Take Control of Your Wellbeing.

GAD Program Lesson 3

Managing Persistent Worry
1 WWW.THISWAYUP.ORG.AU
Welcome and Lesson Overview

Welcome to the summary for Lesson 3. This summary reviews the key points discussed in
Lesson 3, and summarises some tasks for you to work on.

Before you start reading this summary, please take a moment to reflect on your progress so
far. It is important to remind yourself that it takes time to learn and develop new skills! Any
practice is better than none, and the more you use new skills and strategies to manage your
anxiety, the more confident you will feel in being able to get on top of your symptoms.

Don’t hesitate to contact us if you have any questions at any stage of this program, by email
or by telephone 02 8382 1437.

Good luck!

The Team from THIS WAY UP Clinic

www.thiswayup.org.au

Topics Covered In This Summary & Action Plan

Here is a list of the topics we will cover in this Summary. Tick these off as you go:

1. Structured Problem Solving (page 3)

2. Identifying Positive and Negative Beliefs About Worry (page 7)
3. Challenging Positive and Negative Beliefs (page 9)
4. Experimenting with Beliefs about Worry (page 11)
5. Shifting Your Attention (page 15)
6. Dealing with Worries Step-by-Step (page 16)
7. Summary of Skills & Action Plan (page 17)

2 WWW.THISWAYUP.ORG.AU
1. Structured Problem Solving

People with GAD often have difficulty making decisions, and often feel overwhelmed by
their problems. Structured problem solving is a practical skill for helping you find solutions
to everyday problems. Problem-solving may already be familiar to you. However, you may
still find it useful to help you gain confidence in making decisions.

Step 1: Identify the problem

Identify one problem that is causing you difficulty and is making you feel anxious or worried.

Tips for this step:

 Get a clear and specific definition of the problem or break it down into smaller
parts. For example, the problem “I’m broke” could be broken down to the specific
problem “My credit card repayment is due next Wednesday and I am unable to pay
it.” This helps you to identify when you have solved the problem.
 Only consider one problem at a time. If other problems arise in the course of the
problem solving session, write them down to tackle in the future.

Step 2: Generate solutions through brainstorming

Brainstorm as many possible solutions as you can.

Tips for this step:

 Get help from friends or family for this step, or think of what options they might
come up with.
 List all solutions that come to mind without evaluating them yet (even if they don’t
seem perfect or ideal, or even if they seem absurd).
 Use your imagination! Even though a solution may at first seem ridiculous, the idea
may help to generate better solutions than those that are more obvious.

Step 3: Evaluate the solutions

Identify and consider the pros (advantages) and cons (disadvantages) of each solution.

Tips for this step:

 You can either write these points down or just quickly run through the list of
solutions in your mind, noting the strengths and weaknesses of each.
 Accept that no solution will be perfect since every good idea will have some faults.

3 WWW.THISWAYUP.ORG.AU
Step 4: Choose the optimal solution and create a plan of action
Pick a solution or a combination of solutions which will solve the problem. Create a detailed
plan to implement it.

Tips for this step:

 Choose a solution that can be readily applied and which is not too difficult to
implement. This is preferable to choosing a solution which is doomed to fail because
you have been overly ambitious.
 Plan out step-by-step how you will carry out your solution, and when you will do it. A
detailed plan of action will increase the likelihood of you solving the problem.

To help make a plan, consider the following questions:

Do you have all the necessary resources (e.g., time, skills, and equipment)
or do you need to arrange them?
Do you have the agreement or co-operation of other people who might be
involved in the plan?
Do you know exactly what needs to be done, and when you will do it?
Can you use any of your other CBT skills, for example thought challenging
or activity planning to help you implement difficult parts of the plan?

Remember: although the problem may not be solved immediately, the solution
might have made a difference, and what is learned from this attempt might be
useful the second time around.

Step 5: Review what happened

This stage needs to be planned in advance. It is an opportunity to assess progress. What has
been achieved? What still needs to be done?

Often, problems are not completely solved after the first round of structured problem
solving. Use this step to reflect on what you have learned, and make plans for your next
solution. If there is more you need to do or achieve, start the Structured Problem Solving
process again.

The next page has an example of a completed ‘Structured

Problem Solving Worksheet’. You can download a blank EXTRA RESOURCE
version of the sheet form the Extra Resources.

4 WWW.THISWAYUP.ORG.AU

Step 1: What is the
problem? Think about this
carefully and write down
exactly what the problem is
– the more narrowly you
can define it, the better.
Step 2: List all possible
solutions. Put down all
ideas, even bad ones.
Remember not to evaluate
at this stage.
Step 3: Evaluate each
possible solution. Quickly
go down the list of all
possible solutions and
consider the advantages
(pros) and disadvantages
(cons) of each one.
Step 4: Choose the best or
most practical solution.
Choose the solution that
can be carried out to most
easily solve (or begin to
solve) the problem.
5 WWW.THISWAYUP.ORG.AU
Liz’s Responses Your Responses
I don’t know what to do in
My boss keeps giving extra work to do
life. I sometimes
at the end of the day. This makes me dissacosiate from myself
late to pick up the kids from school.
Do many jobs
a. Come into work earlier.
b. Put the kids in after school care. Stop what i’m doing now
c. Talk to my boss.
d. Get Matt to pick up the kids from
school.
e. Get a new job
Probably the best bet
a. Could do this but my boss often
gives me the new work at 4pm. Only good if i had other
b. Expensive and not ideal, I want to stuff lined up
spend more time with them in the
afternoon.
c. Could deal with him directly and
explain my situation but I feel
really nervous about it.
d. Matt would have to negotiate
getting off work early, he already
starts late to drop the kids in the
morning.
e. Very tricky. This problem could
also arise at a new job.
1
Talk to my boss, explain my situation
and offer a solution of scheduling a
lunchtime meeting to discuss work.
Step 5: Plan how to carry
out the best solution. Plan
out step-by step how you
will carry out your solution,
and when you will do it.
Set aside at time to do step
6 (review of progress):
Step 6: Review progress.
Focus on the things you
have achieved first, and be
pleased with any progress
you have made. Next,
consider what still needs to
be done. You may wish to
complete worksheet over
again to help you keep
moving forward.
What has been achieved?
What still needs to be
done?
6 WWW.THISWAYUP.ORG.AU
1. Plan main points to discuss with
my boss.
2. Ask for a meeting with my boss.
3. In meeting explain my current
difficulties with being assigned
work at 4pm.
4. Offer solution of a regular
lunchtime meeting.
Monday 9am.
I met with my boss. He seemed to
understand the difficultly with
assigning me new tasks at the end of
the day. He agreed to a weekly
lunchtime meeting to discuss progress
and assign new tasks.
To attend weekly lunchtime meeting
and evaluate this solution after a
week.
2. Identifying Positive and Negative Beliefs about Worry

In the last lesson, we discussed how our thoughts can

affect how we feel and behave in different situations. You
learnt that people with GAD often overestimate the
likelihood of threat and underestimate their ability to
cope, leading to physical symptoms of anxiety and to
avoidance of feared situations.

So, why do I keep worrying?

People with GAD often say they have “always been a worrier”, and even though they don’t
want to worry they just can’t seem to stop. However, they are likely to have mixed feelings
about their worries. At times, some worries may be very distressing and upsetting, and stop
people from enjoying normal activities, however, other worries may seem helpful or
beneficial. These are called positive and negative beliefs about worry and are very common
among people with GAD. For example, many people believe worrying helps them to prepare
for negative events or challenging situations (e.g. presentation at work or exam at university)
and they would not succeed without worrying. Other people may believe worrying is
harmful and that it makes them sick.

For example, Liz believed ‘worry helps me get things done’. This meant she used worrying
as a coping strategy at stressful and challenging times in her life. While in the past, Liz may
have viewed worrying as a helpful way to motivate herself or to remain productive, now it
may act to maintain her feelings of anxiety and stress.

Worrying helps me get Worry more to try and

Feel anxious
things done be productive

Also, if someone had the negative belief ‘worry is harmful or bad for me’ they may start to
worry about worrying a lot. In this sense, believing that worrying is harmful can cause you to
worry more!

This worrying is making

Feel anxious Worry more
me go crazy

7 WWW.THISWAYUP.ORG.AU
 Why do I need to shift my beliefs about worry?
While it is understandable how these beliefs have developed over time, they can maintain
and reinforce physical and emotional symptoms of GAD. For example, if somebody has the
positive belief “worrying helps me solve problems” then they may be hesitant to complete
this course or apply the skills to challenge or shift their worries, which will prevent them
from getting better over time.
Listed below are some common positive and negative beliefs about worry. Tick those
that apply to you:

Positive Beliefs about Worry Negative Beliefs about Worry

 Worrying helps me to cope  If I don’t control my worry then it will

control me
 Worrying keeps me safe
 If I worry it means I am a weak person
 Worrying stops bad things from happening
 My worry is harmful to others
 Worrying motivates me to check on my
health  My worry is uncontrollable
 Worrying helps me to be prepared for all  Worrying is harmful to me
possibilities
 Worrying makes me sick
 Worrying helps me to solve problems
 Worry could make me go crazy
 Worrying shows I care
 Worries are realistic and likely to happen
 If I did not worry, I would be incompetent
 Other:
 Other:
_________________________________ _________________________________

8 WWW.THISWAYUP.ORG.AU
3. Challenging Positive and Negative Beliefs about Worry
Now you have identified some of your positive and negative beliefs about worry, let’s
apply the thought challenging technique you learned last week. But first, let’s see if
Liz’s belief is based on evidence, and not just what she feels. Remember we want our
beliefs about worry to be realistic, balanced and helpful.

1. Situation
What is the situation that is upsetting you? What has happened?
I have an important presentation at work in front of my boss in two days.

2. Thoughts
What are your thoughts about this situation? What is going through your mind?
I’m worried I will make a mistake and I’ll embarrass myself in front of my boss.

Beliefs about worry

Worrying helps me get things done.

3. Feelings
How do you feel? E.g. angry, sad, happy, surprised, ashamed, scared, guilty, joyful,
anxious, disgusted, annoyed, delighted. *Rate the strength of your feelings from 0
(low) to 100 (high)
Anxious (70/100)
Afraid (80/100)

4. Explore & Evaluate

What are the facts? What evidence do you have that supports this thought?

- I can think of times when I haven’t worried and I’ve still managed to get things
done.
- In the past when I have worried about a work presentation I’ve been too
distracted and unable to focus. I’ve ended up spending longer working on the
presentation than necessary.

5. Moving forward
What is your conclusion? How can you help yourself cope better in the future?
Perhaps worrying isn’t as helpful as I thought. I tend to get less work done and feel
exhausted and tense for days. Instead I could try another approach next time I have a
presentation.

Now it’s your turn, pick a positive or negative belief about worry on the previous page
and have a go challenging it.

9 WWW.THISWAYUP.ORG.AU
Thought challenging: My positive and/or negative beliefs about worry
1. Situation
What is the situation that is upsetting you? What has happened?

2. Thoughts
What are your thoughts about this situation? What is going through your mind?

Beliefs about worry

3. Feelings
How do you feel? E.g. angry, sad, happy, surprised, ashamed, scared, guilty, joyful,
anxious, disgusted, annoyed, delighted. *Rate the strength of your feelings from 0
(low) to 100 (high)

4. Explore & Evaluate

What are the facts? What evidence do you have that supports this thought? If the
worst were to happen, how would you cope? What would you say to a friend in this
situation?

5. Moving forward
What is your conclusion? How can you help yourself cope better in the future?

10 WWW.THISWAYUP.ORG.AU
 Helpful questions for challenging positive/negative beliefs
? Were there times when I didn’t worry and everything was ok?

? Are there other explanations other than worry as to why XYZ did not happen?

? Did worry stop the negative event from happening?

? Have you been able to cope before without worrying?

? Are there alternative explanations for what happened?

? Are there times when I didn’t worry and I still got sick?

? What is the evidence I will lose control from worrying?

? What would it look like if I lost control from worrying?

? Would it still be so bad in a week/month/year?

For more information on “Challenging Beliefs about

Worry” go to our extra resources section after this
EXTRA RESOURCE
lesson.

There are other ways you can test your positive and negative beliefs about worry. One
very effective way of tackling these beliefs is to use an experiment.

4. Experimenting with Beliefs about Worry

As we have discussed before, your beliefs about worry are essentially predictions about
something happening in the future. For example, if we believe thinking about rain will make
it rain then we can test this.
We have learnt so far in the course that predictions are not always true and often we need
to put them to the test to figure out if they are realistic, helpful and balanced. One of the
best ways to do this is to use an experiment.

Let’s try an example together.

11 WWW.THISWAYUP.ORG.AU
Example 1:

Step 1
Identify the Belief “By worrying I can stop bad things from happening”.

Step 2 Select an external event where bad things generally

Design an experiment to happen. For example “deaths on state roads”. Make sure
see whether this belief is you can check the statistics (e.g., by checking the Police
true (accurate) or false Service website).
1. Check the statistics on the Police Service Website
regarding deaths on state roads
2. For one week, plan a period of time to worry each
day about these events.
3. Look up the statistics again for the week in which
you worried. Compare these statistics to the week
prior when you didn’t worry about this topic (i.e.,
were the numbers and frequency the same,
different, did they drop when you worried?)
Step 3 If worrying stops bad
3T If worrying does not stop bad
3T

Write down your things from happening, I things from happening, I

predictions would notice: would notice:
 No deaths on state
3T  The rate of deaths on
3T

roads during the week state roads stays the

when I worry same whether or not I
worried
Step 4 If there were no deaths on the state roads during the
“worry week” then this means your worry has prevented
Evaluate the outcome
those bad things from happening. If no changes occurred,
Evaluate the evidence: this means your positive belief is false.
was your prediction
correct?

12 WWW.THISWAYUP.ORG.AU
Example 2: Testing out a Negative Belief about Worry

Step 1
Identify the Belief
Step 2
Design an experiment to
see whether this belief is
true (accurate) or false
“If I think too much, I will go crazy and lose
control”
Define how you would know you whether you had gone
crazy or lost control. Would you run around the room
screaming? Would you be unable to complete some simple
arithmetic? What are the hallmarks of ‘craziness’ or loss of
control?

Set a period of 5 or 10 minutes in which you deliberately try

to worry yourself crazy or worry until you lose control.
Step 3 If worrying makes me go
3T If worrying does not make
3T

Write down your

3T crazy and lose control, I me go crazy and lose control,
predictions would notice: I would notice:
 I would not be able to
3T  I may not be able to
3T

do the task I set concentrate, but I

myself would still get the task
done
 I will have a panic
3T

attack  I won’t panic or

3T

collapse
 I will collapse
3T

Step 4
3T

If you have gone crazy (based on your definition of crazy)

Evaluate the outcome
your prediction is correct. If you haven’t gone crazy, your
Evaluate the evidence: was belief is false!
your prediction correct?

(Examples taken From Abbott, M & Kemp, K. A 12 week program for treating excessive worry).

13 WWW.THISWAYUP.ORG.AU
Your Turn!

Step 1
Identify the Belief

Step 2
Design an experiment to
see whether this belief is
true (accurate) or false

Step 3
Write down your
3T

predictions

Step 4
3T

Evaluate the outcome

Evaluate the evidence: was
your prediction correct?

Once you’ve designed this experiment, do it and remember to evaluate the outcome
afterwards.

If you’d like more information about experimenting beliefs

about worry, download the “Worry Time” extra resource
EXTRA RESOURCE
after this lesson.

5. Shifting Your Attention

In any particular situation, once you have identified a thought or a thinking trap that was
triggering anxiety, challenged it by looking at the evidence, and arrived at the conclusion
that it’s “just worry” and your worrisome predictions aren’t realistic or helpful, it’s time to
shift your attention to something else to prevent worry from escalating further.

14 WWW.THISWAYUP.ORG.AU
For example, when Liz worries about Matt being in an accident she experiences an increase
in anxiety. But, because she knows that it is unlikely Matt is actually in an accident, she can
shift her attention away from her anxiety, and back onto what she was doing. Overtime, the
skill of shifting attention can help prevent anxiety and worry from becoming intense and
unbearable.

How to Shift Your Attention

So, how do you shift your attention away from worrying thoughts? As with all
of the techniques we’ve talked about in the this Program, the
most important rule is to start gradually: Practise, and you’ll notice
improvements.

Techniques that help to shift attention include (tick the ones you think you
can try):
 Distract attention away from the worrying thought: For example, ask yourself
questions such as “What’s in my diary for later today?”, “What do I need to buy at the
supermarket?”, “What did I do yesterday?” etc.

 Acknowledge that you feel anxious, but coach yourself through it: For example, “I
know I’m feeling anxious, but that’s normal, and I’m actually feeling better than usual,
and I’m going to do this slowly and carefully.”

 Think about the people around you, and how they might be feeling: For example, “It’s
possible that other people at work are feeling very busy too, they will probably
understand if I am a bit late to the meeting.”

 Concentrate on the task that you’re doing: For example, while shopping at the
supermarket concentrate on the items in the aisles, rather than on what you think
people might be thinking of you.

It is essential that you practice shifting your attention. Practice in situations where you’re
likely to succeed, as success breeds success! It might be useful to start trying to shift your
attention in situations where you are not worried first (for example, when listening to music
shift your concentration from one instrument to another) so that it is easier to do this when
you find yourself worrying.
Let’s take a look at an example of shifting attention:
Imagine you are sitting on the train on the way to work and worrying about the 9am work
meeting. You could be going over and over all the worries you have, like “I will not be able
to say anything”, “The boss will think I am incompetent”, or “Everyone will look at me like I
am an idiot”.

15 WWW.THISWAYUP.ORG.AU
Let’s imagine you have already written these thoughts down, and recognised that you have
been mind-reading and fortune-telling. Once you have done this, it is a good time to shift
your attention away from your thoughts. You could do this by focusing on what is actually
happening on the train by asking yourself:
 What is actually happening around me?
 What can I see?
 What are the sounds I am hearing, and smells I can smell?

You could shift your attention to the newspaper in front of you. Next you could shift your
attention to the sound of the train on the tracks. You could observe all the sights and
sounds that are occurring around you.

The aim of this skill is to return your attention to the present moment, whatever might be
happening. Notice when your mind drifts back to negative thoughts and practise letting
them go, as if they were leaves floating down a stream. Overtime and with practice, it
will become much easier to ‘disengage’ from your worries.

6. Dealing with Worries Step-by-Step

So far in this course, you’ve learned multiple skills to manage your thought symptoms of
GAD. To help you decide which skill to use for which problem, we have created a decision
tree.

16 WWW.THISWAYUP.ORG.AU
If you find yourself worrying, you can ask yourself some questions to decide which
strategies to use to help you cope:

1. Is it realistic? – If your worry is not realistic, or you are not sure, you can use thought
challenging to challenge your worries. If you then decide that your fears are realistic,
then you can ask yourself:

2. Can I do something about the problem? – If the problem is not solvable, you can
choose to shift your attention to stop worrying and do something active to take
your mind off your worries.

3. If you decide that your problem might be solvable, and there is something you can
do about it, you can use Structured Problem Solving to help you decide a course of
action.

7. Lesson 3 Summary of Skills and Action Plan

Congratulations on all of your hard work! Let’s quickly review the skills you have learned
this lesson.

Today you learned to:

 Address solvable problems in a structured way.

 Identify limiting beliefs about worry.
 Challenge and experiment with positive and negative beliefs about worry.
 Shift your attention away from worries.
 Learn which strategies to use when.

17 WWW.THISWAYUP.ORG.AU
Below is your action plan for the following week. Make sure to schedule time to complete
each activity and practise each skill.

LESSON 3: MY ACTION PLAN

 Identify and evaluate my beliefs about worry: Are they realistic? Are they
accurate? Are they helpful?

 Design and run an experiment to test my beliefs about worry.

 Use Structured Problem Solving to help me with worries that are realistic.

 Continue noticing and reframing any unhelpful thoughts or thinking errors

using the Thought Challenging technique.

 Exercise at least 30 minutes per day 3 times per week and reward myself when
you meet your exercise goal.

 Use Controlled Breathing whenever I notice anxiety increasing.

 Use Progressive Muscle Relaxation when I notice tension building up in my
body.

Good Luck!

The Team from THIS WAY UP Clinic

www.thiswayup.org.au

18 WWW.THISWAYUP.ORG.AU