annoying supervisor, the very noisy neighbors that once enraged her, and the not-very-neat friend with whom she shared an apartment became less daunting or upsetting when “I could give them the ‘so what’ treatment,” Laura happily told me.

The other therapeutic accomplishment Laura identified was her ability, over the course of our time together, to give up her “what ifs.” Early on, she was filled with what we termed “anticipatory dread.” This both created and perpetuated her highly stressful existence.

This anticipatory dread took the form of identifying worst-case scenarios, e.g., “What if he says no?” or “What if I fail the exam?” or “What if I have cancer?” She did this as a way of preparing for what she had convinced herself were the likely outcomes of almost anything that occurred in her life. When Laura understood that her worry and dread were not serving to prepare her for those worst-case scenarios as she had originally believed, she was able to gradually relinquish this troubled view of the future and found herself much less anxious and unhappy. To quote Laura, “No more ‘What if...’ and plenty of ‘So what?’ really set me free!”