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Tag: Rumination

Living with Anxiety: Turning the Mind’s What If Into a What Now

Anxiety is a universal human experience. It’s not just the 30% of people who will meet criteria for an anxiety disorder in their lifetime (Bandelow & Michaelis, 2015). It’s the friend who can’t sleep before a big meeting, the parent who mentally runs through a dozen worst-case scenarios before their child even leaves the driveway, or the student who rewrites a text message three times before pressing send.

Our brains evolved to anticipate. This remarkable ability to look ahead has kept humans alive for millennia—it’s why early hunter-gatherers carried tools before they needed them and why we pack an umbrella when the forecast calls for rain. But the same foresight that allows us to prepare can also trap us in mental simulations of disaster, living in the tension of problems that haven’t happened yet—and may never happen at all.

From Story to Narrative—and Back Again

I hear the same underlying struggles in my recent therapy sessions with patients. One worries that a partner’s habits might shape their child’s future in harmful ways. Another lay awake imagining a tragic bike accident before their child even left the house.

Both situations were rooted in what I call the difference between story and narrative:

  • The story is what is actually happening right now.
  • The narrative is the version of events our mind constructs, often based on fear, assumption, or incomplete information.

When we mistake the narrative for the story, we start responding emotionally to a movie in our head rather than the facts in front of us. That’s where anxiety thrives.

What Science Says About Why We Worry

Modern research tells us anxiety is shaped by multiple forces—biological, cognitive, and environmental.

  • Trait vs. state anxiety (Spielberger, 1983) explains why some people tend to feel anxious across many situations, while others experience it only under specific stressors.
  • Reinforcement sensitivity theory (Gray & McNaughton, 2000) describes how an overactive “behavioral inhibition system” makes us extra alert to potential threats.
  • The tripartite model (Clark & Watson, 1991) helps explain why anxiety often overlaps with depression, highlighting shared features like negative mood and unique features like physiological arousal.
  • Recent neuroscience adds another layer: stress can actually alter gene expression through epigenetic mechanisms, potentially making us more sensitive to anxiety triggers over time (Zannas & West, 2014).

What these theories have in common is the recognition that anxiety isn’t just “in your head”—it’s a complex interaction between brain, body, and lived experience.

Worrying vs. Planning: A Crucial Distinction

Here’s the important part: worrying is never a requirement for effective action.

  • Worrying is imagining the future as if it’s already gone wrong, then reacting to that imagined outcome.
  • Planning is choosing an action in the present, without demanding that the future turn out a certain way.

Both are future-oriented, but only planning moves you forward. Worry burns energy; planning invests it.

What Works: From Therapy Room to Daily Life

In those sessions, the shift came from turning worry into intention. The process looked like this:

  1. Catch it early — Recognize, “This is worry.” Naming it interrupts the spiral.
  2. Anchor in the present — Ask, “What needs my attention right now?”
  3. Plan without prediction — Choose one next step without adding “and it must work out this way.”
  4. Use external supports — Reminders, notes, or scheduled check-ins to keep you aligned with action rather than rumination.
  5. Reframe the narrative — Replace “This will go badly” with “I’ll handle whatever comes.”

These strategies echo what research shows works best for anxiety: cognitive-behavioral methods to challenge distorted thoughts (Beck & Clark, 1997), mindfulness to stay in the present (Hofmann et al., 2010), and acceptance-based approaches that allow worry to exist without letting it steer the wheel (Hayes et al., 2006).

Try This Today

If you find yourself caught in “what if” thinking:

  • Pause and label it: “This is a narrative, not the story.”
  • Shift to a “what now” mindset: “What’s the smallest action I can take in the next 10 minutes?”
  • Ground yourself in sensory details—the sound of a kettle, the texture of your desk, the feel of your feet on the floor.
  • Close the loop by acting on your plan, no matter how small.

Final Thought

The challenge is not to silence our worries completely but to respond skillfully, using it as a prompt to plan instead of a trap and a downward spiral. When we can move from “what if” to “what now,” we reclaim the energy that worry steals and put it toward a present moment that we actually want to live in.

Read more from Rizaldy R. Ferrer, Ph.D.


References

Bandelow, B., & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in Clinical Neuroscience, 17(3), 327–335.

Beck, A. T., & Clark, D. A. (1997). An information processing model of anxiety: Automatic and strategic processes. Behaviour Research and Therapy, 35(1), 49–58.

Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression. Journal of Abnormal Psychology, 100(3), 316–336.

Gray, J. A., & McNaughton, N. (2000). The neuropsychology of anxiety: An enquiry into the functions of the septo-hippocampal system. Oxford University Press.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2006). Acceptance and Commitment Therapy: An experiential approach to behavior change. Guilford Press.

Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169–183.

Spielberger, C. D. (1983). Manual for the State-Trait Anxiety Inventory. Consulting Psychologists Press.

Zannas, A. S., & West, A. E. (2014). Epigenetics and the regulation of stress vulnerability and resilience. Neuroscience, 264, 157–170.

Pain is Inevitable, but Suffering is a Choice

We inevitably encounter painful experiences in life—breakups, humiliation, rejection, failure, and various stressors that challenge our mental and emotional well-being. These events can be understood as emotional or psychological pain, similar to the way physical injuries or diseases cause pain or discomfort to our bodies. Just as physical pain is a natural response to injury, emotional pain is a response to the mental and emotional “injuries” we face. However, while physical pain tends to subside with time or treatment, emotional pain may linger, even after the original cause has passed.

The key distinction I argue in this philosophy is the difference between pain and suffering. Pain is the initial emotional response to life’s inevitable hardships. It is unavoidable, much like the pain of a physical injury. But suffering—the prolonged and often deepened emotional distress we experience long after the event—is something we contribute to and, to a degree, choose.

Let’s consider physical pain as a metaphor. When you suffer an injury, the body’s natural healing processes often take over. A cut heals, a bruise fades, and with proper care, most physical wounds resolve. While the pain of the injury can be intense, it is typically temporary. Likewise, emotional pain from rejection, failure, or humiliation also has a natural course. Initially, it hurts, but in many cases, it, too, can fade over time, especially when we allow ourselves to process it healthily.

However, unlike physical pain, emotional pain can evolve into something more persistent—suffering. Suffering is what happens when we continue to hold on to the pain through the narratives we create in our minds. These narratives often revolve around self-blame, shame, and negative self-evaluation. We begin to revisit the painful experience repeatedly, analyzing it, assigning personal fault, and questioning our self-worth. Over time, this pattern transforms the pain into suffering.

The original emotional pain—the rejection, the failure—has ended. What sustains the suffering now is not the event itself, but the stories we tell ourselves about that event. For example, after a rejection, we might internalize the belief, “I’m not good enough” or “I’ll always fail.” This self-blame and shame become a feedback loop, feeding the suffering and allowing it to persist far beyond the original pain.

Below is an excerpt of the therapy session I had to illustrate one example of how I applied this philosophy.

Brandi: I kind of lose control when things get off track. Over the weekend, my friend was celebrating her 30th birthday. I wasn’t going to go because of my upcoming surgery, but then I changed my mind. I wanted to be there for her since I heard she was upset that people were dropping out. So I went, even though I was worried about getting sick. And indeed, I believe I caught COVID from being there. I was really kicking myself for it—blaming myself. I should’ve been more careful since I knew surgery was coming up. But my first instinct was to take care of others. I didn’t think about isolating or protecting myself.

Dr. Ferrer: Many people, including you, go to that place of self-blame. The difference is, for you, it’s harder to get out of that loop. Pain is inevitable, but suffering is a choice. The pain there, of course, is the disappointment that your surgery is canceled because you need to be well to undergo the procedure. However, you stay in the suffering longer than necessary. That is, creating a narrative that shames you.

Brandi: Yeah, it’s like a Buddhist principle. I get stuck in it, even though I know logically there’s nothing I can do about it now. It already happened. There’s another surgery date, but I keep wallowing in the “I should’ve done this differently” mindset.

Dr. Ferrer: Think about how you treat your own kids when they’re in pain. Do you immediately tell them, “See, I told you so.” Of course not. There’s no difference in how you should treat yourself. You can give that same care to yourself, but instead, you revert to shame and blame. Pain is already that feeling let down when you realize that taking care of your friend by being present in her celebration may have caused you to catch a virus. It is something you cannot change anymore. But by responding to that pain with the negative narrative is that suffering you are choosing.

Brandi: It’s easy to tell myself I’m a failure. I beat myself up. I forgot to take care of myself when I should’ve. It’s simply hard to just stay in pain and not suffering. I was crying hard that Monday, and my partner didn’t know how to help. I think she was trying by keeping her distance because I was irritable, which is also a trigger for her. I was upset with myself, feeling like a failure for not thinking about protecting myself before the surgery.

Dr. Ferrer: And that’s where the spiral starts.

Brandi: Exactly. Then my daughter came downstairs and saw me crying. She was supposed to watch a movie, but my partner told her I wasn’t up for it. She got upset. I felt like I had to pull myself together because she needed me. So, I went to the bathroom, blew my nose, and told myself, “You have to get up. She’s a kid, she needs help.”

I took a walk with the dog, trying to comfort myself. But it felt like a battle—the mental loop was still there.

Dr. Ferrer: I hear you. And yet, you found a way to comfort yourself. That’s important. You recognized you needed to carry on, even though you were still in pain. In a way, you dealt with the pain but chose not to suffer by doing your best.

Brandi: Yeah, I told my partner what was going on in my head. I explained that when things like this happen, I spiral and beat myself up. But even though I was still struggling, I could see the loop and work through it.

Dr. Ferrer: You’re recognizing it now, which is a big step. The fact that you didn’t get stuck in the negative loop as long as you used to previously is progress. You’re shortening the duration of those spirals.

Brandi: Yeah, I can see that. It took a while, but I managed to pull myself out of it faster than I would’ve in the past. The next day, I called the surgeon’s office, and they postponed the surgery for 30 days. I felt nervous, but I answered the call, which felt like a victory in itself.

In essence, while pain is an inevitable part of life, suffering is something we often create and sustain through our own narratives of self-blame and shame. The distinction lies in our response: while pain arises naturally from difficult experiences, suffering is the result of holding on to and feeding that pain with negative thoughts. By recognizing this, we can choose to let go of the stories that perpetuate suffering and allow ourselves to heal emotionally, just as our bodies naturally heal from physical wounds. Ultimately, though we cannot avoid pain, we can decide whether or not to suffer.

Read more from Rizaldy R. Ferrer, Ph.D.


Disclaimer:
The information provided in this newsletter is not intended to be a substitute for professional medical or mental health advice. If you are experiencing any mental health issues, please seek professional help. The author of this blog is not liable for any damages or injuries that may result from the use of the information provided here.

When applicable, the names, gender identification, location and/or other identifiable characteristics have been modified to maintain privacy and confidentiality; whilst, still maintaining the integrity of their stories and narratives.

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