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Worry

Worry is a pervasive cognitive and emotional process characterized by repetitive, often uncontrollable thoughts and mental images about potential future threats or uncertainties, which evoke feelings of anxiety, apprehension, and distress.^[1] Unlike fear, which responds to immediate dangers, worry centers on anticipated or hypothetical negative events, ranging from everyday concerns like work performance to broader existential uncertainties.^[2] In its moderate form, worry functions as an adaptive mechanism to anticipate problems and facilitate planning, but when excessive, it becomes a maladaptive habit that interferes with daily life.^[3] Excessive worry is the defining feature of generalized anxiety disorder (GAD), a common mental health condition with a 12-month prevalence of approximately 2.7% among U.S. adults and a lifetime prevalence of around 6%, according to 2001–2003 data.^[4] GAD typically emerges in late adolescence or early adulthood, affects women at nearly twice the rate of men, and is associated with physical symptoms such as muscle tension, fatigue, irritability, and sleep disturbances.^[5] Pathological worry differs from normal worry in its pervasiveness, lack of control, and focus on low-probability catastrophic outcomes, often fueled by intolerance of uncertainty and meta-worry (worry about worrying itself).^[2] From an evolutionary standpoint, worry likely developed as a survival tool, enabling early humans to simulate threats and rehearse responses, thereby reducing actual risks in unpredictable environments.^[3] In contemporary settings, however, chronic worry contributes to heightened stress responses, including elevated cortisol levels and prefrontal cortex overactivity, which can exacerbate health problems like impaired immune function and increased susceptibility to coronary heart disease.^[6]^[7] Effective management strategies include cognitive-behavioral therapy (CBT), which targets worry patterns through techniques like cognitive restructuring and exposure to uncertainty, often yielding significant improvements within 3-6 months.^[5]

Conceptual Foundations

Definition

Worry is defined in psychology as a chain of thoughts and images, negatively affect-laden and relatively uncontrollable, that imaginatively concern possible future negative events or outcomes perceived as threatening.^[8] This process centers on anticipatory concerns about potential threats, distinguishing it from constructive problem-solving by its repetitive, unproductive nature that often heightens rather than resolves distress.^[9] Key components of worry include the anticipation of future threats, accompanying emotional distress, and cognitive rumination characterized by verbal-linguistic processing over vivid imagery.^[10] In clinical contexts, worry serves as a hallmark symptom of generalized anxiety disorder (GAD) according to DSM-5 criteria, where it manifests as excessive anxiety and apprehensive expectation occurring more days than not for at least six months, involving multiple events or activities and proving difficult to control. This uncontrollable quality often leads to interference in daily functioning, marking a shift from adaptive vigilance to maladaptive preoccupation. Everyday worries typically involve manageable concerns, such as performance at work or upcoming deadlines, which may motivate action without overwhelming the individual.^[3] In contrast, pathological worry escalates to excessive and pervasive levels, like unfounded health fears that dominate thoughts despite reassurance, contributing to chronic anxiety disorders.^[11] The concept of worry in psychology has evolved from early psychoanalytic views, where Sigmund Freud described "anxious expectation" as a core feature of anxiety neurosis tied to repressed libidinal tensions in the late 19th century, to modern cognitive frameworks.^[12] By the mid-20th century, diagnostic systems like DSM-III (1980) began separating GAD from other anxiety forms, but it was DSM-III-R (1987) that elevated worry as the defining cognitive symptom, reflecting a paradigm shift toward viewing it as a distinct mental process rather than mere emotional overflow.^[12] Contemporary definitions, pioneered by researchers like Thomas Borkovec in the 1990s, emphasize worry's role in cognitive avoidance and its verbal, future-oriented structure, integrating it into evidence-based models of anxiety.^[13]

Etymology and Historical Usage

The word "worry" originates from the Old English verb wyrgan, meaning "to strangle" or "to choke," referring initially to the physical act of an animal seizing and shaking its prey by the throat.^[14] This sense, derived from Proto-Germanic wurgjaną and linked to the Proto-Indo-European root wer- ("to turn, bend"), persisted into Middle English as worien or wirien, retaining connotations of harming or tormenting through biting and tearing.^[14] By around 1400, the term began to acquire figurative meanings of annoyance or vexation, evolving further by the early 19th century to denote mental distress and harassing anxiety, with the intransitive sense of "to feel anxious" attested from 1860.^[15] The noun form, meaning "a harassing anxiety" or "state of worry," first appeared in 1804.^[14] In early English literature, "worry" largely maintained its physical and destructive implications, as evidenced by its rare appearance in Shakespeare's works—used only once in Richard III, referring to the physical act of seizing and shaking prey rather than abstract anxiety.^[16] By the 19th century, however, the term shifted toward psychological interpretations in both literary and medical contexts, reflecting broader cultural concerns with mental strain amid industrialization and social change.^[17] In Victorian literature, worry often symbolized inner turmoil or a somatic ailment tied to nervous exhaustion, portrayed as a debilitating force that blurred the lines between moral weakness and physical disorder.^[18] Medical texts of the era increasingly associated worry with nervous disorders such as neurasthenia, a condition diagnosed by George Miller Beard in 1869 as involving fatigue, irritability, and anxious apprehensions resulting from modern life's demands on the nervous system.^[19] Figures like Charles Darwin exemplified this view in personal accounts, describing worry as a chronic, debilitating affliction that exacerbated his physical symptoms, including palpitations and gastrointestinal distress, which he attributed to inherited nervous vulnerability and incessant mental fretting over health and legacy.^[20] In pre-20th-century discourse, worry was thus frequently framed as both a moral failing—stemming from insufficient self-control—and a bodily ailment, amenable to rest cures or lifestyle reforms rather than deeper psychological intervention.^[21] The transition to modern psychology in the early 20th century reframed worry within psychoanalytic frameworks, where Sigmund Freud conceptualized it as a form of anxiety arising from repressed libidinal tensions or unconscious conflicts, often manifesting as transformed sexual energy rather than mere physical strangulation of the past.^[22] Freud's 1895 separation of "anxiety neurosis" from neurasthenia underscored worry's role in signaling ego threats, marking its evolution from somatic symptom to a key element of intrapsychic dynamics.^[23] Worry is primarily a cognitive process characterized by future-oriented chains of thoughts and images about potential negative events and outcomes, distinguishing it from fear, which serves as an immediate, alarm-like response to a perceived present or imminent threat, often accompanied by fight-or-flight physiological activation.^[24] In contrast, anxiety encompasses a broader, more pervasive emotional state that includes worry as its cognitive component but also features heightened physiological arousal, such as increased heart rate and tension, directed toward anticipated dangers.^[25] This cognitive emphasis in worry aligns with Borkovec's avoidance theory, which posits it as a verbal-linguistic strategy to suppress deeper emotional processing of uncertain future threats, thereby providing a temporary sense of control. A key distinction exists between worry and rumination, another form of repetitive negative thinking; worry is predominantly future-directed and problem-focused, involving verbal rehearsals of potential solutions to hypothetical scenarios, whereas rumination is past-oriented, self-referential, and centered on causes, meanings, and consequences of negative experiences, often exacerbating depressive symptoms. Empirical studies, including one showing worry as a stronger predictor of both anxiety and depression symptoms than rumination, underscore their divergent emotional correlates despite shared repetitive qualities.^[26] In clinical contexts, excessive worry defines Generalized Anxiety Disorder (GAD) according to DSM-5 criteria from the American Psychiatric Association, requiring apprehensive expectation about multiple domains (e.g., work, health) occurring more days than not for at least six months, accompanied by symptoms like restlessness and difficulty concentrating.^[27] This pervasive, unfocused worry differentiates GAD from panic disorder, where the core feature is recurrent, unexpected panic attacks—abrupt episodes of intense fear peaking within minutes, often with physical symptoms like chest pain—without the chronic anticipatory cognition central to GAD.^[27] Similarly, specific phobias involve marked, disproportionate fear or anxiety triggered by a particular object or situation (e.g., animals, blood), leading to immediate avoidance, unlike the diffuse, future-oriented worry in GAD.^[27] Evolutionarily, worry functions as an adaptive mechanism for episodic foresight, allowing individuals to mentally simulate future threats and rehearse responses, which conferred survival advantages by promoting preparedness in uncertain ancestral environments.^[28] However, in contemporary settings, this foresight can become maladaptive when it escalates into chronic over-preparation, contributing to anxiety disorders as a byproduct of normally beneficial vigilance systems.^[29]

Psychological Theories

Cognitive Models

Cognitive models of worry emphasize the role of thought processes in generating and maintaining this mental state, viewing it as a product of biased information processing, threat evaluation, and metacognitive strategies rather than mere emotional reactivity. These frameworks, developed primarily in the late 20th century, highlight how worry emerges from selective attention to potential dangers and appraisals that amplify perceived risks while downplaying coping abilities. Key contributions include explanations of worry's verbal nature, its function in avoiding deeper emotional engagement, and beliefs that sustain it as adaptive. One influential model is Thomas Borkovec's cognitive avoidance theory, which posits that worry serves as a strategy to suppress distressing mental imagery and associated emotional arousal. According to this view, worry predominantly involves verbal-linguistic rumination on abstract future threats, which inhibits the formation of vivid, sensory-based images that could trigger intense somatic responses like increased heart rate.^[13] This avoidance is negatively reinforced because it temporarily reduces anxiety by precluding full emotional processing of feared outcomes, thereby maintaining pathological worry over time. Borkovec et al. (2004) elaborate that this mechanism explains why individuals with generalized anxiety disorder (GAD) report using worry to distract from emotional topics, as the abstract, non-imagery focus mutes physiological reactivity compared to relaxation or direct confrontation with threats.^[30] Richard Lazarus's appraisal theory provides another foundational cognitive perspective, framing worry as arising from the evaluation of events in relation to personal well-being. In primary appraisal, an event or potential outcome is assessed as threatening or harmful, often involving uncertainty about future dangers, which initiates worry as a precautionary response. Secondary appraisal follows, where individuals gauge their coping resources and options; perceived inadequacy in handling the threat—such as low control or insufficient support—intensifies worry by heightening feelings of vulnerability. Empirical evidence supports this in GAD contexts, where biased appraisals (overestimating threats and underestimating coping potential) predict higher worry frequency and contribute to disorder risk, as shown in large-scale surveys linking these patterns to stable negative emotion dispositions.^[31] Lazarus (1991) originally outlined this two-stage process as central to stress and emotion, with applications to worry underscoring how cognitive interpretations transform neutral uncertainties into persistent concerns. Attentional bias represents a core cognitive mechanism in worry, characterized by heightened sensitivity to and difficulty disengaging from threat-related information in the environment. This bias leads individuals to selectively allocate cognitive resources toward potential dangers, perpetuating a cycle of apprehension. Studies using the emotional Stroop task, a modified version of the classic color-naming interference paradigm, demonstrate this effect: participants with high worry or GAD exhibit slower response times when naming the ink color of threat words (e.g., "danger" or "failure") compared to neutral words, indicating interference from automatic threat detection. For instance, in older adults with pathological worry levels, color-naming latencies were significantly prolonged for negative stimuli (bias score ≈27 ms), mirroring patterns in younger GAD samples and contrasting with non-worriers who show reduced interference.^[32] Similarly, meta-analyses of Stroop studies in GAD confirm robust attentional capture by external threats, with delays in disengagement contributing to sustained worry independent of depressive biases.^[33] Adrian Wells and Gerald Matthews's metacognitive model further elucidates worry through beliefs about thinking itself, proposing that positive metacognitions drive its persistence. Developed in the 1990s, this framework argues that individuals endorse views of worry as beneficial, such as a strategy for thorough problem-solving or mental rehearsal to prepare for worst-case scenarios, which motivates continued engagement despite its costs. These beliefs, assessed via tools like the Meta-Cognitions Questionnaire, correlate with pathological worry in GAD, where worry is appraised as a form of proactive coping that enhances readiness. Wells and Matthews (1994) integrated this into a broader self-regulatory executive function model, emphasizing how such positive appraisals activate and prolong worry cycles, distinguishing it from mere content-focused rumination.^[34]

Avoidance and Uncertainty Models

The intolerance of uncertainty (IU) model posits that excessive worry in generalized anxiety disorder (GAD) arises primarily from a dispositional aversion to ambiguous future events, where uncertainty is appraised as threatening and uncontrollable, prompting worry as a maladaptive coping strategy to gain perceived predictability.^[35] Core features include heightened prospective anxiety about potential negative outcomes and behavioral avoidance of situations involving risk or ambiguity, which perpetuate the cycle by reinforcing the belief that uncertainty must be eliminated.^[36] This model, originally proposed by Dugas and colleagues, distinguishes IU as a transdiagnostic factor but emphasizes its centrality in GAD, where individuals engage in worry to mentally rehearse and neutralize uncertain threats.^[35] Within the acceptance and commitment therapy (ACT) framework developed by Hayes, experiential avoidance refers to attempts to suppress or escape distressing internal experiences, such as emotions or thoughts, which in the context of worry manifests as repetitive mental rumination to sidestep direct emotional confrontation and maintain psychological distance from anxiety. This avoidance sustains anxiety cycles by paradoxically amplifying worry over time, as individuals fuse with worry content to evade underlying affective experiences, leading to chronic emotional suppression rather than acceptance and value-driven action.^[37] Empirical evidence supports these models through strong positive correlations between IU measures, such as the Intolerance of Uncertainty Scale, and GAD symptom severity, including worry frequency and intensity, observed across clinical and non-clinical samples.^[38] Interventions targeting IU, like uncertainty exposure training within cognitive-behavioral therapy, have demonstrated reductions in worry by enhancing tolerance for ambiguity, with meta-analyses indicating moderate to large effect sizes on GAD symptoms post-treatment.^[39] Similarly, ACT-based approaches reducing experiential avoidance have shown mediation effects, where decreased avoidance predicts lower worry levels in GAD patients.^[37] Behaviorally, worry functions as a form of avoidance that postpones emotional processing and confrontation with feared outcomes, thereby contributing to the chronicity of anxiety as evidenced in 1990s behavior therapy research examining physiological and cognitive suppression during worry episodes.^[40] This postponement creates a self-perpetuating loop, where short-term relief from immediate distress reinforces worry as a habitual response, hindering adaptive problem-solving and exposure to uncertainty.^[41]

Metacognitive and Evolutionary Perspectives

The metacognitive model of worry, developed by Adrian Wells, emphasizes that pathological worry arises not primarily from the intrusive thoughts themselves but from metacognitive beliefs—individuals' appraisals and knowledge about their own cognitive processes, particularly worrying. According to this framework, positive metacognitive beliefs portray worry as beneficial, such as a form of mental preparation or problem-solving strategy that anticipates and mitigates future threats, thereby motivating continued engagement in the process. In contrast, negative metacognitive beliefs frame worry as uncontrollable, harmful, and dangerous, leading to meta-worry (worry about worrying itself) and reinforcing a self-perpetuating cycle of cognitive activation. These beliefs are central to the model's explanation of generalized anxiety disorder, where appraisals of worry thoughts as uncontrollable and posing personal danger sustain the disorder by inhibiting disengagement and promoting avoidance of emotional processing.^[34]^[42] The Metacognitions Questionnaire-30 (MCQ-30), a validated 30-item scale derived from Wells's model, assesses these dimensions across five subscales, including uncontrollability and danger (e.g., beliefs that worry signals mental instability or physical harm) and cognitive confidence (e.g., doubts about one's thinking reliability). Empirical studies confirm the MCQ-30's internal consistency (Cronbach's α > 0.70 for most subscales) and test-retest reliability (r > 0.75 over 5 weeks), with higher scores correlating strongly with worry severity in clinical populations. This measurement tool has facilitated research demonstrating that targeting these metacognitive appraisals, rather than thought content, disrupts worry cycles more effectively than traditional cognitive restructuring.^[43]^[44] From an evolutionary standpoint, worry is conceptualized as an adaptive psychological adaptation shaped by natural selection to enhance survival through threat simulation and anticipatory planning in ancestral environments rife with unpredictable dangers. Drawing on principles of evolutionary psychology outlined by Tooby and Cosmides, worry aligns with error management theory, which posits that cognitive mechanisms evolved to bias toward over-detection of threats (false alarms) rather than under-detection (missed alarms), as the fitness costs of the latter were asymmetrically higher in hunter-gatherer contexts. This system facilitated proactive problem-solving and resource allocation for potential hazards, such as predator encounters or social conflicts, by mentally rehearsing scenarios and generating coping strategies. However, in contemporary low-threat settings, this "fossilized alarm response"—a conserved mechanism from human evolutionary history—often misfires, transforming an once-adaptive vigilance into chronic, maladaptive rumination disconnected from real dangers.^[45] Recent research since 2010 has integrated metacognitive and evolutionary perspectives by examining how mindfulness interventions cultivate metacognitive awareness, thereby interrupting worry cycles rooted in evolved threat biases. For instance, mindfulness-based programs reduce negative metacognitive beliefs about uncontrollability and danger, leading to decreased physiological arousal (e.g., lower heart rate variability) and self-reported worry in high-worriers, as these practices promote detached observation of thoughts akin to disengaging an overactive alarm system. A 2025 study further evidenced that changes in metacognitive beliefs mediate symptom reductions in anxiety following mindfulness training, indicating moderate clinical impact and supporting the model's emphasis on meta-level regulation over content-focused change. This convergence highlights how enhancing awareness of worry's evolutionary origins can normalize it as a vestigial response, fostering adaptive detachment in modern contexts.^[46]^[47]

Philosophical Perspectives

Ancient Views

In ancient Greek medicine, worry and related states of melancholy were conceptualized within the humoral theory, which posited that health depended on the balance of four bodily fluids: blood, phlegm, yellow bile, and black bile. An excess of black bile was believed to cause melancholy, manifesting as persistent sadness, anxiety, or despondency, as described in Hippocratic texts such as Aphorisms and On the Nature of Man, where emotional disturbances were seen as physiological imbalances requiring dietary and lifestyle adjustments to restore equilibrium.^[48] Aristotle, in his Nicomachean Ethics, linked worry to akrasia (weakness of will), portraying it as an excess of emotion—such as fear or apprehension—that disrupts rational judgment and prevents the pursuit of eudaimonia (flourishing or happiness). He argued that the virtuous person maintains emotional moderation to align actions with knowledge of the good, whereas akrasia occurs when passions override reason, leading to self-defeating behaviors akin to worrying over uncertainties rather than focusing on controllable virtues (Book VII).^[49] Stoic philosophers further developed these ideas, viewing worry as a futile preoccupation with uncontrollable externals. Epictetus, in his Enchiridion, introduced the dichotomy of control, stating: "Some things are up to us and some things are not up to us," advising that worry arises from mistaking externals like health or reputation for internals like judgment and intention, and thus should be dismissed to achieve tranquility (Chapter 1). Similarly, Seneca, in Letters to Lucilius, described anxiety as suffering in anticipation, writing in Letter 13: "We suffer more often in imagination than in reality," urging focus on the present to counteract groundless fears about the future.^[50] In Eastern thought, early Buddhist texts in the Pali Canon framed worry as a form of dukkha (suffering or unsatisfactoriness) stemming from attachment (upādāna) to impermanent phenomena. The Dhammacakkappavattana Sutta (SN 56.11) identifies craving and clinging as the origin of dukkha, including mental afflictions like anxiety over loss or change, which can only be alleviated through detachment and the Noble Eightfold Path. Confucian philosophy, as recorded in the Analects, cautioned against excessive worry as a disruptor of social harmony (he), with Confucius advising: "Do not worry about lack of position; worry about becoming worthy of it" (4.14), emphasizing self-cultivation over fretting about external recognition to maintain inner and communal balance.^[51]

Modern and Existential Interpretations

In the 19th century, Søren Kierkegaard introduced a profound existential interpretation of worry as a form of dread or angst, arising from humanity's radical freedom and the infinite possibilities of choice. In The Concept of Anxiety (1844), he describes anxiety not as fear of a specific object but as the "dizziness of freedom," a vertiginous awareness of one's responsibility to actualize the self amid boundless potential, which can manifest as paralyzing worry over moral and spiritual decisions.^[52] This ontological dread, for Kierkegaard, is essential to the human condition, marking the leap toward authentic faith and selfhood, rather than mere psychological distress.^[52] Friedrich Nietzsche extended this critique by viewing worry as a symptom of "slave morality," a reactive and resentful mindset that stifles the affirmative "will to power" through excessive concern for security, pity, and conformity. In works like On the Genealogy of Morality (1887), he contrasts this with master morality's noble indifference to petty anxieties, arguing that slave morality inverts values to valorize weakness and worry as virtues, thereby inhibiting life's creative overflow. To confront such inhibitions, Nietzsche proposed the thought experiment of eternal recurrence in Thus Spoke Zarathustra (1883–1885), urging individuals to embrace their existence without regret or anticipatory worry, as if every moment would repeat infinitely, thus transforming dread into joyful affirmation.^[53] In the 20th century, Jean-Paul Sartre and Albert Camus reframed worry within absurdism as an anguished response to the universe's inherent meaninglessness, where human quests for purpose clash with indifferent reality. Sartre, in Being and Nothingness (1943), posits that worry stems from the anguish of absolute freedom, leading individuals to evade responsibility through "bad faith"—inauthentic pretenses that disguise existential worry as external fate or social role, such as the waiter who over-identifies with his profession to avoid the dread of self-creation. Camus, in The Myth of Sisyphus (1942), portrays worry as the initial revolt against the absurd, but advocates lucid acceptance and defiant living—through art, love, or rebellion—rather than suicide or escapist illusions, emphasizing that authentic existence demands confronting meaninglessness without succumbing to paralyzing concern.^[54] Contemporary existential philosophy, particularly Martin Heidegger's Being and Time (1927), interprets worry as inherent to "care" (Sorge), the fundamental structure of human existence (Dasein), encompassing "thrownness" into a world not of one's choosing and the anticipatory anxiety of finitude. Heidegger describes Sorge as an ontological worry over being-toward-death, where everyday distractions (fallenness) mask this primordial concern, yet authentic resoluteness emerges by owning one's thrown project amid uncertainty. Complementing this, Simone de Beauvoir's feminist existentialism in The Second Sex (1949) critiques gendered worry as a social imposition, where women are conditioned into immanent roles of domestic vigilance and self-effacing concern, perpetuating bad faith and limiting transcendence; she calls for women to transcend these anxieties through economic independence and mutual recognition, reclaiming freedom from patriarchal scripts.^[55]^[56]

Religious and Cultural Dimensions

Abrahamic Traditions

In Abrahamic traditions, worry is often interpreted as a spiritual affliction arising from insufficient trust in divine providence, with theological responses emphasizing reliance on God to restore inner peace. In Judaism, the Hebrew Bible portrays worry as an "anxiety of heart" that afflicts those who stray from covenantal obedience, as seen in Deuteronomy 28:65, where it is described as a consequence of exile and disobedience, manifesting as restless fear and dread among the people. This anxiety is balanced by calls to trust in God, exemplified in Deuteronomy 31:6, which urges Israel to "be strong and courageous" because "the Lord your God goes with you; he will never leave you nor forsake you," framing divine presence as the antidote to human trepidation. Talmudic literature further nuances this by permitting limited worry as a catalyst for repentance, particularly in discussions of teshuvah (return to God), where mild concern over past sins motivates ethical self-examination without descending into despair; for instance, the Babylonian Talmud in Yoma 86b stresses that genuine remorse, akin to constructive worry, facilitates atonement, distinguishing it from paralyzing fear. Christian theology similarly views worry as indicative of faltering faith, most prominently in the New Testament's Sermon on the Mount, where Jesus instructs in Matthew 6:25-34, "Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear," portraying it as unnecessary given God's provision for creation, like birds and lilies, and urging seekers to prioritize the kingdom of God instead. Early Puritan thinkers, such as John Flavel, reframed certain forms of worry as "providential" when they prompt reliance on God's sovereignty, advising believers to meditate on divine oversight to alleviate anxiety, in contrast to unchecked fretting that undermines assurance of salvation.^[57] In modern evangelical contexts, this evolves into self-help paradigms that integrate biblical exhortations with practical faith exercises, as in resources from Ligonier Ministries, which counsel replacing worry with theological reflection on God's control to foster resilience against daily concerns.^[58] Islamic teachings counter worry through tawakkul, or complete reliance on Allah, as articulated in Quran 65:3: "And whoever relies upon Allah—then He is sufficient for him," presenting trust in divine decree as a remedy that dispels anxiety over worldly affairs. Hadiths reinforce this by warning against excessive concern for material matters as a whisper (waswas) from Shaytan, the devil, who seeks to erode faith; for example, a narration in Sahih Muslim describes Shaytan's tactics in instilling doubts and fears to divert believers from submission to Allah, urging instead steadfast prayer and remembrance of God to neutralize such influences.^[59] Medieval scholasticism, particularly in the works of Thomas Aquinas, classifies inordinate fear (including excessive worry) as a venial sin when it pertains to temporal matters and causes contraction in the mind, preventing the performance of duties without fully severing charity toward God, as explored in the Summa Theologica (II-II, q. 125) on fear. Aquinas ties such disorders to the broader effects of original sin, which incline the will toward inordinate attachments that can manifest as anxious preoccupations with temporal security rather than eternal providence.^[60]

Eastern Philosophies and Religions

In Hinduism, worry, referred to as chinta, arises from entanglement in maya—the illusory nature of the material world—and the binding effects of karma, which perpetuate cycles of desire and suffering.^[61] The Bhagavad Gita, a foundational text, addresses this in Chapter 18 by emphasizing equanimity (samatva) as a means to transcend such mental agitation; Lord Krishna instructs Arjuna to perform actions without attachment to outcomes, integrating bhakti yoga (devotional surrender) and karma yoga (selfless action) to cultivate inner balance and freedom from anxiety over results.^[62] In Buddhism, particularly within Theravada traditions, worry manifests as vicikiccha (doubt or skeptical uncertainty), identified as one of the five hindrances (nivarana) that obstruct meditative concentration and insight.^[63] Theravada texts, such as the Visuddhimagga, link this hindrance to tanha (craving or thirst), where obsessive attachment to future possibilities fuels restlessness and prevents clear seeing; it is resolved through vipassana (insight meditation), which systematically dismantles doubt by fostering direct awareness of impermanence (anicca), suffering (dukkha), and non-self (anatta).^[64] Taoism views worry as a symptom of disharmony with the Dao (the natural way), stemming from excessive striving and interference with life's spontaneous flow, as articulated in Laozi's Tao Te Ching. The principle of wu wei (effortless non-action) serves as a countermeasure, encouraging alignment with the Dao through non-coercive responsiveness rather than forceful control over outcomes, thereby dissolving anxiety born of resistance.^[65] Ancient texts like the Upanishads further illuminate these perspectives by promoting the realization of unity between atman (individual self) and Brahman (ultimate reality), which diminishes future-oriented worry by revealing the illusory separation of self from the eternal whole.^[66] In Zen Buddhism, a later development influenced by these traditions, koans—paradoxical anecdotes or questions—confront worry indirectly by shattering dualistic thought patterns, inviting practitioners to embrace ambiguity and transcend anxious projections through intuitive insight beyond rational analysis.^[67]

Cross-Cultural Variations

In collectivist societies, such as those in East Asia, worry frequently revolves around maintaining social harmony and avoiding offense to others, reflecting cultural emphases on interdependence and group cohesion. For instance, in Japan, taijin kyofusho represents a culturally specific manifestation of social anxiety, characterized by intense fears that one's body, odor, or bodily functions might disgust or embarrass others, leading to heightened interpersonal worry.^[68] This contrasts with individualist Western cultures, where worry more often centers on personal achievement, self-efficacy, and individual failure, as self-esteem and autonomy are prioritized in psychological well-being.^[69] Cross-cultural studies indicate that these differences contribute to higher reported social anxiety in collectivist contexts, while Western individuals may experience elevated worry tied to personal goals and independence.^[70] Among Indigenous populations, such as Native American communities, worry and anxiety are often conceptualized as disruptions in holistic balance between mind, body, spirit, and nature, stemming from disconnection from the natural world or ancestral traditions.^[71] Resolution typically involves traditional healing practices and time spent in nature to restore harmony and spiritual alignment, viewing these as essential for emotional equilibrium rather than isolated psychological symptoms.^[72] In African contexts, the Ubuntu philosophy promotes communal sharing of worries as a core mechanism for emotional support, emphasizing that individual well-being is intertwined with the collective, where burdens like anxiety are collectively borne through dialogue and mutual care within the community.^[73] This approach fosters resilience by redistributing personal distress across social networks, aligning with cultural values of interconnected humanity.^[74] Gender differences in worry appear consistently across cultures, with women reporting higher levels globally, often linked to societal roles and expectations.^[75] World Health Organization-affiliated research highlights that women are approximately 1.5 to 2 times more likely to experience anxiety disorders, including excessive worry, than men, a pattern observed in diverse settings from high-income to low-income countries.^[76] Socioeconomic factors further amplify worry in developing regions, where economic instability—such as poverty and unemployment—exacerbates anxiety through chronic stress and resource scarcity, with individuals in low-income groups facing 1.5 to 3 times higher risks of mental distress compared to higher-income counterparts.^[77] In these areas, financial insecurity intensifies worry about basic needs, contributing to broader psychological strain.^[78] Globalization has introduced hybrid forms of worry influenced by social media, blending local cultural concerns with universal pressures like social comparison and fear of missing out, which heighten anxiety across borders.^[79] Studies from the 2020s, particularly during the COVID-19 pandemic, reveal cross-cultural spikes in worry, with global surveys showing elevated distress levels in 48 countries due to health uncertainties and isolation, though expression varied by cultural norms—such as greater communal fear in collectivist societies versus individual health concerns in the West.^[80] These findings underscore how digital connectivity and shared global events create overlapping worry patterns while retaining cultural nuances.^[81]

Biological and Neurological Basis

Brain Structures and Pathways

Worry involves a distributed network of brain structures that detect threats, regulate emotional responses, and monitor for errors or uncertainties. The amygdala serves as a primary hub for threat detection, rapidly evaluating environmental cues for potential dangers and triggering affective responses that underpin the initial stages of worry. This structure receives sensory inputs via thalamic and cortical pathways, enabling quick appraisal of ambiguous or future-oriented threats. The prefrontal cortex, encompassing the ventromedial prefrontal cortex (vmPFC) and dorsolateral prefrontal cortex (dlPFC), exerts top-down regulation over the amygdala, facilitating cognitive reappraisal and suppression of excessive worry through inhibitory projections. Additionally, the anterior cingulate cortex (ACC) plays a crucial role in error monitoring and conflict detection, heightening awareness of discrepancies between expectations and reality, which can perpetuate worry loops by amplifying perceived risks.^[82]^[83]^[84] Key neural pathways integrate these regions to sustain worry as a persistent state. The hypothalamic-pituitary-adrenal (HPA) axis links emotional processing to physiological stress responses, with worry-induced activation of the amygdala and prefrontal areas stimulating hypothalamic release of corticotropin-releasing hormone, culminating in cortisol secretion from the adrenal glands; this feedback reinforces vigilance but can dysregulate chronic worry. Concurrently, hyperactivity in the default mode network (DMN)—comprising the medial prefrontal cortex, posterior cingulate cortex, and angular gyrus—facilitates rumination, a repetitive focus on worries about potential future events, by promoting self-referential and prospective thinking during rest or low-demand states. These pathways highlight worry's integration of rapid threat signaling with prolonged cognitive elaboration.^[85]^[86] Functional neuroimaging provides evidence for altered connectivity in worry-prone individuals. Functional magnetic resonance imaging (fMRI) studies reveal heightened amygdala-prefrontal connectivity during anticipation of uncertain threats, such as in tasks involving unpredictable negative outcomes, correlating with self-reported worry levels in healthy and anxious participants. This increased coupling reflects an adaptive bias toward threat vigilance but becomes maladaptive in excessive worry, with stronger dorsomedial prefrontal-amygdala interactions predicting anticipatory anxiety.^[87] Developmentally, worry circuits undergo significant maturation during adolescence, a period of heightened vulnerability due to ongoing refinement of corticolimbic connections. The prefrontal cortex, critical for regulation, shows delayed structural and functional development relative to the amygdala, leading to imbalances that amplify emotional reactivity and worry in teens. Genetic factors influence this trajectory; variants in the COMT gene, particularly the Val158Met polymorphism, modulate dopamine signaling in prefrontal regions, with the Met allele (associated with "worrier" profiles) linked to enhanced stress reactivity and altered circuit efficiency in adolescents under pressure.^[88] Recent research as of 2025 has also implicated microglia, brain immune cells, in anxiety regulation, with specific microglial populations (non-Hoxb8) promoting heightened anxiety levels by influencing neural circuits.^[89]

Neurochemical Influences

Worry, as a core feature of generalized anxiety disorder (GAD) and related conditions, is modulated by several key neurochemical systems, including serotonin, the GABA/glutamate balance, the hypothalamic-pituitary-adrenal (HPA) axis involving cortisol, and dopaminergic pathways. These systems influence the intensity and persistence of worry through interactions with brain circuits, such as those involving the amygdala and prefrontal cortex.^[90] Serotonin plays a critical role in regulating emotional responses, with low levels associated with heightened worry and anxiety. Specifically, reduced activity at 5-HT1A receptors, which are inhibitory autoreceptors and postsynaptic sites, contributes to diminished serotonergic tone, leading to increased amygdala reactivity and impaired top-down control from the prefrontal cortex.^[91]^[92] Selective serotonin reuptake inhibitors (SSRIs), by blocking serotonin reuptake, elevate extracellular serotonin levels, which desensitizes presynaptic 5-HT1A autoreceptors over time and enhances postsynaptic signaling. This mechanism strengthens prefrontal inhibition over limbic regions, thereby reducing pathological worry.^[93]^[94] The balance between gamma-aminobutyric acid (GABA), the primary inhibitory neurotransmitter, and glutamate, the main excitatory one, is essential for preventing excessive neural activation underlying worry. Deficient GABAergic inhibition relative to glutamatergic excitation creates excitatory loops that sustain ruminative thoughts and hypervigilance characteristic of worry.^[95]^[96] Benzodiazepines, acting as positive allosteric modulators at GABA_A receptors, enhance GABA binding and chloride influx, temporarily dampening these excitatory circuits and alleviating acute worry symptoms.^[97]^[98] Chronic worry activates the HPA axis, resulting in sustained cortisol elevation that sensitizes noradrenergic systems, promoting heightened vigilance and arousal. In individuals with GAD, studies reveal altered diurnal cortisol patterns, including elevated morning levels and a flattened slope, which correlate with persistent worry and impaired stress recovery.^[90]^[99] This hypercortisolemia enhances norepinephrine release from the locus coeruleus, amplifying noradrenergic signaling in vigilance networks and perpetuating a state of anticipatory anxiety.^[100] Dopamine contributes to worry through its involvement in processing reward uncertainty, where ambiguous outcomes trigger persistent evaluation and rumination. Dysregulation in dopaminergic pathways, particularly in the mesolimbic system, can fuel worry by heightening sensitivity to potential negative rewards.^[101] Genetic polymorphisms in the dopamine D4 receptor gene (DRD4), such as the 7-repeat allele in exon III, have been linked to context-dependent anxiety biases and altered stress reactivity.^[102]^[103]

Health and Societal Impacts

Mental Health Consequences

Excessive worry serves as a core diagnostic criterion for generalized anxiety disorder (GAD), defined in the DSM-5 as apprehensive expectation occurring more days than not for at least six months, accompanied by difficulty controlling the worry and associated with symptoms such as restlessness or fatigue.^[104] This pervasive feature distinguishes GAD from normal anxiety and contributes to its high comorbidity with other psychiatric conditions, notably major depressive disorder, where meta-analyses from national surveys indicate that approximately 58% of individuals with 12-month GAD also meet criteria for major depression.^[105] Such overlap exacerbates symptom severity and functional impairment, as worry reinforces negative cognitive patterns shared between the disorders. Worry also plays a significant role in obsessive-compulsive disorder (OCD), where it functions as a maladaptive thought control strategy that interacts with obsessive beliefs to predict increased intrusive thoughts and subsequent ritualistic behaviors.^[106] In posttraumatic stress disorder (PTSD), hypervigilant worry mediates the link between attentional biases toward threats and core symptoms like re-experiencing, amplifying the involuntary recall of traumatic events through sustained anticipatory anxiety.^[107] These connections highlight worry's transdiagnostic influence, positioning it as a predictor of symptom persistence across anxiety-related pathologies. Over time, chronic worry contributes to broader mental health deterioration, including burnout, where repetitive negative thinking, such as pre-sleep rumination, directly associates with elevated next-day emotional exhaustion.^[108] It frequently disrupts sleep, with 60-70% of individuals with GAD reporting significant insomnia due to persistent cognitive arousal.^[109] Furthermore, even mild worry symptoms in healthy older adults predict declines in learning and memory over two years, suggesting a pathway to cognitive impairment independent of diagnosed disorders.^[110] Epidemiologically, the lifetime prevalence of problematic worry, as manifested in GAD, ranges from 5-10% globally, reflecting its status as a common yet burdensome condition.^[111] Post-2020 studies, particularly amid the COVID-19 pandemic, indicate higher rates in urban settings, where anxiety symptoms, including excessive worry, were more severe than in rural areas due to intensified stressors like population density and resource constraints.^[112]

Physical Health Effects

Chronic worry activates the hypothalamic-pituitary-adrenal (HPA) axis, leading to sustained elevations in stress hormones such as cortisol, which can contribute to increased blood pressure and heightened cardiovascular risk. Longitudinal studies have shown that individuals with high levels of worry experience steeper trajectories in systolic and diastolic blood pressure, with high deportation-related worry associated with a 2.17-fold increased hazard ratio for incident hypertension over five years. In the Normative Aging Study, prospective data linked worry to elevated risk of coronary heart disease, with anxiety components including worry contributing to a 60% excess risk of CHD independent of traditional factors like smoking or hypertension.^[113]^[114] Elevated cortisol from chronic worry suppresses immune function by inhibiting cytokine production and impairing T-cell activity, resulting in higher susceptibility to infections and delayed wound healing. Research on caregivers, who often experience repetitive worry as a form of chronic stress, demonstrates reduced vaccine efficacy and increased reactivation of latent viruses due to this immunosuppression. In older adults, sustained cortisol exposure from stress-related worry promotes immune resistance to glucocorticoids, exacerbating systemic inflammation and weakening overall immune responsiveness.^[115]^[115] Worry correlates with gastrointestinal disorders through dysregulation of the gut-brain axis, where heightened anxiety amplifies visceral hypersensitivity and alters gut motility. Studies indicate that individuals with irritable bowel syndrome (IBS) exhibit elevated trait anxiety and worry, with genetic overlaps (e.g., in genes like CADM2) between IBS and anxiety disorders supporting a bidirectional link. This axis disruption contributes to symptoms like abdominal pain and altered bowel habits, with up to 4.27 odds ratio for co-occurring anxiety in IBS patients. Ulcer development is similarly promoted via stress-induced mucosal damage and reduced protective factors in the stomach lining.^[116]^[117] Recent 2020s research highlights chronic worry's role in accelerated biological aging, including telomere shortening, where high perceived stress equates to 9–17 years of additional cellular aging through oxidative damage and reduced telomerase activity. Worry and related anxiety are associated with metabolic syndrome (MetS), with meta-analyses showing a 7% increased odds of MetS in anxious individuals and vice versa, mediated by inflammation and HPA dysregulation. These findings underscore worry's contribution to broader physiological wear, overlapping briefly with mental health risks like depression but manifesting distinctly in somatic changes.^[118]^[119]

Societal and Economic Ramifications

Worry, as a component of anxiety disorders, significantly impacts workplace productivity and leads to substantial economic losses through absenteeism and presenteeism. Globally, depression and anxiety, which often manifest as chronic worry, result in the loss of approximately 12 billion working days annually, costing the world economy nearly US$1 trillion in lost productivity each year.^[120] This figure encompasses reduced efficiency among affected workers who continue to show up but perform at lower capacity due to persistent worry, with studies highlighting that untreated mental health conditions like anxiety amplify these effects in high-stress professional environments. On a societal level, collective worry intensifies during crises, fostering widespread emotional strain that affects community cohesion and youth well-being. For instance, in the 2020s, surveys of young people have revealed high levels of climate-related anxiety, with 59% of respondents aged 16-24 across 10 countries reporting they were very or extremely worried about climate change, contributing to broader social disconnection and reduced civic engagement.^[121] Such collective worry can exacerbate intergenerational tensions, as younger populations grapple with future-oriented fears that influence social interactions and collective action.^[122] Public health policies have increasingly addressed worry through targeted campaigns, particularly during pandemics, while economic models demonstrate its influence on consumer patterns. During the COVID-19 outbreak, the World Health Organization's #HealthyAtHome initiative provided resources to manage pandemic-induced worry and fear, aiming to mitigate its spread through accessible mental health guidance.^[123] Economically, models show that heightened anxiety drives behaviors like hoarding, as seen in early 2020 when consumer panic buying of essentials was linked to fear of scarcity and uncertainty, disrupting supply chains and inflating short-term costs.^[124] Media sensationalism further amplifies societal worry by promoting negative content, with doomscrolling— the compulsive consumption of distressing online news— playing a key role in elevating anxiety levels. Research indicates that doomscrolling correlates with increased existential anxiety and pessimism, as users repeatedly engage with alarming headlines that reinforce a cycle of worry.^[125] Studies on social media algorithms reveal how negative news spreads virally, intensifying collective unease and contributing to broader mental health burdens during uncertain times.^[126]

Management and Interventions

Self-Management Techniques

Mindfulness and meditation practices offer accessible self-management strategies for addressing worry by promoting non-judgmental awareness of anxious thoughts. Developed by Jon Kabat-Zinn, Mindfulness-Based Stress Reduction (MBSR) is an eight-week program incorporating mindfulness meditation, body awareness, and gentle yoga to help individuals observe worries without becoming entangled in them.^[127] Randomized controlled trials (RCTs) have demonstrated that MBSR significantly reduces anxiety symptoms, including pathological worry, in individuals with generalized anxiety disorder, with meta-analyses indicating moderate effect sizes (Hedges' g ≈ 0.5) corresponding to approximately 20-30% symptom reduction compared to control groups.^[128]^[129] Journaling and structured "worry time" provide cognitive tools to contain and process worries, drawing from cognitive-behavioral therapy (CBT) principles without requiring professional guidance. In this approach, individuals schedule a dedicated 15-30 minute period daily to write down worries, distinguishing between those amenable to problem-solving (e.g., actionable steps like preparing for a deadline) and those requiring acceptance (e.g., uncontrollable events like past regrets).^[130] Evidence from studies on worry postponement shows it effectively reduces the frequency and intensity of intrusive worries by postponing rumination, with one trial reporting significant decreases in subjective health complaints related to anxiety.^[131] A meta-analysis of cognitive therapy techniques for pathological worry confirms large effect sizes (Cohen's d = 1.81) in symptom reduction versus no-treatment controls.^[132] Lifestyle modifications further support worry management by influencing physiological stress responses. Regular aerobic exercise, such as brisk walking or cycling for 30 minutes most days, lowers cortisol levels—a key stress hormone linked to heightened worry—with one study finding a 20% reduction in serum cortisol following aerobic sessions.^[133] Sleep hygiene practices, including maintaining consistent bedtimes, creating a dark and cool sleep environment, and avoiding screens before bed, improve sleep quality and thereby mitigate anxiety, as poor sleep exacerbates worry cycles; interventions enhancing sleep hygiene have shown medium-sized effects on mental health outcomes like reduced anxiety.^[134] Dietary intake of omega-3 fatty acids, found in foods like fatty fish or supplements, modulates brain neurochemistry to alleviate anxiety symptoms, with RCTs demonstrating a 20% reduction in self-reported anxiety alongside decreased inflammatory markers.^[135] In the 2020s, digital tools have emerged as convenient self-management aids for worry. Apps like Worry Watch enable users to log worries, track patterns, and apply CBT-inspired postponement during designated sessions, fostering greater self-awareness. Preliminary evidence from studies on similar low-intensity CBT apps indicates high engagement and significant reductions in worry symptoms, with one trial showing decreased anxiety after four weeks of use via mindfulness and exposure features.^[136]^[137]

Clinical Treatments and Therapies

Cognitive-behavioral therapy (CBT) represents a cornerstone treatment for pathological worry, particularly in generalized anxiety disorder (GAD), where it targets core processes such as excessive worry through techniques like worry exposure and cognitive restructuring.^[138] Worry exposure involves imaginal or in vivo confrontation with feared worry scenarios to reduce avoidance and habitual rumination, while cognitive restructuring challenges catastrophic predictions and overestimation of threat.^[139] These protocols draw from influential cognitive models adapted for anxiety, emphasizing the modification of maladaptive beliefs about worry.^[140] Meta-analyses of randomized controlled trials demonstrate that CBT yields moderate to large effect sizes, with symptom reductions typically ranging from 50% to 60% on standardized anxiety measures compared to waitlist or control conditions.^[138] Pharmacotherapy serves as a first-line option for managing pathological worry in GAD, with selective serotonin reuptake inhibitors (SSRIs) like escitalopram recommended due to their efficacy in modulating serotonin pathways to alleviate anxiety symptoms.^[141] Escitalopram, at doses of 10-20 mg daily, has shown significant improvements in worry and overall anxiety severity in clinical trials, often achieving response rates of 50-60% within 8-12 weeks.^[142] Benzodiazepines, such as lorazepam or clonazepam, are reserved for acute symptom relief in GAD due to their rapid onset via GABA enhancement, but chronic use is discouraged owing to risks of tolerance, dependence, and withdrawal.^[143] Emerging therapies for pathological worry incorporate acceptance-based approaches, including Acceptance and Commitment Therapy (ACT) and Mindfulness-Based Cognitive Therapy (MBCT), which integrate mindfulness and acceptance strategies to disrupt worry cycles without direct suppression.^[144] ACT promotes psychological flexibility by encouraging value-aligned actions amid uncertainty, with meta-analyses indicating efficacy comparable to traditional CBT for reducing GAD symptoms, achieving moderate effect sizes (Hedges' g ≈ 0.6-0.8).^[145] MBCT combines mindfulness practices with cognitive elements to foster non-judgmental awareness of worry, demonstrating reductions in anxiety severity and improved long-term functioning in GAD patients.^[144] For treatment-resistant cases, transcranial magnetic stimulation (TMS) offers a non-invasive neuromodulation option, targeting prefrontal circuits implicated in worry regulation; while FDA-approved for depression since 2008, off-label use for anxiety has gained traction in the 2020s with accelerated protocols showing promise in reducing symptoms by 40-50% in resistant GAD.^[146] As of 2025, psychedelic-assisted therapies have emerged as a novel approach, with a single moderate dose of MM120 (a lysergide derivative) demonstrating significant and sustained reductions in GAD symptoms—equivalent to five to six points on standardized anxiety scales—in a phase 2b RCT involving 198 adults, marking a potential first new pharmacological treatment in nearly 20 years.^[147] Additionally, machine learning models are being explored to personalize treatment selection for GAD by predicting recovery based on patient factors, enhancing outcomes in CBT and pharmacotherapy as of early 2025.^[148] Efficacy data from large-scale trials underscore the long-term benefits of these interventions in preventing relapse among individuals with pathological worry. The Coordinated Anxiety Learning and Management (CALM) study, a collaborative care trial involving CBT and pharmacotherapy, reported sustained symptom remission in 40-50% of GAD participants at 12-18 months post-treatment, with lower recurrence rates (around 30%) compared to usual care.^[149] These outcomes highlight the role of integrated clinical approaches in maintaining gains, often augmented by self-management techniques for relapse prevention.^[150]

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Poverty, depression, and anxiety: Causal evidence and mechanisms
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Unraveling the Cross-Cultural Differences in Online Expression of ...
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Cross-cultural validation of the Worries about COVID-19 and its ...
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Deportation Worry, Cardiovascular Disease Risk Factor Trajectories ...
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Climate anxiety in children and young people and their beliefs about ...
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Helping youth move from climate anxiety to climate action
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#HealthyAtHome - Mental health
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Anxiety and Panic Buying Behaviour during COVID-19 Pandemic ...
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[PDF] Mindfulness-Based Stress Reduction for Generalized Anxiety Disorder
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Randomized Controlled Trial of Mindfulness Meditation for ... - NIH
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Worry Postponement - Psychology Tools
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Application of a worry reduction intervention in a medically ...
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A meta-analysis of cognitive therapy for worry in generalized anxiety ...
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Improving sleep quality leads to better mental health - NIH
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Omega-3 Supplementation Lowers Inflammation and Anxiety in ...
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Use and Engagement With Low-Intensity Cognitive Behavioral ...
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Does Using a Mindfulness App Reduce Anxiety and Worry? A ...
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Approaching Cognitive Behavior Therapy For Generalized Anxiety ...
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Cognitive‐behavioral therapy (CBT) for generalized anxiety disorder ...
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Understanding Social Anxiety Disorder in Adolescents and ...
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Generalized Anxiety Disorder and Panic Disorder in Adults - AAFP
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Escitalopram: A New SSRI for the Treatment of Depression in ...
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SSRIs and Benzodiazepines for General Anxiety Disorders (GAD)
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Mindfulness-based cognitive therapy for generalized anxiety disorder
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A meta-analysis of the efficacy of acceptance and commitment ...
Conclusions: Our findings indicate that ACT is more effective than treatment as usual or placebo and that ACT may be as effective in treating anxiety disorders, ...
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Transcranial Magnetic Stimulation (TMS)
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Disorder specific impact of CALM treatment for anxiety disorders in ...
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