Further tests of a cognitive model of generalized anxiety disorder: Metacognitions and worry in GAD, panic disorder, social phobia, depression, and nonpatients

Advances in treating generalized anxiety disorder (GAD) are likely to result from a better understanding of the dysfunctional cognitive mechanisms underlying persistent worrying. In a cognitive model of GAD, Wells (1995) proposed that pathological worry is maintained by maladaptive metacognitions (negative beliefs about worry concerning uncontrollability and danger, and negative appraisal of worrying [meta-worry]) and linked behaviors. Twenty-four patients with GAD were compared with sex-matched groups-social phobia, panic disorder, and nonpatients-on measures of negative metacognitions and worry. It was hypothesized that patients with GAD would obtain higher negative metacognitive belief scores and higher meta-worry scores than the other groups; differences in negative metacognitions would be independent of the general frequency of worry. A group of individuals with major depression was also examined as a subsidiary exploration of relative metacognitive and worry characteristics of this disorder. All of the hypotheses were upheld in the univariate ANOVAs. There was a loss of one hypothesized significant difference between the GAD and panic disorder groups in meta-worry when general worry frequency was controlled. However, the GAD group still had higher meta-worry scores than the panic group. This effect appears to be the result of patients with panic having intermediate meta-worry scores falling between the GAD and other groups. Differences between the GAD group and all other groups in negative metacognitive beliefs concerning uncontrollability and danger remained when general worry was controlled. The results add further support to the cognitive model, and treatment implications are briefly discussed.