Real problems and what-ifs: telling them apart
Your worries are usually about real things. That does not mean worrying is the right response. Here is how CBT separates a problem you can act on from a what-if you cannot.
One of the first things people say to me when we start working on worry is some version of this: but my worries are about real things. The money is really tight. The job really is uncertain. My mother really is unwell. This is not imaginary.
They are right, and I want to say so clearly, because a lot of people have been told, in one way or another, that their worries are silly. That is not what I think. CBT separates the problems you can act on from the what-ifs you cannot, and changes what you do with each.
Two kinds of thought that feel identical
From the inside, a real problem and a what-if feel the same. Both arrive with urgency. Both feel like they need attention now. Both produce the same tightening in the body. This is why worriers cannot simply decide to stop: the mind is presenting everything as equally pressing, and there is no obvious way to tell which ones actually are.
The difference is whether there is an action available, rather than how serious the subject is.
A real problem has a next step. The money is tight: there is a budget to look at, a call to make, a decision to take. Your mother is unwell: there is an appointment to arrange, a conversation to have, a rota to sort with your siblings. The action may be hard or unpleasant, but it exists, and once it is taken the worry about that particular thing has done its job and can stop.
A what-if has no next step. What if the money gets tighter next year? What if the treatment does not work? What if I lose the job and cannot find another? They are possibilities, and there is nothing to do about a possibility except wait and see. Worrying about them produces no action, only more worry.
Why the mind blurs them
Generalised anxiety is very good at attaching a what-if to every real problem. You start with the budget, which has an action, and within minutes you are worrying about next year, which does not. The real problem gets a bit of attention and the what-if gets an hour. Meanwhile the action that would actually have helped does not get taken, because the worrying felt like dealing with it.
This is also why problem-solving advice tends to backfire for worriers. "Just make a plan" works for the real problem and makes the what-if worse, because you cannot plan for a possibility, and trying to teaches the mind that possibilities need planning.
The sorting exercise
So in the CBT work we do a very practical thing. When a worry arrives, before engaging with it, we ask one question: is there something I can do about this today?
If yes, it goes on the list and the action gets scheduled rather than worried about. The doing is what resolves it.
If no, it is a what-if, and it gets a different treatment. It is noted, it is deferred to a set worry time later in the day, and in the meantime it is not engaged with. At worry time it gets its fifteen minutes, and the aim in those minutes is to practise tolerating an open question, since it cannot be solved.
Tolerating the open question
Worriers tend to have a very low tolerance for not knowing. An unanswered question feels like a danger, and the worrying is an attempt to close it. But most of the important questions in a life cannot be closed in advance. Will the treatment work, will the job last, will the child be all right: these stay open, for everyone, whether they worry or not.
Learning to carry an open question without processing it constantly is a skill, and it is built the way skills are built: small, repeated, in real situations. Each time a what-if is deferred rather than engaged with, and the world does not end, the tolerance grows a little. This is the harder half of the work, and where most of the change happens.
What changes
People do not stop having real problems, and they do not stop caring about them. The real problems get actions instead of worry, and the what-ifs get a fixed appointment instead of the whole day. Most people describe the worry as getting smaller and more useful at the same time.
If you have been told your worries are irrational and have always known they were about real things, there is more on how I treat generalised anxiety, and this distinction is at the centre of it.