Dealing with persistent worry

Worry can be useful when it helps us plan or problem-solve but becomes unproductive when focused on unlikely or worst-case scenarios. Persistent worry can interfere with your life, but effective strategies can help you regain peace of mind.

What is persistent worry?

Persistent worry—often referred to as rumination—is obsessive thinking in response to stress or uncertainty. People who ruminate have difficulty concentrating on the here and now because they are focused on things that have happened or might happen. Severe persistent worry may indicate a more serious condition, such as an anxiety disorder.

Scientists have not yet determined what causes people to persistently worry. The environment, genetics, and brain chemistry can all have an impact.

Signs of a problem

Persistent worry can feel like:

discomfort with success or fear of failure
lack of self-confidence/constant need for reassurance
being overly critical of oneself and/or others
fear of confrontation/preference for isolation
procrastination/indecisiveness
perfectionism
fragile self-esteem
physical pain in response to stress
gloomy daydreams/pessimism
extreme superstitious beliefs and/or behaviour
feeling “on edge”
difficulty concentrating

Forms and features of persistent worry

Hypervigilance. This refers to feeling easily threatened, frequently on edge, and unable to relax. For instance, a person experiencing hypervigilance who has to catch an early train might not be able to stop thinking about what will happen if their alarm doesn't go off on time. Such people often feel agitated and angry with themselves and others.

Insomnia. Lack of adequate sleep can affect physical and mental health and interfere with daily activities. Some people have trouble falling asleep, while others have trouble staying asleep. This can cause a vicious circle of worry because the insomnia itself becomes another source of worry.

Mental health conditions. If persistent worry is interfering with work or relationships, a mental health condition may be present.

In post-traumatic stress disorder (PTSD), a person who has endured a traumatic event, such as sexual assault, may be flooded with worry of it happening again.
A person with generalised anxiety disorder (GAD) may be plagued by unrealistic worries about possible misfortune when the risk is low or non-existent (for example, having a high-paying job but worrying about going bankrupt).
Social phobia causes people to avoid social situations (such as giving a speech) because of excessive worry about being embarrassed or humiliated.
In obsessive-compulsive disorder (OCD), a person is bothered by obsessions (say, worry over contamination) and engages in repetitive behaviour, like hand washing in an attempt to cope.

Worry can also lead to depression, referred to officially as major depressive disorder (MDD), characterised by a low mood, decreased energy, and poor concentration.

Medical problems. Worry can affect your immune system. It can contribute to high blood pressure, back pain, digestive problems, rashes, and headaches. If you are experiencing concerning symptoms, contact your GP to rule out any other medical conditions.

Since worry is often a deeply ingrained habit, you can't expect to change it overnight. But you can develop new coping skills that will, over time, help you retrain your brain to reduce persistent worry.

Self-help strategies

These simple strategies may help you to manage your persistent worry:

Acknowledge and release worries. If you tend to worry excessively, accept this part of yourself for now. Try setting a limit on how long you allow yourself to worry. For example, you could spend 20 minutes a day journaling about your worries, setting a timer so you know when time is up, then telling yourself it's time to let go of your worries and redirect your energy. If the worries return, say "Stop! I've finished worrying about this."

Take action. After making a realistic assessment of a worry, you could find that taking action puts your mind at ease. For instance, if you worry about preparing your tax return properly, you could prepare questions, gather your documents, and contact an accountant.

Stay connected. Isolation can cause worry to spin out of control. Talk to supportive people regularly. Voicing feelings of worry, anger, and frustration is a useful coping skill.

Make lifestyle changes. Creating time for physical activity every day can help release worry and keep you calm. It can also help you release your energy, making it easier to sleep at night. A healthy diet minimising sugar, caffeine, and processed food can also reduce the risk of anxiety and depression.

Be aware of your worry triggers. Our bodies tell us when we are upset with symptoms like muscle tension and increased heart rate. When triggered, focus on something else, call someone, go for a walk, or do something to interrupt the cycle.

Try meditation to stay in the present. No one can change the past or foresee the future. When people view things negatively, they usually tend to exaggerate potential problems. Meditation can help you stay in the present. Carve out a little quiet time for yourself each day. Aside from meditation, you can try listening to music or doing yoga.

Accept that some things are beyond your control. Unexpected traumatic events do occur. But worrying about possible disasters doesn’t make you any safer. Take charge of the things you can control and let go of the things you can't.

Be a problem solver. By realistically appraising your situation and focusing on the solution (instead of the problem), you have a better chance of interpreting things clearly and positively. Write down your worry and make a list of actions you can take to resolve it. This will help you accurately assess what needs to be done in order to move from immobilisation into action.

Remember that everyone worries sometimes. Approach difficult situations as concerns that need to be addressed rather than catastrophes. This can give you a more positive attitude and greater ability to cope with the situation, even if the outcome isn't favourable.

Treatment options

If you have a diagnosed mental health condition or need extra support, you can seek counselling from a mental health professional or ask for a referral from your GP. Cognitive behavioural therapy (CBT) is a form of psychotherapy that explores how you react to situations and the thought patterns that may be causing anxiety. It can be helpful for anxiety disorders and specific phobias—for example, a fear of flying.

If you are having difficulty engaging in everyday activities, anti-anxiety and antidepressant medication can be used in addition to counselling. Anti-anxiety medication can improve your sleep and/or help you face situations that make you uncomfortable. Antidepressants can give you more energy if you are feeling immobilised and listless due to worry. Your therapist or GP can give you more information about medication.

Where to get help or more information

Contact your assistance programme. Your organisation’s assistance programme can provide resources to help assess the nature of your problem and direct you to appropriate solutions.

Consider talking to a licensed therapist. You can get a referral from your GP or visit an online directory for therapists in your area.

Visit the World Health Organization – Mental Health and Global Mental Health Peer Network (GMHPN). The WHO provides comprehensive resources, guidelines, and research to improve mental health care worldwide, while the GMHPN offers peer support and advocacy.