Worry
Kevin D. McCaul, North Dakota State University,
and Paul W. Goetz

1 Description & Theoretical Background

Worry has been conventionally defined as a chain of thoughts and images, which are negatively affect-laden and relatively uncontrollable (Borkovec, Robinson, Pruzinsky, & Dupree, 1983 xClose
Borkovec, T.D., Robinson, E., Pruzinsky, T., & Dupree, J.A. (1983). Preliminary exploration of worry: Some characteristics and processes. Behaviour Research and Therapy, 23, 481-482. ). Early research concerning worry focused on what might be called pathological worry-the extremes of worry that make it the main feature of generalized anxiety disorder (GAD; Sanderson & Barlow, 1990 xClose
Sanderson, W.C., & Barlow, D.H. (1990). A description of patients diagnosed with DSM-III-R generalized anxiety disorder. Journal of Nervous and Mental Disease, 178, 588-591. ). It is possible to worry, of course, without having a clinical diagnosis of GAD. Ruscio and Borkovec (2004) xClose
Ruscio, A.M., & Borkovec, T.D. (2004). Experience and appraisal of worry among high worriers with and without generalized anxiety disorder. Behaviour Research and Therapy, 42, 1469-1482.  tested high worriers with and without GAD and reported that the former group experienced less control over their negative thoughts and reported greater arousal after worrying. The feeling of not being able to control one's worry ("meta-worry") is probably the key to distinguishing between "pathological" and "normal" worrying.

Even normal worrying has been associated occasionally with negative health outcomes, although all of the data are correlational. Kubzansky et al. (1997) xClose
Kubzansky, L.D., Kawachi, I., Spiro, III, A., Weiss, S.T., Vokona, P.S., & Sparrow, D. (1997). Is worrying bad for your heart? A prospective study of worry and coronary heart disease in the normative aging study. Circulation, 1997, 95, 818-824. , for example, showed in a prospective study that men who worried more about social conditions (e.g., economic recession) were more likely to suffer from coronary heart disease, and Brosschot and Thayer (2004) xClose
Brosschot, J.F., & Thayer, J.F. (2004). Worry, perseverative thinking, and health. In L. R. Temoshok (Ed.), Biobehavioral Perspectives on Health and Disease, 6, Harwood Academic Publishers.  identified a general positive relationship between dispositional worry and risk for coronary heart disease. Specific worries may also increase one's risk of negative health outcomes. Cohen et al. (2003) xClose
Cohen, L., Fouladi, R.T., Babaian, R.J., Bhadkamkar, V.A., Parker, P.A., Carmack Taylor, C., Smith, M.A., Gritz, E.R., & Basen-Engquist, K. (2003). Cancer worry is associated with abnormal prostate-specific antigen levels in men participating in a community screening program. Cancer Epidemiology, Biomarkers & Prevention, 12, 610-617. , for example, discovered that greater worry about prostate cancer was associated with higher levels of prostate-specific antigen (PSA) levels-a screening index of prostate cancer.

Although worry may have negative effects, worry may also have value. Investigators have pointed out that day-to-day worries function to motivate action to cope with the threat that is causing the worry (Davey, 1993b xClose
Davey, G.C.L. (1993b). A comparison of three cognitive appraisal strategies: The role of threat in devaluation of problem-focused coping. Personality and Individual Differences, 14, 535-546. ). Nearly everyone worries occasionally, and many people say that they worry every day (Tallis, Davey, & Capuzzo, 1994 xClose
Tallis, F., Davey, G.C.L., & Capuzzo, N. (1994). The phenomenology of non- pathological worry: a preliminary investigation. In G.C.L. Davey and F. Tallis (Eds.), Worrying: Perspectives on Theory, Assessment and Treatment. John Wiley & Sons. ). Data from a study asking people to complete daily diaries suggest that many of these worrisome thoughts are related to problem solving. Szabo & Lovibond (2002) xClose
Szabo, M., & Lovibond, P.F. (2002). The cognitive content of naturally occurring worry episodes. Cognitive Therapy and Research, 26, 167-177.  asked students to self-monitor and to record worrisome thoughts each time they had worried at least a little bit. Raters later categorized these thoughts, and well over half involved problem solving, such as worrying about how to break up with a significant other, resolving a dispute with a friend, or making a plan. The other half were more stereotypically "worrisome" thoughts, including anticipating bad outcomes, ruminating, and self-blame.

Still, worry is often related to an increase in behaviors that the worrier believes will protect his or her health. For example, higher worry levels predict:

• Obtaining an ultrasound test supposedly useful as an ovarian cancer screening tool (Schwartz et al., 1995 xClose
  Schwartz, M., Lerman, C., Daly, M., Audrain, J., Masny, A., & Griffith, K. (1995). Cancer Epidemiology, Biomarkers & Prevention, 4, 269-273. )
• Requests for genetic testing for breast cancer (Lerman et al., 1997 xClose
  Lerman, C., Schwartz, M.D., Lin, T.H., Hughes, C., Narod, S., & Lynch, H.T. (1997). The influence of psychological distress on use of genetic testing for cancer risk. Journal of Consulting and Clinical Psychology, 65, 414-420. )
• Whether sunbathers take a coupon for sun screen (Mermelstein, Weeks, Turner, & Cobb, 1999 xClose
  Mermelstein, R., Weeks, K., Turner, L., & Cobb, J. (1999). When tailored feedback backfires: A skin cancer prevention intervention for adolescents. Cancer Research Therapy and Control, 8, 69-79. ) and attending a screening clinic for skin cancer (melanoma; De Rooij, Rampen, Schouten, & Neumann, 1997 xClose
  De Rooij, M.J., Rampen, F.H., Schouten, L.J., & Neumann, H.A. (1997). Factors influencing participation among melanoma screening attenders. Acta Dermogoloy Venereology, 77, 467-470. )
• Interest in cancer prevention surgery (undergo bilateral prophylactic mastectomy) among high-risk women (Stefanek, Enger, Benkendorf, Flamm-Honig, & Lerman, 1999 xClose
  Stefanek, M.E., Enger, C., Benkendorf, J., Flamm-Honig, S., & Lerman, C. (1999). Bilateral prophylactic mastectomy decision making: A vignette study. Preventive Medicine, 29, 216-221. )

It is important to note that worry may not always lead to self-protective health behaviors, and the relationship between worry and behavior may not be a particularly strong one (McCaul, Branstetter, Schroeder, & Glasgow, 1996 xClose
McCaul, K.D., Branstetter, A.D., Schroeder, D.M., & Glasgow, R.E. (1996). What is the relationship between breast cancer risk and mammography screening?: A meta-analytic review. Health Psychology, 15, 423-429. ). Still, we might ask why worry should influence health behavior. Here are some possibilities (McCaul, Mullens, Romanek, Erickson, & Gatheridge, in press xClose
McCaul, K.D., Mullens, A.B. Romanek, K.M., Erickson, S.C., & Gatheridge, B.J. (in press). Thought, worry, and motivation to quit smoking cigarettes. Cognition and Emotion. ): a) worry can add a set of thoughts adding to one's reasons for taking health-protective action, b) worry is intrusive and, as such, it may keep a health threat salient, serving to remind the worrier to do something, c) worry could motivate specific planning, and d) worry may promote mental simulations of the health threat, including coping actions.