When the worrying comes back

It will. At some point you'll have a week when the slot gets skipped and the log lies unopened. There you are at two in the morning on the fifteenth lap of the same subject, as if you'd never read a word of this. I'd like you to know in advance that this is ordinary, so that when it happens you'll recognise it.

There are predictable triggers. Tiredness is the biggest, because a tired mind starts rounds more easily and is worse at leaving them. Illness does it, and so does drinking, particularly the morning after. Big changes do it, such as a new baby, a move or a new job, since they throw up real uncertainties by the dozen. Bad news that happens to someone else can do it as well. A friend's diagnosis sends you to check your own body, and you've started again.

When it happens, the response is small and undramatic. At the next convenient moment, write the current worries down, one line each. Ask of each whether there's a step. Date the steps. Put the rest in tomorrow's slot. You're back. You haven't lost your progress, because there's no streak to lose. I'd advise against counting worry-free days at all. When you count days, one bad night feels like a collapse, and then you start worrying about that.

That last problem, worrying about worrying, has been given a lot of weight by the psychologist Adrian Wells in his account of chronic worry. People move from "what if I lose my job" to "what if I can't stop worrying, what if it's damaging my health, what if I'm losing my mind". This second layer can be worse than the first. If you recognise it, two things may help. Worrying is unpleasant and it costs you time, but a round of it isn't a sign that you're losing your mind, and it does end. And you've just read ten chapters arguing that it's a habit with understandable payoffs, not a sign that something is wrong with you. It doesn't deserve to be feared as well.

I'll say a little about the night, since that's where many people do most of their worrying. Your judgment is at its worst at that hour. A problem that looks impossible at three will look like an errand at nine. You can't solve anything from bed anyway, because no step can be taken until morning. So the when-then plan from chapter 11 matters most here. Keep a pad by the bed. Write one line and tell yourself it's on the list for six o'clock. If you're still awake and going round after a while, get up, sit somewhere else with a dull book, and go back when you're sleepy. If you lie there wrestling with it, your mind learns to treat bed as the place for wrestling.

Now the limits of a book. Self-help is a reasonable place to start with worry. The national guidance for England treats it as an early option for generalised anxiety disorder. But it's only one step among several, and you should move to the next if you need to. I'd see a GP, or refer yourself to a talking therapies service if you live in England, in any of these cases.

You've worried on most days for six months or more and you can't control it. It's affecting your work, your sleep or your relationships. You have physical symptoms that trouble you, such as a racing heart, dizziness, stomach problems or constant tension. You've had sudden attacks of intense fear. Your mood has been low for weeks, or you've had thoughts of harming yourself, in which case don't wait for a routine appointment but get urgent help the same day. Or you've given the method in this book an honest month and nothing has moved.

You shouldn't think of any of these as a failure. They tell you which kind of help fits. The treatments are well established. Cognitive behavioural therapy and a method called applied relaxation are the two talking treatments the English guidance recommends, and there are medications that help many people. If you're already taking medication, keep taking it as prescribed, and talk to your doctor before changing anything.

If you do see a therapist, you'll find that much of what they teach is already familiar from these pages, and you'll be starting a few steps ahead.