If you’ve been feeling stressed lately, you’re far from alone – even before the COVID-19 pandemic, UK survey data from 2018 suggested that 74 per cent of people had been so stressed, worried or anxious at some point in the prior year that they’d felt overwhelmed or unable to cope. Stress – defined as a state in which a person feels that they do not have the resources to meet the demands of a particular situation – is everywhere and is central to the human condition. It affects multiple biological systems and, long term, it can cause damaging wear and tear to our health.
One reason that stress can be so harmful is that, even after the initial trigger has passed, it often continues to influence how we think, feel and behave. An important theory, the ‘perseverative cognition hypothesis’, put forward by a team of international psychologists in 2010, helps to explain how: it suggests that worry and/or rumination amplify the initial short-term bodily response to a stressful situation (ie, the fight-or-flight response) and also reactivate the stress response even after a stressor has passed. Moreover, perseverative cognition about past and future stressors (that is, worrying about upcoming stressors, and ruminating about past stressors and whether they might occur again) can also harm our health indirectly, by influencing our health behaviours. For instance, it has been shown that more worry and rumination is linked to poorer sleep, unhealthier eating and substance abuse.
All of this suggests that reducing worry and rumination (via psychological interventions) could be a powerful way to reduce the harm to health caused by stress, both directly by helping to ‘switch off’ the stress response system and indirectly via avoidance of unhealthy behaviours. To explore this possibility, we conducted the first ever comprehensive review of all the high-quality studies that have ever taken the dual approach of aiming to reduce worry or rumination via a psychological intervention and, crucially, that also later measured the intervention’s impact on health or health behaviours. We decided to look only at studies known as ‘randomised controlled trials’, as these are considered the gold standard for assessing the effectiveness of any intervention or treatment within psychological and medical research.
After examining more than 10,500 potentially eligible studies, we found 36 (comprising more than 5,000 participants across nine countries) that were suitably high-quality and relevant for our purposes. These studies featured psychological interventions for combating worry and rumination that fell into seven broad types:
- action-planning (ie, proactive planning interventions to help better manage worry, such as giving yourself a special worry window in the evening to challenge your worries);
- stress management (ie, broad-ranging therapies concerned with eliminating stress, such as focusing on the more controllable aspects of life);
- mindfulness and relaxation (ie, refocusing on the present moment);
- psychological detachment (ie, ‘switching off’ from situations, such as work, that trigger negative thoughts. Participants might have been advised to set themselves a rule to not look at work emails after a certain time, for example);
- cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT) (ie, challenging unhelpful thoughts and engendering self-help strategies);
- expressive writing (ie, disclosing one’s deepest thoughts and feelings); and
- pain management (ie, interventions concerned with alleviating pain).
We found that these various psychological interventions reduced participants’ worry and rumination (by a medium-sized amount in statistical terms), with corresponding small, but positive, improvements in their health behaviours. This suggests that it’s possible to learn to worry (or ruminate) less, and that these changes will in turn trigger healthier lifestyles, which if maintained over time, will help to protect your long-term health.
There is no magic bullet to help cure your worries, and each technique will work differently for different people
The reductions in worry and rumination were even greater in a small number of interventions delivered by healthcare professionals compared with those where participants were left to complete the techniques or exercises by themselves. Aside from that difference, no particular type of intervention outperformed any other at reducing worry or rumination. However, there was evidence that psychological detachment style and action-planning interventions were the most important for improving positive health behaviours. From a health perspective, this suggests that the most effective approach is to focus on switching off your worries and planning ways to better manage them – over time, this shift in mindset is especially likely to have a positive spillover effect on your health-related behaviours.
If, like so many, you’ve been experiencing a lot of stress and you’re concerned about the impact on your health, then, based on the weight of the evidence we uncovered, we suggest three key techniques that might help. Our findings indicate that these techniques can help you to worry and ruminate less, thereby cope better with stress, and, in turn, this could have positive knock-on benefits for your lifestyle and health. We do want to caution that there is no magic bullet to help cure your worries, and that each technique will work differently for different people. Therefore, it is important to consider what might work best for you and your personal circumstances, and try to be patient while doing so.
1. Make a plan:
Create specific and achievable predefined plans about when you are going to engage in worrying. This will help you stick to it when times get tough. Here are some examples of how you might consider creating such plans:
Plan a worry ‘budget’ and/or postpone your worries. Each day, give yourself a limited number of worry windows during which you allow yourself to think about what is bothering you, or even schedule a specific time of day for challenging your worries. By doing this, not only will you contain all that negative energy to confined periods (rather than being dispersed throughout the day) but you’ll also reduce the potential short-term threat to your health that comes with long periods of worrying, such as increased heart rate or blood pressure. If you schedule a specific worry time, many people find it’s optimal to do this later in the day (but not too close to bedtime), when you’re less busy, so you can face your worries with a clearer mindset.
You could also consider writing down your worries (either on paper or digitally), perhaps also at planned times. You’ll often find that the problem in your head is much smaller (and less severe) once you see it in black-and-white. Research has shown that simply writing about worries can reduce their severity and frequency.
Open up to unpleasant feelings, and learn not to overreact to them, and try not to avoid triggering situations
2. Acceptance and control:
Aiming high and trying your best at tasks is obviously a good thing. However, it’s important to remember that you cannot be perfect all the time. Equally, it’s important to recognise which of your worries fall into your ‘locus of control’ – that is, which you can realistically do something about, and which are beyond your control. Here are some examples of how to do that:
Create a list. This can be a useful way of navigating the many challenges that life throws at you. Seeing them spelled out will help you to understand which tasks are most important, which are achievable, as well as to identify those that are out of your control. Inevitably, highlighting where to focus your energy and how to best manage the daily hassles in your life means you are less likely to worry about them.
Accept that things are not always going to be perfect. Open up to unpleasant feelings, and learn not to overreact to them, and try not to avoid triggering situations. If you feel too overwhelmed, then consider turning your focus on the present moment; for example, you could engage in mindfulness: the cultivation of a present-oriented, nonjudgmental attitude toward oneself.
Halt your unhealthy habits of mind. The tendency to worry is often habitual. By adopting self-coping strategies, you can take more conscious control. Consider developing a ‘mantra’, or a saying, that you repeat to yourself when you begin to notice yourself worrying. Something like ‘Not now, James’ or ‘Save it for later, Laura’ might work well. Or you could use something deeper and more meaningful, such as ‘Nothing lasts forever’ or ‘It will get done.’ Whatever your approach, it’s important to make your mantra personal.
In small doses, worry, rumination and stress can be positive forces in our lives, and serve an evolutionary purpose to protect us from harm
3. Find time to switch off:
All work and no play can lead to negative health effects such as burnout, mental fatigue and increased instances of physical problems arising from stress. Therefore, it is probably unsurprising that research says that finding the time to switch off and detach yourself from work (or indeed other stressors) is vital for your sustained wellbeing. Here are some tips for doing that:
Detach yourself. If your worry about work or other matters becomes all-consuming, thinking about it more could only make it worse. As an immediate coping mechanism, detach yourself from your worries: for example, listen to music or a podcast, read a book or magazine, or do some restful breathing exercises. Whatever you do, it’s important to find time each day to focus on the present.
Use your senses. Relaxation techniques can take your mind away from the worry. When you are feeling the heat, spend at least a few minutes paying particular attention to your breathing or giving your toes a wiggle. Pause and reflect – how do they feel? This type of refocusing via your senses can also help.
Get active. While no particular intervention in our review tested the effects of a healthy lifestyle, each endorsed the use of exercise and limiting the intake of sugar, alcohol and caffeine, as helpful towards contributing to a more positive state of mind.
Remember that, in small doses, worry, rumination and stress can be positive forces in our lives, and serve an evolutionary purpose to protect us from harm. It’s only when they become persistent and overwhelming that it’s problematic. The good news from our research is that you can stop this from happening by learning to control your worry and rumination, which can then have long-term benefits for your lifestyle and health. Despite the recent statistics showing that we are an increasingly stressed population, there are simple and evidence-based steps to help you manage your worry and intrusive thoughts. The techniques highlighted by our review point to a collection of brief, inexpensive and easily self-administered interventions that we’re hopeful can support you to manage your wellbeing.