What To Do With “What If” Thoughts

BY AMBER BATEMAN

8/19/2024

Our brains are designed to protect us, to keep us safe from as many dangers as possible. In the movie Inside Out, the emotions ask the character Fear to make a list of all the things that could go wrong on the first day of school. Fear unrolls a long scroll and says, “Way ahead of you… How do you spell Meteor?”

When we perceive a physical or emotional threat, systems in our brain start churning so we can take action. If you are sitting on train tracks and you hear a train horn blaring, your body should start reacting. It’s going to have a physical response such as an increased heart rate or rising body temperature.

Some of us (due to a variety of reasons such as genetics, childhood environment, trauma, etc.), have very sensitive brains. It’s like a smoke alarm that’s a little too touchy and starts squealing when someone lights a candle. A frequent or consistent over reactive brain is what we refer to as anxious. Professional Counselor Sissy Goff describes worry as “overestimating the threat and underestimating your resources,” and I like that description of anxiety as well.

So what do you do if you have a lot of “what if” thoughts? Here is my go to strategy based off of Cognitive Behavioral Therapy and Mindfulness techniques.

Notice. Evaluate. Action. (NET)

Okay, acronyms aren’t my strong suit, but we’re going with it! Here’s an example scenario for us to walk through:

 You are in a book study and a woman in the group tells everyone that she has been diagnosed with stage 3 cancer. By the end of the evening, you realize that you are not okay.

Step One—NOTICE

The first step is to slow down and take time to really notice your thoughts. When you first become aware that you are anxious, ask yourself: what am I thinking about right now? What words, phrases, sentences, or mental images keep coming to me?

Take a few moments to write down those thoughts or say them out loud to yourself or a friend. In this example, it may look something like this:

·      The lady in the group had no idea she had cancer. Cancer could happen to any of us.

·       What if I have cancer? What if my spouse has cancer and we don’t know it?

·       I probably have cancer too.

Step Two—EVALUATE

In step two, we are taking control of our thoughts by evaluating their use for us. If your thoughts are anxiety/what if based, then we can ask two questions:

·       Is this in my control? (Is there anything I can do about this?)

·       Is this my responsibility? (Is there anything I should do about this?)

NOTE: For other thoughts that are not necessarily anxiety/what if based (such as I am a total failure), stay tuned for another blog post…

Answering these two questions will be extremely difficult for some of you. Hang in there. This step is important because we don’t want to disregard warnings from our brains that could actually be of some use to us. For example, if you are considering starting to smoke, your brain may send you the thought “what if I get lung cancer?” In this case, we do want to evaluate this warning and consider whether it’s worth the risk. Evaluating thoughts is important.

If you can answer no to either or both of the evaluate questions, then at this point, we can treat this thought as an Unhelpful Anxious Thought. Thinking about what if scenarios you have little control or responsibility over is not helpful. We’ll talk about what to do with these thoughts in a minute.

If the answer to these questions is yes, maybe, or I’m not sure, try to identify specifically what could be in your control/responsibility about the situation and what is not. If you are unsure, think about what you would advise to someone you love who was in that same situation. And I should clarify here, that you are looking to identify things you can do today, in the present, as opposed to things you should have done in the past or being overwhelmed by things you could do in the future.

As it relates to our cancer example, you might acknowledge that cancer is complicated and there is a lot that is out of your control; however, you identify a few things that might mitigate the risk, such as limiting substance use or wearing a mask if you work with toxins. In my faith, we believe in a powerful, loving Creator who invites us to bring requests to Him, so some of us would include prayer as something within our control. If you’re still not sure if you are doing “enough” or “the right things”, consider asking someone you trust for advice. What do they think is in your control or your responsibility?  

NOTE: Some find it helpful to ask, “How likely is it that this fear will happen?” If that works for you, great! Personally, I don’t find it very useful as most overactive brains will disregard the 99% chance of things going well and latch onto the 1% they might not. It’s also just really hard to nail down an accurate likelihood of various disasters…Anyway, if it works for you, wonderful; but know you’re not alone if it doesn’t.

 Step Three—ACTION

In step three, we are taking action. Our thoughts are meant to be useful to us. Simply ruminating/thinking thoughts without taking action is rarely beneficial. So if you identified responsible (not perfect or foolproof, but responsible) action steps in step two, DO THEM. Taking responsible action is important because it frees you to be able to challenge your anxious thoughts. When your brain starts assaulting you with images of yourself dying of cancer, you can talk back to your own thoughts and say, “Thank you, brain for trying to protect me, but I am already doing what is reasonable to mitigate that risk, and so this thought is not helpful.” It is also really important because it helps protect you from inappropriate guilt or regret if something bad does end up happening to you. For example, if you do end up being diagnosed with cancer, you can look back and truthfully tell yourself that you did what you felt was within your control to mitigate risks. Beyond that, we have to trust for some reason, it was meant to be.

Now, we’re getting to the really juicy stuff that I know most of you were really interested in when you saw this blog post. What to do with thoughts that you have established are unhelpful. So here are some things to try.

Practice thought stopping. As soon as you identify a thought is unhelpful, try imaging a stop sign and saying STOP to yourself. Tell yourself that thought is not helpful to me, and redirect your attention to whatever you are trying to do in the present moment (dishes, taking a shower, driving a car, going to the bathroom, whatever). Direct your attention to the things that are within your control or responsibility.

Practice mindfulness. Take some slow deep breaths from your belly/diaphragm in through your nose and out through your mouth. Try to focus your attention on the sensation of your breath going in and out. If the unhelpful thought/image keeps coming into your attention, try imagining a peaceful scene such as fluffy clouds against a blue sky. Visualize the unhelpful words or images and “place” them on one of the clouds and see if you can tolerate it being there, without it needing to distress you. Tell yourself, “It’s just a thought. Just because I’m having a thought, doesn’t mean it’s true. I can tolerate it sitting on the cloud in my mind without it harming me.”

Practice self care/healthy coping. Take time to identify (and write down) some practices that help you when you are not feeling well. This may include things like taking a walk outside, cuddling with a loved one or pet, listening to soothing music, engaging in a spiritual practice such as prayer or reading Psalms, talking with someone you trust, or going to bed a little early. More on self care in a future blog …

Practice gratitude. This one, y’all. For me, when I start to swim in anxious thoughts, the last thing that comes naturally is to be thankful, but y’all, it helps. Begin naming as many things that you are grateful for that you can. Even little things like a soft blanket or the intricate details of a daisy. Express thankfulness for each of these things and remember that life is full good and bad, the difficult and the beautiful. This is the way of all the earth, and we can be okay.

And lastly, if you are really struggling with unhelpful thoughts, consider seeing a licensed professional counselor and/or trying medication if necessary. A good therapist can help you identify what may be contributing to the anxiety and offer fresh perspective. It’s also just helpful to have someone come alongside you in your journey.

People are often disappointed with mental health strategies because they want a quick fix. Who doesn’t? We all want to feel better quickly, so we can get on with the rest of our lives. But just like learning a language or becoming good at tennis, learning a new skill takes time and practice. The same is true of improving mental health. Just because you don’t see instant improvement, doesn’t necessarily mean it’s not working. It takes time, but stick with it and you will see change. Check out the What To Do with What Ifs handout/worksheet here to practice these strategies in your own life.

Hang in there. I’m rooting for you.