​Metacognitive therapy (a form of CBT) tackles the clients ‘positive beliefs about worrying’ (“I think worrying is a useful thing to do!”), as well as their ‘negative beliefs about worrying’ (“I am afraid that I can’t control it… What’s going to happen to me if I can’t?... What if I have a nervous breakdown?!”).  It is recommended that those (very frightening) negative beliefs are fully dealt with first, moving the client to a better understanding of their anxiety and its manageability.  This part of therapy may be challenging, and may take some time, but will be well worth the effort!

​Having done this, the therapist next explores, with the client, their previous attempts at controlling their worry/anxiety.  Distraction is a favourite!  On the surface, distraction seems like a good strategy and, to a degree, it does work.  Perhaps the greatest issue with distraction, as a strategy for managing anxiety, is when it comes from a place of fear.  If one is fearful of their anxiety, and fearful of not being able to control their thinking, then attempts to ‘Suppress’, ‘Block’, or ‘Distract’ from those thoughts/emotions, will be of little real benefit – and may even reinforce their sense of danger.

​The term ‘Re-Focusing’ can be useful here, to help the client modify this coping strategy into one that will be more beneficial.  Re-Focusing, like Distracting, is about deliberately choosing to not engage with one’s distressing thoughts/emotions.  Unlike Distracting, though, the client is encouraged to; first acknowledge their worrying and/or anxiety, accept it as manageable, and only then, deliberately ‘ignore and re-focus’.

​Taking the time to generate a comprehensive list of ‘Re-Focus Activities’, with the client, can help to reinforce this helpful strategy.  It might also help to group the activities into the following categories;

​Daytime

• Socialising
• Exercising
• Working/Studying
• Housework/DIY project…

​Evening time

• Crafting
• Puzzles, Crosswords
• Board games

** READING AND/TV CAN BE TOO PASSIVE, MAKING IT EASY TO RETURN TO WORRYING

​Middle-of-the-night-time.
​
For many clients who struggle with anxiety, the night-time can be very difficult (mostly because they have no distractions!).  ‘Mental Re-Focus Activities’ can be of some assistance here;

• Designing your dream garden
• Create, in your mind, a Fantasy Football Team
• Name four countries that begin with the letter ‘A’, four countries that begin with the letter ‘B’…
• (You get the idea!)

References and Recommended Reading

Dugas, M. J. & Robichaud, M. (2007). Cognitive-Behavioural Treatment for Generalised Anxiety Disorder: From Science to Practice. New York: Routledge.
Meares, K. & Freeston, M. (2015). Overcoming Worry and Generalised Anxiety Disorder: A self-help guide using Cognitive Behavioural Techniques. London: Robinson.
Wells, A. (2007). Cognitive Therapy of Anxiety Disorders. England: Wiley
Wilkinson, A., Meares, K. & Freeston, M. (2011). CBT for Worry & Generalised Anxiety Disorder. London: Sage.

​Our clients who struggle with anxiety don’t always make the connection between their ‘worry-ing’ and their ‘anxiety’.  And even when they do, they may not be fully aware of how (and why) they are choosing this ‘worry-ing’ as a coping mechanism.  When asked, “Why do you worry so much?”, most of our clients will quickly deny any choice or control in the matter!  Mostly, they will insist that, “Of course worrying is a pointless exercise!”. 

​CBT-for-Anxiety researchers, however, have shown that ‘positive beliefs about worrying’  (ie " I think it's good to worry!") can play a crucial role in the cause – and maintenance – of anxiety disorders.  A psychotherapy that explores and challenges these positive beliefs about worrying (ideally through Socratic Dialogue and Guided Discovery) will greatly enhance the clients understanding of their anxiety, thereby leading to better outcome.

​Positive Belief #1: Worrying is Problem-Solving.
People who like to; be organised, plan ahead, and always be prepared, can often relate to this belief.  However, if we define ‘worrying’ as an ‘always on’ internal process, focusing only on the worst possible outcomes, then we can begin to see it as mostly unhelpful (and even counter-productive).  Psychotherapy can then help the client to explore more productive and efficient ways to ‘proper problem-solve’.

Positive Belief #2: Worrying Motivates me to get things done.
Having ‘specific concerns’ about an upcoming event, such as an exam/job interview can certainly motivate us to be prepared.  Concerns are good.  Concerns are spontaneous and automatic.  Worrying excessively about those specific concerns, however, has no value in itself.  Worrying excessively and catastrophising all that could go horribly wrong creates extra anxiety which only impedes our ability to concentrate on studying/preparing for that event!

Positive Belief #3: Worrying helps me avoid nasty surprises.
One of the most common ‘positive beliefs about worrying’ that clients offer, is that they always want to be ready for bad news.  They tell themselves that they couldn’t cope with something unexpected.  Having a lack of confidence in one’s ability to cope with difficult life events – and difficult emotions – is very often an important feature of an anxiety issue.  Challenging both of these beliefs, in psychotherapy will always pay dividends.

​Positive Belief #4: Worrying (magically) prevents bad events.
True story:  Many years ago, having just completed my Leaving Cert exams, I wondered if spending the Summer worrying excessively – or not at all - about the results would somehow magically influence those results!  Although this ‘positive belief about worrying’ seems to be less common than some of the others, it is certainly worth checking out.

Positive Belief #5: Worrying shows that I care.
“What sort of mother would I be if I didn’t worry about my children?!”  Of course, we often have ‘specific concerns’ about our loved ones.  Yet again, though, the activity of ‘worrying’ is of no benefit to the loved one, and is extremely unhelpful to the worrier.  Some useful questions here might be; “Who does your worrying serve/benefit?”, “Is there a better way that you can support this person?*

​While these are five of the most commonly held positive beliefs about worrying, Socratic dialogue and genuine (and gentle) curiosity, may elicit some others.

​References and Recommended Reading
Dugas, M. J. & Robichaud, M. (2007). Cognitive-Behavioural Treatment for Generalised Anxiety Disorder: From Science to Practice. New York: Routledge.
Meares, K. & Freeston, M. (2015). Overcoming Worry and Generalised Anxiety Disorder: A self-help guide using Cognitive Behavioural Techniques. London: Robinson.
Wells, A. (2007). Cognitive Therapy of Anxiety Disorders. England: Wiley
Wilkinson, A., Meares, K. & Freeston, M. (2011). CBT for Worry & Generalised Anxiety Disorder. London: Sage.