By Shaun Hotchkiss, CBT Psychotherapist
Anxiety is a normal and adaptive human response. It evolved to help us detect and respond to threat. When functioning well, it sharpens attention, increases alertness and motivates preparation.
However, for many people anxiety becomes persistent, excessive, and difficult to control. Rather than responding to immediate danger, the mind begins anticipating potential future threats. This process is commonly experienced as worry.
While worry can sometimes feel protective or productive, chronic worry often maintains anxiety rather than resolving it. Cognitive Behavioural Therapy (CBT) offers a structured, evidence-based approach to understanding this cycle and learning how to respond differently.
What Is Worry?
Worry is typically defined as a chain of repetitive, negatively focused thoughts about uncertain future events (Borkovec, Robinson, Pruzinsky, & DePree, 1983). It often takes the form of “what if…” thinking:
- What if I make a mistake?
- What if something goes wrong?
- What if I can’t cope?
- What if this means something serious?
Research suggests that worry is primarily verbal in nature (rather than image-based) and functions as a cognitive attempt to problem-solve potential threats (Borkovec & Inz, 1990). However, unlike effective problem-solving, worry tends to be circular, abstract and difficult to resolve.
In Generalised Anxiety Disorder (GAD), excessive and uncontrollable worry is the central feature (American Psychiatric Association, 2013). But problematic worry also plays a role in health anxiety, social anxiety, panic disorder and obsessive-compulsive difficulties.
A CBT Understanding of Worry
From a CBT perspective, worry is not random. It is maintained by identifiable cognitive and behavioural processes.
The cognitive model of Generalised Anxiety Disorder (Dugas et al., 1998; Wells, 1997) highlights several key maintaining factors:
- Intolerance of uncertainty – difficulty accepting that outcomes cannot be fully predicted.
- Positive beliefs about worry – e.g. “Worrying helps me prepare”.
- Negative beliefs about worry – e.g. “My worrying is uncontrollable”.
- Cognitive avoidance – using worry to avoid more distressing mental imagery.
Worry often provides short-term relief. When a person engages in worry, they may temporarily feel more prepared or more in control. This short-term reduction in distress reinforces the behaviour, increasing the likelihood that worry will be used again in the future.
This creates a maintenance cycle:
- Trigger (internal or external).
- “What if…” thought.
- Anxiety increases.
- Worry escalates.
- Temporary sense of control.
- Anxiety returns.
CBT aims to interrupt this cycle by modifying both the thinking patterns and behavioural responses that maintain worry.
How CBT Helps with Anxiety and Worry
CBT does not aim to eliminate anxiety altogether. Anxiety is a normal emotional response and plays an important protective role. Instead, CBT focuses on helping individuals develop a different relationship with their thoughts and uncertainty.
Interventions may include:
- Psychoeducation about anxiety and threat systems.
- Identifying worry triggers and patterns.
- Differentiating between productive and unproductive worry.
- Behavioural experiments to test feared predictions.
- Reducing reassurance-seeking and avoidance.
- Developing tolerance of uncertainty.
- Scheduled “worry time”.
One particularly effective and accessible strategy is the use of a worry diary, often combined with scheduled worry time.
The Worry Diary: Postponing Rather Than Suppressing
Attempting to suppress worry is generally ineffective. Research on thought suppression demonstrates that trying not to think about something can paradoxically increase its frequency (Wegner, 1994).
CBT therefore adopts a different strategy: postponement rather than suppression.
The principle is simple:
You may not be able to control which thoughts arise — but you can influence when and how you engage with them.
A worry diary helps operationalise this.
How a Worry Diary Works
1. Notice the Worry
When a worry thought appears, it is briefly recorded.
For example: “What if I embarrass myself in tomorrow’s meeting?”
This step builds awareness without engaging in prolonged rumination.
2. Postpone to Scheduled Worry Time
The individual designates a specific daily period (often 20–30 minutes, not close to bedtime) as “worry time.”
When the thought arises outside this period, they tell themselves:
“I will think about this properly during my worry time.”
This is not avoidance — it is structured postponement.
3. Redirect Attention
The individual gently redirects attention to the present activity. This may need to be repeated multiple times.
Over time, the brain begins to learn that worry does not require immediate action.
Why Worry Postponement Is Effective
There are several mechanisms involved:
Reduced Urgency
The brain learns that worry is not an emergency requiring immediate cognitive engagement.
Breaking Reinforcement
Immediate engagement with worry is reinforcing. Delaying it weakens this cycle.
Increased Tolerance of Uncertainty
Postponement strengthens the ability to sit with unanswered questions.
Cognitive Restructuring
Individuals experience that thoughts can be observed and scheduled, rather than cause automatic behaviours.
Research suggests that structured worry postponement can significantly reduce worry frequency and intensity (Borkovec et al., 1983; Dugas & Robichaud, 2007).
Interestingly, many people report that by the time scheduled worry time arrives, the earlier concerns feel less urgent or less believable.
Taking Back Control from Automatic Thoughts
A common experience in anxiety is the sense that thoughts are intrusive and uncontrollable. This can lead to secondary anxiety — worrying about worrying.
CBT reframes this:
While we cannot fully control the automatic emergence of thoughts, we can influence our response to them.
This shift — from reaction to response — is central to regaining a sense of agency.
Over time, individuals often notice:
- Fewer spontaneous worry episodes
- Reduced intensity of anxiety
- Greater psychological flexibility
- Increased confidence in coping
The goal is not to eliminate uncertainty or silence the mind. It is to respond in ways that reduce the long-term maintenance of anxiety.
Conclusion
Anxiety often persuades us that constant mental rehearsal will prevent bad outcomes. In reality, excessive worry rarely produces certainty. Instead, it sustains physiological arousal and cognitive distress.
CBT offers structured, evidence-based strategies to:
- Understand the function of worry
- Break maintenance cycles
- Strengthen tolerance of uncertainty
- Develop intentional responses to intrusive thoughts
A worry diary may appear simple, but its power lies in restoring choice.
Not every thought requires immediate attention. And learning that distinction can be transformative.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Borkovec, T. D., Robinson, E., Pruzinsky, T., & DePree, J. A. (1983). Preliminary exploration of worry: Some characteristics and processes. Behaviour Research and Therapy, 21(1), 9–16.
Borkovec, T. D., & Inz, J. (1990). The nature of worry in generalized anxiety disorder. Behaviour Research and Therapy, 28(2), 153–158.
Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: A preliminary test of a conceptual model. Behaviour Research and Therapy, 36(2), 215–226.
Dugas, M. J., & Robichaud, M. (2007). Cognitive-behavioral treatment for generalized anxiety disorder: From science to practice. Routledge.
Wegner, D. M. (1994). Ironic processes of mental control. Psychological Review, 101(1), 34–52.
Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. Wiley.
