Worry is an effective short-term response to uncertainty that can become self-perpetuating with adverse long-term consequences. Worry reduces subjective uncertainty, contributes to a sense of vigilance and preparedness, dampens autonomic arousal, and fuels the belief that uncertain events and overall risk can be controlled. When such relief is coupled with the likely nonoccurrence of low-probability feared events, it can powerfully reinforce the worry response, shaping beliefs that worry is adaptive and somehow prevents bad things from happening. Worry also is a form of emotional suppression and cognitive avoidance that becomes self-perpetuating, in part because it blocks other emotions such as fear or anger.

Worry involves two things, both of which are natural and helpful in the proper context, which come together in the worrier to wreak havoc. The first is our ability to imagine the future and plan ahead. This is a marvelous gift to mankind and has allowed us to accomplish amazing things. The second, is our ability to take control of and respond to our environment. We do this with the help of the fight-or-flight response. This too is an amazing benefit that has helped us to survive as a species. When these two things come together, however, and we are trying to control and respond to imaginary events in the future, we get into trouble. For the chronic worrier, there is often limited awareness that this is what is happening. Because they believe that the worry is helpful or productive (despite evidence to the contrary), it becomes a habitual response.

Excessive "checking in" or reassurance-seeking can become a problem in personal life and relationships. Constant worry can leave you feeling emotionally depleted and depressed. Also, worry can also affect how productive and effective you are in pursuing your goals. Worry about the future interferes with problem-solving and decision-making in the present, and often leads to a pattern of avoidance and procrastination.

The common experience across all kinds of anxiety including excessive worry involves physiological symptoms such as heart pounding, chest tightness, sweating, trembling, muscle aches and tension, stomach or headache, dizziness, and insomnia.

When we worry, we feel like our senses are on full alert. Emotional signs such as nervousness, anxiety, fear, edginess and irritability are also common. Finally, nonproductive obsessing or ruminating about oneself or the feared situation is common, as is avoiding the feared situation. People with anxiety and worry falsely believe that if they face what they fear, they will fail, be embarrassed or humiliated, or be met with criticism or rejection. While they are not necessarily depressed, they usually do not feel strong and competent to deal effectively with things in their lives.

• Intolerance for uncertainty: “If I think about this enough, I should feel a sense of certainty.”
• Intolerance for discomfort: “If I can just think this through, I won’t have to feel this way.”
• Inflated sense of culpability: “If bad things happen, it is my fault.”
• Distorted risk assessments/emotional reasoning: “If it feels likely, it is likely. If it feels dangerous, it is dangerous.”
• Perfectionism about mistakes: “Mistakes mean I screwed up because I was not in control.”
• Pessimism/presumed incapability: “Bad things will happen to me and I will not be able to deal with it.”
• Misconstrued virtue: “Worry shows how deeply I care about my children.”
• Overvaluation of the thought process: “Because I have a thought, it is important and I must give it my full attention.”
• Implicit magical beliefs about worry: “Worry prevents bad things from happening. It keeps me from being blindsided. It keeps loved ones safer.”
• Worry about worrying too much: “I am out of control. I am making myself sick. I have got to stop worrying.”

Cognitive Behavioral Therapy (CBT) is an effective treatment for excessive worry. Cognitive behavioral strategies that may be adapted to primary care contacts include education about the worry process, repeated challenge of cognitive distortions and beliefs that underpin worry, behavioral exposure assignments (e.g., scheduled worry periods, worry journals), and learning mindfulness meditation. Antidepressants medications could also be helpful is some situations.

Cognitive-Behavioral Therapy (CBT) is effective for many people, helping them to identify, understand, and modify faulty thinking and behavior patterns. This enables people learn to control their worry. Some may take medication as well. Relaxation techniques, meditation, yoga, exercise, and other alternative treatments may also become part of a treatment plan.

Clients can learn ways of managing their worry through practical and common sense strategies, and will be encouraged to take an active role in their improvement by engaging in practice exercises inside the therapy room as well as in between sessions.

Worry and anxiety represent two different approached to troubling thoughts or situations. However, while worry can have positive effects, anxiety can have negative effects. Worrying can assist in reflecting upon and developing positive solutions to problems. On the other hand, chronic worry creates a cycle of anxiety and unproductive obsessive thoughts. Worrying puts you in a frame of mind that enables you to rehearse and evaluate possible solutions, while anxiety builds on itself and leads to unproductive, obsessive behavior.

Anxiety involves fight-or-flight arousal. This is a natural, "hard-wired" response that all animals have. Its purpose is to help us to respond to a crisis or problem that is right in front of us, an immediate threat. Worry is a verbal process, unique to humans, where we use our minds as a time machine, traveling into the future to encounter problems and threats that are not here yet. What makes worry different from simply planning for the future is that we are triggering this fight-or-flight response. Since the crisis has not yet arrived, and may never actually show up, this arousal can hang around for long periods of time. This can lead to health problems, difficulty getting things done, relationship stress, and other troubles.

ACT (Acceptance & Commitment Therapy) is one of several new approaches based on acceptance and mindfulness of the present moment. These approaches have been shown to be useful in treating anxiety, depression, substance abuse, eating disorders, trauma, couples' distress, and personality disorders.

The essential components of ACT include letting go of the struggle to control unwanted thoughts and feelings, being mindfully aware of the present moment, and committing to a course of action that is consistent with what you value most in life. In this way, ACT is about both acceptance and change. It is the acceptance of the thoughts and emotions that accompany a difficult but valuable act that allow you to take that action. As applied to the problem of chronic worry, acceptance of the uncertainty of the future and anxious thoughts and feelings about that uncertainty, allow you to focus more clearly on the present and to take the steps that move you closer to the life you truly want to live.

LLAMP presents a five-step model to guide you through learning the component skills of acceptance and commitment therapy and applying them to the problem of worry. It starts by interrupting the fight-or-flight response and the accompanying impulse toward controlling your thoughts and feelings, and goes on to help you accept your thoughts and feelings and focus more on the present-moment. Finally, it guides you in taking actions directed by your values rather than by worry.

The five steps are contained in the acronym LLAMP:

• Label "anxious thoughts"
• Let go of control
• Accept and observe thoughts and feelings
• Mindfulness of the present moment
• Proceed in the right direction

The step-by-step instruction and exercises allow you to practice and develop each component as an individual skill. With practice, the steps begin to flow one into another, so that applying LLAMP becomes a fluid process. Labeling certain thoughts as "anxious thoughts" is a cue to Let go of the control response, which makes room for Acceptance and Mindfulness of your thoughts, feelings, and experience in the present moment, which allows you to Proceed with valued, purposeful action.

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