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MAO Inhibitors such as Nardil require dietary changes users must avoid wine, cheese, and chocolate but are very effective for worry tied to a fear of rejection, or to post-traumatic stress. Medications are only part of a treatment program for worry, and often they are not necessary at all. First, you must understand the pattern of your worrying. Is it based in anxiety, depression, unhealed trauma?

Whatever your diagnosis, learn as much about it as you can. Then develop a treatment plan.

Fear of Death Phobia - Thanatophobia

One of the most powerful methods to decrease worry is through gradual exposure. If heights make you nervous, you might start by imagining you are standing at a certain height, looking down. Then in your imagination, and in the presence of a therapist, start going up, a few floors at a time.

After you feel comfortable being exposed to heights in your imagination, try it in reality, using the same graduated process. Similarly, a therapist may deliberately recreate the physical sensations accompanying worry, to help you get more comfortable with them. I helped my patient Adrienne recreate the feelings of panic within herself—breathlessness, dizziness, rapid heartbeat. She'd exercise until her heart raced, then talk herself through the feeling, noting that nothing bad was happening.

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Then we tackled her dizziness: she sat in a chair and I spun her around a few times. In this way, she began to take apart her worried state until she got comfortable with each individual piece. When she experienced them all together, in the stew of worry, she was less afraid of their impact. Most of the worriers I treat need to retrain their minds and learn new mental skills. It's like training your muscles to learn the pattern of a golf or tennis swing, so that the correct swing becomes automatic.

You can train your brain to learn effective ways of dealing with situations that arise again and again, such as financial worries or fears of failure. There is a window of opportunity that lasts about a minute, during which you can sever the tentacle of a toxic worry before it grips you totally. Your brain has not yet gone into spasm. That is the time to defuse worry. Talk to yourself in a useful way. Most worriers talk to themselves in half-phrases of imagined doom, little punches and jabs of negativity.

The Source of Fear

Try to erase those old, automatic patterns by deliberately distracting yourself. Whistle or sing. Snap your fingers. Insert a positive thought. One positive thought at a time can gradually shift the balance of your thinking from negative to positive.

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Monitor your automatic thoughts whenever you get bad news or perceive danger of some sort. It's helpful to write them down. Often you can see immediately how wildly exaggerated they actually are. Then examine these thoughts for errors in logic. Create alternative hypotheses that are more logical. You may find that these automatic thoughts and errors in logic grow out of the fundamental way you look at life and at yourself, your self-schema.

Do you fear that the deck of life is irretrievably stacked against you? Are you afraid that nobody will ever find you attractive? Whatever your self-schema might be, you can change consciously. Over time, self-questioning begins to replace reflexive self-flagellation. Become creative in finding ways of quenching worry.

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  • Allison Barnes would blow into the palms of her hands sometimes before going into a meeting and say she had just "blown off" her worries. She bought an ugly-looking toad figurine, which she kept in her purse ready to deposit on a shelf whenever she needed a reminder that her worries could be put aside. You have to be willing to play along and suspend your disbelief for this method to work, but if you are willing it can work very well. Worry paralyzes the sufferer and prevents him from taking action. My brain-training program teaches you to make concrete plans, eliminating unnecessary worry before it occurs.

    I call this program EPR: evaluate, plan, remediate. Evaluate a possible problem rationally, set up a plan to take care of it, then act on the plan.

    Understanding the Anxious Mind

    Turn worry into action. I recommend that worriers make a list of three—and only three—changes they want to make in their life. They might be as simple as making a dentist appointment or consolidating their credit cards. Persist until all three tasks are done. Then make a new list of three, and only three, changes you want to make in your life. After six months to a year, you will have dramatically changed your life for the better. And you will worry less, because you will be safer. Structure reduces risk. As simple as it sounds, exercise is the best natural antianxiety agent we have. Exercise reduces tension, drains off excess aggression and frustration, enhances well-being, improves sleep, curbs the tendency to overeat, aids in concentration, and reduces distractibility.

    It is healing to the body, and therefore to the mind. Getting exercise at least every other day should be part of your plan to reduce anxiety and control worry. But you can also exercise on the spot to reduce acute worry. If you are having a bad day at the office, try walking up and down a flight of stairs five times. Your mind will be less troubled when you come back to your desk. The change in physiology induced by exercise calms the mind. Prayer or meditation can change the state of your brain as well. Talk to God when you feel worried. If you are not religious, learn how to meditate.

    Brain scans and EEG monitors show beneficial changes in the brain during meditation and prayer. These changes correlate with most of our measures of improved health, including longevity and reduced incidence of illness.

    And extended worry subsides with regular prayer or meditation. I was playing squash one Sunday morning with Jeff Sutton, a neuroscientist and good friend, when I told him I was writing about people who worry too much. He instantly responded, "But worry is good! You have to worry to survive! Deeper than any other feeling. If you don't want to worry, be a plant! Jeff, of course, is right. There is such a thing as wise worry. It is our reaction to worry that counts.