Worry about Worrying: What if’s, Why’s, and Shifting your Thoughts

By Claire Cusack, B.A., Lab Manager
 
“If you would only stop thinking, you would be much happier”
―Pavilion of Women, Pearl S. Buck
 
Individuals with eating disorders are often bombarded with negative thoughts, both eating disorder specific and general. Some thoughts may resemble worry and others rumination. Yes, there is a difference between worry and rumination! Though worry and rumination are similar negative thinking patterns (Fresco et al., 2002),
 

• Worry refers to an uncontrollable, sequence of negative thoughts, whereas
• Rumination refers to brooding about negative thoughts and feelings (Ellis & Hudson, 2010; Papagerogiou, 2006).

 
Worry is usually repetitive negative thoughts about the future, and rumination is usually repetitive negative thoughts about the past.  In other words, worry is characterized by “What if’s” and rumination is characterized by “Why’s.”
 
What if I fail? Why did I say that?
What if I gain weight? Why can’t I eat normally?
 
At some level, everyone worries and ruminates, even those without eating disorders, and worry and rumination may be adaptive! For instance, concern about an upcoming test may motivate you to study, to reflect on a time that things didn’t go as well as you hoped, or may help you do things differently next time. However, for individuals with eating disorders who also show anxious and depressive symptoms, the thoughts may become unhelpful (Smith et al., 2018). This is where you may get stuck. Have you ever kept circling over an event and have gotten nowhere?
 
Have you asked yourself things like:
​

​Repeating these thoughts may make them seem true or like your fears are inevitable. The good news is that 93% of worries do not come true (LaFreniere & Newman, 2020). When worries do come true, it’s often because we make them come true or what happens turns out to not be as bad as we thought it would.
 
For example, before you know it, you’ve spent so much time thinking that you haven’t checked in with your friend about how they actually interpreted what you said. Or, you’ve spent so much time worrying about failing, that you didn’t study for the test. These sorts of behaviors in response to thoughts may actually cause a rift in the friendship or a low grade. Indeed, it is easy to get trapped in these cyclical negative thought patterns and believe them. These thoughts may make it more difficult to concentrate, do daily activities, or focus on the present (Paperogiou, 2006). Moreover, you may believe that these thoughts are valuable (Behar et al., 2009) and help you (Ellis & Hudson, 2010), such as by avoiding weight gain, or make you feel better (Schmidt & Treasure, 2006). What makes rumination even more insidious is it doesn’t always appear like “negative” or brooding thoughts. Reflecting on food, weight, and shape can lead to eating disorder symptoms just like brooding does (Cowdrey & Park, 2012). An example may be writing down food intake, thinking about it, and analyzing it (Cowdrey & Park, 2011). Though not obviously problematic, this type of behavior encourages repetitive (and unrealistic) negative thinking that takes you out of the present moment.
 
How do I know if my thoughts are helpful or not?

“Yes” to these questions may suggest your thinking patterns are not serving you. When worry and rumination become unmanageable, people often engage in corrective responses (Rawal et al., 2011). These responses may look like seeking reassurance (e.g., weighing or body checking) and attempting to avoid the negative thoughts (Cowdrey & Park, 2012), which ultimately increases eating disorder symptoms (Rawal et al., 2011). The reverse may be true too, where eating disorder symptoms trigger worry and rumination, thus circling back to more eating disorder behaviors (Smith et al., 2018). The repetitive negative thoughts, eating disorder behaviors, and management of both are exhausting.

​So, what can you do about it?
 
While you may currently be in the throes of an endless loop of worry, depression, and symptoms, you can put a pin it and break the cycle. It may seem counter-intuitive, yet approaching and accepting your thoughts can help you find a way out. This means inviting curiosity into your thoughts. When a thought (or series of thoughts) pops into your head, instead of accepting them as fact, notice them, acknowledge them, and try saying “Maybe, maybe not.” This lessens their power. You might wonder, “Why do I need to approach my thoughts and emotions when I am already constantly thinking?” Certainly, worry and rumination can be near constant and thus, may not seem like avoidance. Ironically, they are forms of avoidance. So, how do you approach a thought or feeling when you feel like you’re already doing that, and in fact, can’t avoid thinking? Surprisingly, this does not involve changing the content of your thoughts, but rather changing the thought processes (Ellis & Hudson, 2010; Watkins et al., 2007). Simply put, you don’t have to change what you’re thinking about, but how you’re thinking about it. Here are some suggestions when encountering repetitive negative thoughts:
 

• Acknowledge and Accept. Try noticing the thought and emotions; acknowledge them; and watch them pass without engaging in an eating disorder behavior. For instance, if the thought is “What if I get fat?” Acknowledge the feeling: “I feel scared.” Reframe how you are thinking: “I notice that I am scared.” Instead of avoiding food, approach food by eating the meal or snack anyway. Cycling through a litany of “What if’s” is a strategy to avoid the fear of weight gain.

 

• Take a step back from the thoughts, take a step into the feelings. Entertaining an endless list of “What if’s” or pondering an equally exhaustive list of “Why’s,” may lead you to get lost in the details and forget the purpose. It’s challenging to see the big picture with that level of scrutiny. Taking a step back may provide you with room to acknowledge the feelings. For example:

 
When giving a presentation at school or at work, you might slip on your words. If you catch yourself wondering “Why did I do that? Did they notice? Everyone must think I’m incompetent,” you can take a step back from the thoughts by acknowledging them. “I think that others think less of me because I made a mistake.” Taking a step into the feelings may look like, “I feel embarrassed.” Remembering the big picture could look like, “Even though I messed up a few words, the audience was still able to follow my presentation. Everyone makes mistakes.”
 

• Tune in to your body. This does not mean evaluate and judge your body, but instead to listen to your body (Park et al., 2011). It may be helpful to consider this as a shift from “doing” (e.g., ruminating and worrying) to “being” (e.g., how do you feel in this moment). As worry is typically future driven and rumination is typically past-driven, it can be helpful to focus on the present moment. Taking an inventory of the five senses may be a place to start. What can you see, hear, feel, taste, smell right now? Other activities that have been found helpful for worries include relaxation skills (Hoyer et al., 2009), meditation (Course-Choi et al., 2017; Eberth & Sedlmeier, 2012), and yoga (Zoogman et al., 2019).

 
Here are three take-aways: 
 

1. Not all of your thoughts are facts.
2. Most of your worries are not likely to come true.
3. You can create peace with your thoughts.

 
This doesn’t mean you won’t think negative thoughts or experience uncomfortable emotions. This is a hope that by shifting the way you think, you can not only face uncomfortable emotions, but you create room to feel the happier ones, too.