Worry as a Compulsion

Another common reaction to an anxiety trigger is worry. The general public doesn’t usually think of worry as a compulsion. Worrying seems like something we’d try to avoid as opposed to an avoidance technique. Sometimes worry starts with an intrusive thought—a quick, unwanted image or idea that pops in—and then you “pick it up” and run with it. The quick pop‑up is the intrusive thought, and the long mental story that follows is the worry (a compulsion).

As you monitor your worry during the exercise concluding this chapter, pay attention to whether each instance begins with a quick pop-up image or thought, or if you deliberately initiate it by attempting to mentally navigate through every potential consequence. Think of it this way: when faced with a potential threat or trigger, our brains attempt to find a solution. Using our imaginations, we think about possible outcomes, including WCSs.

Even though feelings associated with worry are uncomfortable, those feelings peak with the trigger and usually become less intense simply because our brains eventually signal the release of hormones that reduce the intensity of the fight-or-flight response (anxiety/ fear). Sometimes, coping thoughts are mixed in with worry. Coping thoughts generate more positive feelings. So, the natural lessening of intensity combined with the effect of coping thoughts becomes associated with short-term anxiety reduction, releasing the neurotransmitter dopamine and strengthening the association between triggers and the behavioral or mental compulsions such as worry. Research monitoring people in their daily lives confirms that worry is often reinforced by the relief we feel when a feared threat doesn't happen or isn't as bad as we expected. This is made more difficult by evidence showing that those with anxiety disorders learn more intensely from negative outcomes, which pushes them toward using worry as a strategy to avoid threats. This process defines worry as a form of negative reinforcement; when you experience unexpected relief from a threat, your brain's chemistry signals your internal circuits to strengthen the worrying behavior that came just before that relief. (Newman, M. G., Schwob, J. T., Rackoff, G. N., Van Doren, N., Shin, K. E., & Kim, H., 2022).

In both GAD and OCD, worry shows up as a classic way of dodging uncomfortable thoughts. Worry works as cognitive avoidance, metaphorically the handwashing compulsion for ridding the “contamination” of intrusive thoughts.

Worrying can feel productive, like I’m working on the problem or staying alert. My brain treats this as a “safety behavior,” reinforcing the cycle: when nothing bad happens, the brain learns to associate worry with a reduction in anxious arousal developing into an automatic habit.

Therefore, the mental behavior of worry becomes strengthened through a process known as negative reinforcement. Negative reinforcement occurs when we engage in a behavior that is associated with a decrease in discomfort. In this case, the cognitive behavior of worry is associated with a decrease in anxiety, and the tendency to worry becomes strengthened. The behavior used to reduce anxiety can make absolutely no rational sense—like counting ceiling tiles—or it may seem quite logical—worrying about what we’d do if the worst happens. Unfortunately, these behaviors don’t provide an actual solution to reducing anxiety in the long term. Worry is not problem-solving.

If you look up the verb worry in The Merriam-Webster Online Dictionary, you’ll find a couple of definitions. Here is one: “to touch or disturb something repeatedly; to change the position of or adjust by repeated pushing or hauling”. This definition reminds me of a behavior common in OCD in which the person compulsively shifts or moves objects to line them up or puts them “just so” in order to reduce their anxiety. Worry is that mental tendency to move a situation around, think about it just so, in order to feel better.

It is not reasonable to think that we should try to never worry or that those of us who practice a religious faith should stop praying. However, for people with anxiety disorders, physical and mental attempts to cope can develop into compulsive behaviors that keep them in a loop of triggers and compulsions that become dysfunctional.

Manifestations of anxiety and OCD can wax and wane over time. Stress and acute stress from trauma can be associated with such manifestations, but stress is not always clearly a precursor. For example, OCD symptoms often manifest in the teens and twenties, but not always. We also see OCD symptoms showing up in four-year-olds and forty-year-olds. Sometimes the symptoms worsen with stress, and sometimes they don’t. Without treatment, however, symptoms tend to persist and generalize to new triggers. With treatment, most individuals will achieve long-lasting, significant relief.