Chronic Worry and Anxiety Hitchin, Hertfordshire

Diagnosis: Generalised Anxiety Disorder (patient lives in Hitchin in Hertfordshire)

Sally (not her real name), is 42 years of age, and a chronic worrier.

She wasn't just worrying about situations, or things that happened in her life, but she was worrying about worrying. She would find herself at night, lying in bed, unable to get to sleep. The sorts of thoughts that would float into her head were that, for example, she'd be tired at work later because she hadn't been able to sleep, and she worried that all this worrying would make her ill, because her mum, who had also been a consistent worrier, had died from cancer.

After introducing Sally to some theory around anxiety, and working out her "worry profile", her own individual way of worrying, her physical symptoms, etc., I suggested a small strategy that we call "Worry Time".

This entailed assigning two fifteen minute periods of worry time during each day, the objective was to get Sally to be able to evaluate how 'helpful' (or harmful) worrying was to her: Sally was someone who believed that worrying is very helpful for her, and that if she were to stop worrying, things would 'fall apart', she'd forget to do certain things, she wouldn't be able to cope with things as well as she did up to this point, and so forth.

So, I introduced Worry Time in order to test out whether or not this worrying was a helpful strategy for her.

I asked Sally to assign one worry time in the morning, and one in the evening, where she would sit herself down at a table and just worry for fifteen minutes, non-stop, cramming as much worry as she possibly could into each quarter hour assigned.

At first, Sally said that she doubted that fifteen minutes would be nearly enough, as she had too many worries and things to worry about. She 'boasted' proudly, "I worry all day". She began to worry, in session, about how that would just not be enough time.

I insisted that those fifteen minute sessions would be her worry time and that, in the meantime, she would have to 'put off' worry until her assigned worry time. She could, for example, if she began to worry outside of those allotted times, write down the specific worry and take it to her next worry time, and worry about it then.

By the time she came to do her first worry time, she had plenty of stored worries on several pieces of paper. She sat down at her table and, with her list of worries in front of her, she began to worry.

At our next session, I asked her how her first worry time went, and she told me that it was "impossible" to worry for the full fifteen minutes.

"I sat there, started to worry about something, and then my mind just 'drifted off' somewhere else." Not, incidentally, to another worry, but thoughts like, 'oh, look at the paint on that wall' or 'wonder what's on telly later', but then would remind herself to stop and come back to worrying. But whenever she dried "dragging" herself back to worrying, she found she could do no more than a few minutes.

I asked her what she did then and she said that she just got up and made herself a cup of tea. I told Sally that she needed to worry for the full fifteen minutes, no breaks. To which she replied, "that's impossible!" And, when I pointed out to her that she'd said she could worry all day, so why was she unable to do it when she had a time specifically designated to worry?

I 'insisted' that she go back to these fifteen minute worry time periods and worry for the full fifteen minutes. The best she managed to do, she reported at our next session, was about five minutes but that, on my instruction, she had stayed at the table for the other ten minutes. Ten minutes spent, really just doing nothing, instead of worrying.

This exercise, this behavioural experiment, had shown her that worry was less helpful than she had previously supposed, something which ate into a lot of her time, time she could have spent more productively. This was the first step in Sally learning, very quickly, to stop worrying, and was able to postpone worry until later. And the very process of writing down her worries, gave her an opportunity to evaluate her worries, and she concluded, again quite quickly, that she had little or nothing to worry about.

In the two weeks we'd been working with each other, with consistent worry time practice, Sally's worry score, had gone down from an exceptionally high 80 to 23 - a normal level of worry.

Further to this, Sally now reports that she feels a lot more relaxed, she argues with her husband, and her kids, a lot less, is not as 'snappy' and is generally more 'laid back' about things, letting things go, deciding not to worry about all sorts of things that she would have worried about in the past. She also sleeps a lot better.