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 resul t from a better understanding of the dysfunctional cognitive mechanisms und erlying persistent worrying. In a cognitive model of GAD, Wells (1995) prop osed that pathological worry is maintained by maladaptive metacognitions (n egative beliefs about worry concerning uncontrollability and danger, and ne gative appraisal of worrying [meta-worry]) and linked behaviors. Twenty-fou r patients with GAD were compared with sex-matched groups-social phobia, pa nic disorder, and nonpatients-on measures of negative metacognitions and wo rry. It was hypothesized that patients with GAD would obtain higher negativ e metacognitive belief scores and higher meta-worry scores than the other g roups; differences in negative metacognitions would be independent of the g eneral frequency of worry. A group of individuals with major depression was also examined as a subsidiary exploration of relative metacognitive and wo rry characteristics of this disorder. All of the hypotheses were upheld in the univariate ANOVAs. There was a loss of one hypothesized significant dif ference between the GAD and panic disorder groups in meta-worry when genera l worry frequency was controlled. However, the GAD group still had higher m eta-worry scores than the panic group. This effect appears to be the result of patients with panic having intermediate meta-worry scores falling betwe en the GAD and other groups. Differences between the GAD group and all othe r 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 dis cussed.