Worrying Is Optional Break the Cycle of Anxiety and
Rumination That Keeps You Stuck
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—Josh Spitalnick, PhD, ABPP, CEO/owner of Anxiety
Specialists of Atlanta; and author of the parenting guide,
Raising Resilience
“Worrying Is Optional is an exceptional self-help workbook that is
valuable to anyone struggling with worry. The gift of this beautiful
book is that it teaches you how to accept what you can’t control
and live a meaningful life. Eckstein does a superb job exploring the
function of worrying and other unhelpful covert mental behaviors.
The exercises and tips throughout this book will help the reader be
more aware of their unhelpful mental processes and responses,
implement concrete strategies, and be more present in their lives. I
look forward to sharing this wonderful resource with clients and
friends!”
—Marisa T. Mazza, PsyD, psychologist, founder of
choicetherapy, IOCDF BTTI faculty, and author of The ACT
Workbook for OCD
“What a delight to read! This metaphor-rich book empowers
readers to dismantle worrying using tools from a wide evidence
base. Eckstein acknowledges the complexity of how our brains can
latch on to worries, and provides compassionate strategies to help
people get out of the familiar rut of anxious patterns. Even better,
he provides tools to help cultivate new patterns to live a purposeful
and valued life.”
—Amy Mariaskin, PhD, founding director of the Nashville
OCD & Anxiety Treatment Center, and author of Thriving
in Relationships When You Have OCD
“Some people are prone to overthink or think a lot about important
things, small matters, or day-to-day interactions. The challenge is
that, as much as it feels natural to think and problem-solve things in
our head, for some people, that ongoing thinking pattern keeps
them stuck in a cycle of worry. Worry is a very common
psychological struggle across many presentations and if it goes
unchecked, it can be extremely debilitating in a person’s life. In this
book, Ben shows skills derived from different evidence-based
approaches to tackle worry in a skillful, engaged, and actionable
approach. Every chapter includes a specific skill to address
different processes that maintain and perpetuate worry. This is a
must-read book for anyone dealing with worry that wants to
experience a joyful, vibrant, and meaningful life!”
—Patricia E. Zurita Ona, PsyD, author of Acceptance and
Commitment Skills for Perfectionism and High-Achieving
Behaviors and Living Beyond OCD Using Acceptance and
Commitment Therapy
Publisher’s Note
This publication is designed to provide accurate and authoritative information in regard to the
subject matter covered. It is sold with the understanding that the publisher is not engaged in
rendering psychological, financial, legal, or other professional services. If expert assistance or
counseling is needed, the services of a competent professional should be sought.
NEW HARBINGER PUBLICATIONS is a registered trademark of New Harbinger Publications,
Inc.
New Harbinger Publications is an employee-owned company.
Copyright © 2023 by Ben Eckstein New Harbinger Publications, Inc. 5674 Shattuck Avenue
Oakland, CA 94609 www.newharbinger.com
All Rights Reserved
Cover design by Sara Christian
Acquired by Jennye Garibaldi
Edited by Joyce Wu
Library of Congress Cataloging-in-Publication Data on file
For Becca
FOREWORD
Have you ever tried to talk yourself out of being afraid of something? For
those of us who struggle with worry, rumination, or cognitive rituals in
what has been called “pure O” OCD, this is a daily and exhausting task,
one that can sometimes continue from dawn to dusk. It feels automatic,
impossible to stop, never-ending. And we may have difficulty separating
the practice of mental ritualizing from who we are. In fact, this notion is
sometimes reinforced by mental health practitioners, who so often ask the
question, “Are you a worrier?” The fact is you are not your worries. But it
may be that you are stuck inside of them.
Why do we worry? And why does it often become so all-consuming?
Generally speaking, humans don’t like uncertainty. We like knowing the
answers in order to reduce risk. We like our reality neatly categorized and
sorted into neat little pockets, laid out before us like a bento box. We
worry to reduce the anxiety and distress elicited by uncertainty and to
provide a sense of control. Our brains tend to equate worrying about
something with trying to solve it—even if that thing we are trying to solve
isn’t actually within our control. It will likely not surprise you that this
kind of mental engagement is counterproductive, despite feeling
compulsive or necessary. So why do we so often get stuck in it?
I once read a story of a tiger who had lived for many years in a tiny
cage in which she spent her days circling, over and over. One day she was
rescued and released into a vast green field in a wild animal sanctuary.
Upon entering that new, unexplored meadow, she promptly found a corner
and began circling again in the same dimensions as her cage. Worry,
rumination, and cognitive rituals can feel like that: a necessary activity
that gives us some semblance of control in our lives, in the absence of
anything else we’ve discovered that might work. An important question to
ask here is, At what cost? For the tiger, it was a potentially beautiful life
that lay inaccessible, undiscovered.
For those of us who struggle with worry, we often try to think
ourselves out of it. We use logic; we remind ourselves that our
overconcern and rumination doesn’t make sense, and wonder what’s
wrong with us that these insights don’t ever seem to lead to meaningful
change. But talking ourselves out of worry is a fool’s errand. We need to
look no further than our own stuckness for data to support that conclusion.
What does work, however, involves two perhaps novel ideas. First,
anxiety is not our enemy—but how we respond to it can be. Second, we
can think about worry as a behavior in which we engage rather than
something that happens to us, or something we are victims of, or “just
who we are.”
Worrying Is Optional by Ben Eckstein, a seasoned clinician with
years of experience working with chronic worriers, OCD sufferers, and
ruminators, offers an elegant, comprehensive, and process-based set of
tools to help sufferers break the cycle of worry. Unlike so many other
books, he delves deep into the how to practice exposure and response
prevention (ERP) effectively with mental avoidance behaviors like rituals,
worry, and rumination.
In clear and accessible language, this book addresses the worrying
functionally, as a process rather than an outcome, making a clear
distinction between a triggering thought and the ensuing, volitional
activity of worrying. Using clear examples and engaging and effective
exercises, the author provides a new perspective on the nature of
worrying, rumination, and cognitive rituals, all of which share the same
functional characteristics and can be addressed the same way.
This book is divided into four parts. Part 1 helps motivate readers to
tackle worry by clarifying how it works, normalizing how it arises,
undermining it as a control strategy, and describing it as a habit that, with
practice, can be changed over time. Part 2 assists readers in developing a
different relationship to anxiety and worry—one that is less adversarial
and more workable. Integrating strategies from cognitive behavior therapy
(CBT), acceptance and commitment therapy (ACT), and inference-based
therapy (IBT), readers begin to shape foundational skills that will help
them effectively use the evidence-based approach described in part 3,
namely exposure and response prevention.
Part 3 provides readers with clear, actionable strategies to stop
worrying. It describes specific responses to worry that can be accurately
named, labeled, and therefore shaped—awareness, attention, and
engagement. Readers learn when they might interact with these in
problematic ways, and then are offered clear alternatives to shift these
habits to break free from the cycle of rumination. Part 4 fosters self-
compassion, willingness to practice the skills they have learned in
previous sections imperfectly, with a heavy dose of kindness.
If you consider yourself a worrier and are holding this book in your
hands, you are lucky indeed. If you make your way through it
thoughtfully, remaining open to the ideas inside—and perhaps more
importantly, by practicing them systematically, whether on your own or
with a clinician—you will make significant headway out of the worry trap
that’s been keeping you stuck for so long. I encourage you to take your
time. Don’t give up. Lean into what you find in these pages. Let the
practices lead you into that vast, green meadow, full of sunlight. Let the
words in these pages help you turn uncertainty into beautiful, exquisitely
joyful possibility.
INTRODUCTION
I decided to write this book because worrying is one of the most common
problems that clients bring to my office. They think too much and they
don’t like it. Each person’s version of anxiety and worry is a bit different.
Each has its own texture and hue, comprising a litany of thoughts,
feelings, beliefs, and sensations. This pattern of unhelpful thinking is
transdiagnostic. It shows up in obsessive-compulsive disorder (OCD) and
generalized anxiety disorder (GAD). It’s in social anxiety and post-
traumatic stress disorder (PTSD), panic disorder and depression. So many
of the mental health problems that my clients struggle with involve this
same style of perseverative thinking.
Our cognitive inner lives can very easily become intertwined with
our actual lives, coloring and informing how we experience the world.
Anxiety and worry can start to feel so fundamental to who we are that
sometimes we can forget to examine all of the different moving parts. The
task of looking under the mental hood can feel daunting. This book will be
a guide to examine how your anxiety and worry function, how they are
maintained and perpetuated.
Like worry itself, this book is intentionally transdiagnostic. The ideas
and skills contained here can be applied to any number of iterations of
unhelpful thinking. While diagnosis can be a useful tool in many
instances, it is very frequently a mere collection of symptoms. And
symptoms are not always helpful for us. They’re the byproduct—the
external manifestation of another process that’s a bit harder to see. If you
go to the doctor with a fever, you don’t get diagnosed with “fever
disorder;” they try to figure out what’s happening in your body to create
that fever. They recognize that treating the symptom will only get you so
far if you can’t also tap into what’s causing it.
In 2002, Billy Beane, the general manager of the Oakland Athletics,
became known for an unorthodox approach to baseball. As popularized by
the book and movie Moneyball, he was able to wrangle success out of a
small payroll by using different metrics and statistics. He realized that
some of the tools being used by the old guard of baseball were actually
not that useful. Twenty-plus years later, baseball teams use statistics even
more advanced than Beane’s. They don’t care about the output (the
number of homeruns or hits); they care about the underlying metrics—the
launch angle of the ball, the exit velocity off the bat, calculations that
account for luck or predict expected outcomes. They’ve recognized that
the output was merely a rough estimate, a loose correlation; for greater
precision, they needed to go beyond these observable indicators and look
at the mechanisms actually driving the outcomes.
Instead of symptoms, we’re going to be looking at processes. What
are the underlying processes that drive anxiety and worry? Are worries
being perpetuated by behavioral reinforcement? Are they driven by an
intolerance of uncertainty, faulty beliefs, or errors in reasoning? Are
worries amplified by immersion in your imagination or fusion with your
thoughts? Have you become so accustomed to operating in this way that
it’s now automatic or habitual?
As we expand on these aspects of anxiety and worry, you’ll want to
pay attention to the parts that resonate with you. Dismantling worry
requires that we see it for what it is—that we understand what drives it
and keeps it going. Worry is often composed of the same ingredients from
person to person, but the precise recipe—the proportions of one ingredient
or another—will vary. You’ll need to know your unique blend. Rather than
seeing the outcome—an anxious or worried person—take the time to
examine the mechanisms that are at play. Once you understand the
mechanisms, you’ll be able to build and apply skills tailored to your own
anxiety special sauce.
How to Make the Most of This Book
This book is broken down into several sections, each aiming to dismantle
worry from a different angle.
In the first section, we’ll focus on the nature of worry, helping you
understand how anxiety works so that you can plan your approach and
learn to respond more effectively. Anxiety is not the enemy—it’s useful
and adaptive—but you need to have a thorough grasp of how it works to
prevent your worry from straying into unhelpful territory.
In the second section, we’ll focus on challenging your relationship to
anxiety and worry. You may have beliefs about worry—that it’s beneficial,
productive, or necessary—that contribute to your problem. You may find
yourself mired in doubt, attending to a myriad of what-ifs and remote
possibilities rather than forging a more solid foundation of trust in
yourself. Your meta-awareness—that ability to be at the helm of your
mind, observing and making conscious choices about how to interact with
your internal experiences—will be pivotal as you start to develop new
ways of relating to your thoughts, learning new approaches that will no
longer maintain anxiety and worry.
In the third section, we’ll use a behavioral lens to develop strategies
to break the cycle of worry. By removing the components that reinforce
and perpetuate worry and anxiety, you can extinguish these habits and
learn new approaches to manage the chatter in your mind. Rather than
avoiding painful or anxious thoughts, you’ll learn to disengage from
worry by strengthening your attention muscle and building skills to defuse
from unhelpful thinking patterns.
The final section does a bit of reverse engineering: learning from the
characteristics of non-worriers to establish a blueprint of how you can
build a life less consumed by worry.
These approaches draw from several different treatment modalities.
While there are several evidence-based treatments for anxiety, no single
treatment has ever been shown to be effective for 100 percent of people.
As useful as each model can be, they are all incomplete. They’re tailored
to address a particular “active ingredient” in anxiety. For example,
exposure-based models might do wonders to address fear conditioning,
but little to address the aspect of your worry that’s driven by unhelpful
beliefs about anxiety. Similarly, cognitive approaches might help you
learn to relate to your anxiety differently, but without adding some
concrete tools to help you disengage from worrying, this understanding
and insight will only get you so far. Maybe you happen to be the unicorn
whose worry can be boiled down to one specific mechanism, but I’m
willing to bet that your worry is a bit more complicated. It’s probably
maintained by several factors, and it will require a more nuanced approach
that can account for your individual complexity.
Remember, none of these methods are a “cure” for worry. They’re
tools and skills to help you live a life in which worry does not control you.
They’re a blueprint for a new approach to your internal experience—
strategies to navigate the anxiety and incessant thoughts muddying your
mind and preventing you from being present in your life. These skills will
not transform you into a person oblivious to risk. You won’t walk away
without a care in the world. I can’t just make you “chill.” But I can offer
you strategies that will enable you to relate to your cares and worries in a
way where they no longer control your life. Let’s get started!
