Coping with the “What If” of Anxious Thinking (Part 1)

    We all play the “what if” game at some time.  What if I miss the train, what if my mom forgets to pick me up, what if I fail my test, what if I don’t get asked to the prom.  At different ages, different kinds of “what if” thinking are more prominent. What if I don’t get the promotion, what if something bad happens to my children, what if I don’t count my bites of food and something happens to me. But when “what if “thinking paralyzes people, it keeps them from truly living their lives. When the frequency and intensity of this anxious thinking traps someone so that they cannot function well, then it becomes a psychological disorder.

The key to understanding and living with “what if” thinking lies in accepting the fact that there is uncertainty in life.  We may never have true assurances that what we want will happen (like getting asked to a prom or getting a new job) or that the bad thing we are fearing, such as mom forgetting to pick me up or getting a bad illness, will not happen.

So how can we learn to cope better with “what if” thinking. Sometimes people try to cope with “what if” thinking by avoiding the thing that they fear.  A child who fears mom not showing up at dismissal may try to avoid going to school.  A man who hates his job but fears the rejection of applying for new jobs may stay in an unsatisfactory position.  Another way that people try to avoid the uncertainty is by trying to deflect or neutralize the “what if” thinking by using specific thoughts or actions (sometimes called rituals.) The person with OCD may try special rituals that they think reduce the worry, and a person with social anxiety may over- rehearse what they will say in social situations.  A child may seek constant reassurance before going to school, and a mom who fears her child will get pregnant may continually grill her daughter about not having sex.

The problem with trying to neutralize the “what if” worry is that it becomes an endless loop and does not in any way help the person cope better with the anxiety.  The only way to cope better with anxiety is to face it head-on and get through the situation, then realizing that you made it and what you feared did not happen. It takes courage to do this.

There are many techniques that can help cope with anxiety, such as relaxation, mindfulness, cognitive restructuring, anxiety level monitoring and others. One of the most prominent skills is called Exposure and Response Prevention, commonly used in OCD treatment.  Exposure means facing and being aware of the fears, exposing yourself to thoughts, situations, or objects that elicit anxiety or provoke obsessive behavior.  Response prevention means NOT engaging in attempts to neutralize the fear by avoidance, thinking a calming thought, or using a ritualized compulsive behavior.  It means making a conscious decision, even after your fear and worry are triggered, to tolerate it and not let it control what you do.  Eventually, by not engaging in behaviors that minimize your anxiety, the pressure to engage in rituals diminishes and so does the anxiety.

Since E/RP can actually change your brain and change the way you react to your brain’s mistaken danger signals, it is one of the most successful ways to deal with the “what if” thinking of OCD. But when you begin to learn how to use it, it can feel scary at first, and should only be done under the guidance of a therapist.

(Please check my website in a few weeks for Part 2 of Coping with “What If” Thinking, where we look at ways to deal with the “what if” thinking of other disorders that involve anxiety.)