It’s 1:40 in the morning and the WhatsApp is still open on the screen. Two lines from a colleague, sent at dinner: “Can we talk tomorrow about the deck? A few things.”
She has read it eleven times.
By now there are three replies in the drafts. One is breezy. One apologizes for something nobody has mentioned. One asks what the few things are. She sends none of them. The phone goes face down on the nightstand, then face up again.
None of this feels like worry from the inside. It feels like preparation. If she can just work out what the colleague meant, she can be ready.
That is the trap. Overthinking wears the clothes of problem-solving, but it rarely produces a decision, a plan, or sleep.
At The American Wellness Center in Dubai Healthcare City, our Psychology Department sees a lot of adults who describe themselves as “just a thinker.” Many of them are tired in a way a weekend doesn’t fix.
Two Kinds of Loop
Clinicians tend to separate overthinking into two strands.
Worry points forward. It runs on “what if”: what if the meeting goes badly, what if the test result is bad. It tries to rehearse every possible future so none of them can arrive by surprise.
Rumination points backward. It runs on “why did I”: why did I say that at the parent-teacher evening, why am I like this. It replays the past looking for the moment that explains everything.
The psychologist Susan Nolen-Hoeksema built much of her career on rumination. In a major review, she and her colleagues concluded that rumination predicts the onset of depression, helps keep symptoms going, and is also linked to anxiety, binge eating, binge drinking, and self-harm (Perspectives on Psychological Science, 2008).
Both loops share one feature. They feel productive while they are running. A person can spend the whole drive home along Sheikh Zayed Road in one of them, arrive in Al Barsha, and have nothing to show for it except a tight jaw.
If the pattern sounds familiar, the earlier piece on anxiety and therapy covers what the first few sessions usually look like.
When Worry Becomes a Diagnosis
Overthinking is not a diagnosis. There is no entry for it in the DSM-5-TR (American Psychiatric Association, 2022), and plenty of people who overthink would never meet criteria for anything.
The condition clinicians most often consider is generalized anxiety disorder (GAD). The DSM-5-TR describes it in adults as excessive worry about several different areas of life (work, health, family, money) that is present more days than not for at least six months. The person finds the worry hard to control. And it comes with at least three of six physical or mental signs: restlessness or feeling keyed up, getting tired easily, trouble concentrating or the mind going blank, irritability, muscle tension, and disturbed sleep.
The threshold is deliberate. One bad month after a redundancy is not GAD. Worry tied to a single fear, such as being judged in social situations, points a clinician toward a different anxiety condition. Worry that follows a low mood, loss of interest, and early waking may belong to depression instead. The worry also has to cause real distress or get in the way of work, relationships, or daily life, and it can’t be better explained by a medical issue, a medication, or substance use.
For scale: in the U.S., an estimated 2.7% of adults had GAD in the past year (NIMH, based on the National Comorbidity Survey Replication). That survey was carried out between 2001 and 2003, so the number is older than it looks. Worldwide, the WHO estimates that 470 million people had an anxiety disorder in 2023, and that only about one in four people who need treatment receive any (WHO, September 2026).
Dr. Muhammad S. Tahir, Consultant Psychiatrist and Neurologist at AWC, doesn’t start by measuring how much someone thinks:
“Thinking too much isn’t necessarily a problem. It’s when you can’t switch off the worry, even when you want to, and it starts affecting your daily life that I begin to see it as something more than just overthinking.”
In a first consultation, he looks at four things: how long the worry has lasted, how controllable it feels, how severe it is, and what it is doing to the person’s life. “For me, the key is not simply how much someone thinks, but how much control they have over their worry and how significantly it affects their quality of life.”
If the full diagnostic criteria are met, he considers GAD and discusses structured treatment, particularly cognitive behavioral therapy (CBT) and, when clinically indicated, medication.
When sleep, appetite, or daily functioning have started to slip, our Psychiatry for Adults team can assess whether medication belongs in the conversation, alongside therapy rather than instead of it.
Not Arguing With the Thought
Most people try to win the argument. They answer each “what if” with a reassurance, and the mind answers back with a better “what if.” The other side never runs out of material.
Carl Rogers, a founder of person-centered therapy, put the alternative simply:
“The curious paradox is that when I accept myself as I am, then I change.”
(Carl Rogers, On Becoming a Person, 1961)
Applied to overthinking, acceptance doesn’t mean agreeing with the thought. It means noticing it as a thought. “There’s the loop again” is a different mental act from “but what if she’s angry.” The first steps back. The second steps in.
This is the territory of metacognitive therapy (MCT), which works less on what a person worries about and more on their beliefs about worry itself: that it’s uncontrollable, or that it keeps them safe. In a trial of 81 adults with long-standing GAD, 65% of those given MCT recovered by the end of treatment, compared with 38% given standard CBT, and the gap held at two years (BJPsych Open, 2018). It was one trial, of modest size, and one of its authors developed MCT, so the result is promising rather than settled. CBT itself remains a well-established treatment for GAD.
Mindfulness for anxiety trains the same skill from a different direction: watching the thought arrive without following it out the door.
Smaller Than the Loop
Practical strategies work best when they are boring. A few that clinicians use:
- Write the worry down, then ask one question: is any part of this solvable right now?
- Give worry a fixed window, say 20 minutes at 6pm, and postpone anything that shows up outside it
- Name the loop when it starts, instead of answering it
- Act on the smallest solvable piece, even if it is one sentence in an email
- Protect sleep, because the 1:40am mind is not a reliable analyst
The fixed window, often called worry postponement, has some evidence behind it. In a 2024 randomized trial, adults with GAD who practiced postponing worry to a set time over two sessions reported a large drop in worry compared with a waitlist group, and the effect lasted to the four-week follow-up (Clinical Psychology in Europe, 2024). The groups were small and the follow-up short, so treat it as one tool, not the whole answer.
AWC’s April 2025 webinar “Breaking the Cycle of Negative Thinking” covered several of these, and the same principles shape our non-medication therapy options for adults who would rather start without a prescription.
The Fourth Draft
Back at 1:40am, the solvable part of the problem is small. The colleague wants to talk about a deck. That conversation will happen at 10 tomorrow, in an office in Dubai, whether or not a reply goes out tonight.
The fourth option was never on the list: put the phone in the other room and let the question wait until it can actually be answered.
Overthinking rarely stops because someone thinks of the perfect reply. It loosens when a person learns to recognize the loop, give it a time and a place, and step out of it more often than they step in.
The psychologists at The American Wellness Center in Dubai Healthcare City work with adults on exactly this, whether it turns out to be a habit or generalized anxiety disorder. Book a first session and bring the three unsent drafts with you.
