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
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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
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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)
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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)
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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)
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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)
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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
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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
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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)
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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
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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
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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
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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
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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
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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
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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
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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.
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