Solvable vs Hypothetical Worries: A Worry Tree

Two kinds of worry, and why the difference matters

Most worries arrive as a tangle. The car is making a noise, the MOT is due, and what if it fails and costs a fortune and you can't get to work? It feels like one problem, but it is really several, and they need different responses.

Health services sort worries into two groups. The Royal National Orthopaedic Hospital (RNOH) NHS Trust's guide describes a practical worry as a real problem happening now or soon, and a hypothetical worry as something that might happen in the future but isn't happening right now. NHS Every Mind Matters suggests asking whether doing something practical could resolve the worry; if not, it is hypothetical. Its examples include something in the past that can't be changed and a worry about the future that starts with what if.

The distinction has roots in cognitive behavioural therapy for generalised anxiety. A 2000 study by Dugas and Ladouceur described a treatment that taught people to tell worries about situations open to problem solving from worries about situations that are not, and to use a different strategy for each. That study involved four adults, so treat it as the origin of the idea rather than proof that it works. The everyday logic is simple: problem-solving a what-if goes round in circles, and treating a real problem as a what-if leaves it unsolved.

The worry tree, step by step

The worry tree turns the distinction into a short run of questions. This version follows a leaflet from Hull University Teaching Hospitals NHS Trust.

• Notice the worry, and ask: what am I worrying about?
• Ask: is this about a current problem or a hypothetical situation? Or, more simply: can I do something about this?
• If no, it is hypothetical. Let the worry go for now and change the focus of your attention.
• If yes, make an action plan: what, when and how.
• If the action can happen now, do it. If it belongs later, schedule it.
• Either way, once the action is done or scheduled, let the worry go and change your focus.

Both branches end in the same place

Notice that the tree finishes the same way whichever branch you take. A solvable worry doesn't need to be held in mind once it has a plan. NHS Every Mind Matters makes the same point: if the worry comes back, remind yourself that you already have a plan, and turn your attention elsewhere.

Our interactive worry tree runs the same questions in your browser and never asks you to type the worry itself. It can help when you are too wound up to think the questions through on your own.

Questions that make the sorting easier

The central question is easy to ask and sometimes hard to answer. These extra checks are our editorial suggestions:

• Is there something I could do, today or on a date I can name, that would change the situation itself?
• Is the problem happening now or soon, or only in a what-if?
• Would the action change the situation, or only make me feel more certain? Checking again, searching again or asking someone again often fall into the second group.
• Is it mine to act on, or someone else's decision?

Most worries are mixed, so split them

Real worries rarely fall neatly into one box. A useful habit is to break a tangled worry into separate lines, one idea per line, and run each through the tree on its own. What if I lose my job? might contain a practical line, I haven't updated my CV in three years, and a hypothetical one, what if the restructure includes my team?

The sorting can change over time, too. A what-if often becomes practical once a new fact arrives, such as a quote, a reply or a date. When that happens, move the line across and give it a plan. If you can't tell which box a worry belongs in, mark it partly, deal with the practical piece and postpone the rest.

The solvable branch: a plan small enough to start

NHS Every Mind Matters suggests setting aside 5 or 10 minutes to think about possible solutions for one solvable problem, including ideas that seem silly, then weighing the pros and cons of each, how likely it is to work and whether you have what you need. Then choose one and make it specific: what are you going to do, do you need anyone else's support, how much time do you need, and when will you do it?

The RNOH guide breaks this down further. It suggests aiming for at least three possible solutions, rating each from 1 to 10 for how likely it is to work, and planning the first step with where, when and who is involved. If the plan feels overwhelming, it suggests breaking it into smaller steps, then acting, reflecting on what worked and adjusting.

Three of our guides pick up where plans tend to stall. If you are torn between two solutions, see how to compare two options. If the next step is still too vague to start, see how to turn a vague task into a first step. If the action is a call you keep putting off, see how to make a phone call you've been avoiding.

The hypothetical branch: let it go for now

Letting go doesn't mean deciding the worry is silly or forcing it out of your mind. It means accepting that nothing you can do today will answer it. NHS Every Mind Matters suggests acknowledging the worries you can't control, not dwelling on any one for too long, and shifting your focus by distracting yourself, relaxing or bringing your attention back to the present.

Two tools help here. One is worry time: note the what-if in a couple of words and give it a short slot later in the day, as our worry-time guide explains. The other is a reality check for what-ifs that keep growing into disasters; our guide to stopping jumping to the worst-case scenario walks through writing down the worst, best and most likely outcome.

Watch for actions that look practical but aren't. Searching for the twentieth time, rereading a message or asking someone to confirm again can feel like doing something, but if the facts haven't changed, they mostly chase certainty. Our guide to asking for reassurance less covers that loop.

Worked example: the car, through both branches

This example is invented to show the process. On Sunday evening Tom writes: the car is making a grinding noise, the MOT is due on the 14th, what if it fails and costs a fortune and I can't get to work?

He splits it into lines. Grinding noise: practical. MOT due on the 14th: practical. What if it fails: hypothetical. What if it costs a fortune: hypothetical for now. Can't get to work: mostly hypothetical, with one practical piece, knowing the backup route.

Solvable branch. Tom spends five minutes on ideas: book the MOT online, ask the garage to check the noise at the same time, ask his neighbour who knows cars, look up the bus. He picks one plan: phone the garage at 9am on Monday and ask for an MOT before the 14th and a look at the noise. That gets scheduled, because the garage is closed. Checking the bus takes two minutes, so he does it now: the 7:52 would get him in on time.

Hypothetical branch. Whether the car fails and what a repair would cost can't be known until a mechanic looks. Tom writes MOT cost on his worry-time list for 6pm on Monday, then goes back to the film he was watching.

On Monday the garage books the car in for Thursday. At worry time the cost worry is still there, but it now has a date when it will be answered. On Thursday the garage quotes for new brake pads, and the what-if has become a practical question: pay for the repair now or get a second quote first. That is a two-option decision with one fact to check, and Tom makes it by Friday.

A worry-tree template to copy

This is an original editorial template, not a clinical worksheet. Copy it onto paper or into a note.

• The worry, in one sentence:
• Split into lines, one idea each:
• For each line, can I do something about this? Yes / No / Partly
• Yes: what, when, how? Doing it now, or scheduled for:
• No: postponed to worry time at ___. What I'm turning my attention to now:
• Partly: the practical piece is ___; the what-if piece is ___
• Later: did any what-if become practical once I knew more?

When sorting isn't enough

Some worries are hard to sort because the stakes are unclear: a new symptom, an official letter, a growing debt. Don't label them hypothetical to make them go away. Ask someone qualified, such as a GP, a pharmacist or a free advice service, and let their answer tell you what the practical step is.

If most of your worries feel hypothetical and impossible to put down, if worry makes it hard to decide anything, or if it is affecting your sleep, work or relationships, talk to your GP. The NHS says adults aged 18 and over can also refer themselves to an NHS talking therapies service without a referral from a GP. This guide is educational and is not a substitute for that support.

Sources

• NHS Every Mind Matters — Tackling your worries (the worry tree; making a plan; accepting worries you can't control)
• NHS Every Mind Matters — Problem solving (solvable problems and hypothetical worries; 5 or 10 minutes on possible solutions; making a specific plan)
• Hull University Teaching Hospitals NHS Trust — The Worry Tree (PDF; current problem or hypothetical situation; action plan; do it now or schedule it)
• Royal National Orthopaedic Hospital NHS Trust — Patient's guide to postponing worries (practical and hypothetical worries; problem-solving steps and ratings)
• Dugas & Ladouceur (2000) — Treatment of GAD: targeting intolerance of uncertainty in two types of worry, Behavior Modification (PubMed; four-participant study)
• NHS — Generalised anxiety disorder in adults (when to see a GP; self-referral to NHS talking therapies)

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