How PTSD and Emotions Like Worry Are Connected

Why worrying may be an attempt to manage anxiety

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Worry is an emotion that involves thinking about possible future problems, concerns or outcomes. It often takes the form of "what if..." thinking and generally accompanies anxiety.

Everyone experiences worry from time to time. However, some people may experience very severe worry to the point that the worry occurs constantly throughout the day and feels uncontrollable. There is some evidence that people with posttraumatic stress disorder (PTSD) may be more likely than others to struggle with worry.​

Why Worry?

Although worry often goes along with anxiety, some people may worry in an attempt to manage their anxiety. Some of the worry that people experience may actually be driven by the desire to avoid unpleasant emotions. Worrying looks very much like problem-solving and when people experience anxiety, they may be bombarded by feelings of uncertainty, unpredictability, and uncontrollability.

Some people may worry in an attempt to establish some sense of certainty and predictability, reducing their anxiety.

However, in many cases, definite solutions to a problem may not be easily identified. In these cases, worry may only increase the extent with which people think about the problem, further increasing their anxiety.

A number of studies have found that worry is associated with the avoidance of emotions. In fact, people who worry say that they often worry in order to distract themselves from more emotionally distressing topics. In addition, worry has been found to bring down anxious arousal (at least temporarily).

PTSD and Worry

Several studies have found that people with PTSD may be more likely to worry than those without PTSD. Why do we often see excessive worry among people with PTSD? Well, PTSD is associated with high levels of anxious arousal, as well as other strong emotions. In addition, people with PTSD may have difficulties identifying healthy ways of managing these intense emotional experiences.

Therefore, given that worry may temporarily bring down arousal and can distract people from more emotionally distressing topics, people with PTSD may worry in order to obtain some relief from their distress. In fact, one study found that desires to avoid emotions explained the association between PTSD and worry. Unfortunately, as with other emotionally avoidant coping strategies, this relief will be short-lived. Because the anxiety is not really being addressed or processed, it will only come back and sometimes stronger than before.

Managing Your Worrying

As mentioned earlier, everyone worries. Therefore, it probably isn't possible to completely remove worry from your life. However, there are strategies that you can use to reduce worry, especially at times when you are experiencing unpleasant emotions, such as anxiety. For example, learning healthy emotion regulation and anxiety management strategies can reduce your reliance on unhealthy coping strategies, such as worry.

In addition, given that worry is focused on the future, coping strategies aimed at increasing your focus on the present moment can be particularly useful. Mindfulness meditation is one such strategy. Specifically, mindfulness can increase the extent with which you attend to the present moment in a non-judgmental and non-evaluative way. In doing so, you can better disengage from worrisome thoughts and limit their interference in your life.

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  • Borkovec TD, Alcaine OM, Behar E. Avoidance theory of worry and generalized anxiety disorder. In R.G. Heimberg, C.L., Turk, & D.S. Mennin (Eds.), Generalized anxiety disorders: Advances in research and practice (pp. 77-108). 2004; New York: Guilford Press.

  • Scarpa A, Wilson LC, Wells AO, Patriquin MA, Tanaka A. Thought control strategies as mediators of trauma symptoms in young women with histories of child sexual abuse. Behaviour Research and Therapy. 2009;47:809-813.

  • Tull MT, Hahn KS, Evans SD, Salters-Pedneault K, Gratz KL. Examining the role of emotional avoidance in the relationship between posttraumatic stress disorder symptom severity and worry. Cognitive Behaviour Therapy. 2011;40:5-14.

By Matthew Tull, PhD
Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder.