Bart Verkuil, Department of Clinical Psychology, Leiden University, The Netherlands and PEP Group, Noordwijk, The Netherlands.

“What if I get infected and end up in the hospital?” “What if I can’t pay my bills in a few months?” “What effect will this lockdown have on my children’s the health?”

The threat of the coronavirus is having a huge impact on most of our lives. To determine what measures need to be taken and to estimate what risks we are facing, scientists use statistical models to gain insight into the spread of the virus. This surely helps to gain some control over this pandemic. Interestingly, we as individual human beings are continuously acting like these scientists, but in a more automatic manner; our human minds can be thought of as ‘prediction machines’, constantly estimating whether we are currently at risk of getting infected, losing our jobs or being criticized. Yet, there are large differences in how people estimate these risks and for some people these estimations spiral down to intense worries.

What makes some people more prone to worry than others? Interestingly, recent insights from evolution theory suggest that stress and worries are actually very common and logical – even ‘default’ – responses to threat. When making predictions about the future, we all tend to err on the side of caution. That is because, in ancient times, only those people that were cautious when confronted with signs of threat were able to survive. These cautious people passed on their genes to next generations. As such, according to the recently proposed Generalized Unsafety Theory of Stress (in short: GUTS), the question should not be “why do people worry?” but: “why can’t some people turn off this logical response to threat and uncertainty?”.

The answer seems to lie in the ability to recognize signals of safety. It is only when people perceive clear signs that they are safe, that the worrying will be turned off. In our predictions about the risks we may encounter in the world, we assess signals of both danger and safety, but the latter has largely been ignored by previous models of stress. Based on this, GUTS proposes that it is the perception of safety that allows people to turn their worrying off. When no safety is perceived, we will keep on worrying. Neurobiological studies indeed show that when safety is perceived, the prefrontal cortex starts to inhibit the stress response. From this perspective, clinicians need to take into account the amount of safety that patients are currently experiencing in their daily lives. GUTS proposes that there are several sources of safety.

The amount of “feeling safe” is firstly determined by ones learning history. When growing up in safe environments, people gradually learn that their world is a safe place, that is predictable and controllable (at least to some extent). They learn to form close attachments with other people, learn that others can be caring, safe and friendly. However, not everyone will grow up in such safe environments. Stressful experiences during childhood will impact one’s feeling of safety in the world and will predispose people to worry later on in their lives.

But there are other sources of safety as well. For example, safety can come from experiencing a supportive social network. Human beings evolved living in groups. And our stress system is more strongly inhibited when we are with friendly others, then when we are alone. A good cuddle has also been demonstrated to reduces our stress response.

Another source of safety comes from within our own bodies: physical fitness. That is, people who are more active show more resilience against stress. Active people might just experience more safety, because they can more easily deal with physical threats. One can imagine that in ancient times, less physically healthy individuals needed to scan their environments for predators much more often than their fit and healthy peers, who could more easily run away from predators.

A final source of safety is having access to nature. We as humans evolved in natural environments (instead of urbanized ones). Such natural environments may evolutionarily have provided signals of safety (hiding places, lookouts, information about escape routes).

Social networks, physical activity, exposure to nature….it is precisely these sources of safety that have been compromised due to the lockdowns everywhere in the world.

As one of the scientists behind GUTS and a psychologist working in clinical practice, I can state that these insights have changed my work with worrying patients. Besides the usual cognitive-behavioral interventions like writing down worries and seeking for evidence on their rationality, or engaging in mindfulness or relaxation exercises, GUTS emphasizes several other interesting ways to tackle worries.

Practical Recommendations

– Acknowledge and normalize worry as a common response to novelty, uncertainty, and threat. Err on the side of normalizing worries, versus building pathology. Trying to suppress worries (with all kinds of quick fixes) will only make things worse.

– Take time to understand the person’s history with regard to safety. Was the patient able to learn about safety when growing up? This determines the pace with which you can expect change to occur. Some are just a bit more vulnerable to worries, because of learning experiences, or because they are born as more emotionally sensitive. Take this vulnerability into account to avoid disappointed patients.

– Don’t forget the body: regular physical activity can help patients to experience a more relaxed mind, also in the long run. Preferably this activity takes place outside, with lots of environmental green.

– Motivate patients to open up about their worries. Worriers might feel lonely and ashamed. But when you motivate them to talk the worries with others, that can not only lead to more support, but also to experiments where threatening predictions (“she will laugh at me for this”) can be turned into safety learning experiences (“she was actually ok and helped me out”).

– Explain that worry itself can sometimes help to feel in control (“I must do something…at least worry about it”), but that this is a false sense of safety. Help people to recognize that some things are beyond are control – which can be painful – and that practicing acceptance and compassion are key.