Generalized Anxiety Disorder 405
will trigger a much slower, more elaborative processing response that is an attempt to
dampen down the hypervalent threat mode.
Elaborative Processing Phase
Elaborative processing is at the heart of the cognitive basis of GAD and is the level
at which we intervene in cognitive therapy. Worry is a highly conscious, elaborative
cognitive process that is viewed in the current model as a deliberate attempt to reap-
praise negative possibilities in a less threatening manner. Worry is a deliberate, effortful
response intended to suppress or counter schematic threat activation and its associated
anxiety by engaging in a reappraisal of a threat and one’s level of vulnerability (Beck &
Clark, 1997). In this sense worry functions as a cognitive avoidance response intended
to inhibit emotional arousal (Borkovec, 1994; Sibrava & Borkovec, 2006). In nonpatho-
logical states, worry is adaptive because the individual is able to reappraise the potential
threat in a more positive manner. The worry or reappraisal process enables individuals
to process benign or positive aspects of the situation as well as their coping resources,
and so the impending situation is downgraded in threat level.
In GAD threat reappraisal or worry leads to a much different outcome because it
is associated with a number of faulty cognitive processes. As illustrated in Figure 10.1,
worry in GAD is characterized by faulty metacognitive appraisal. Because of the beliefs
activated in GAD, the vulnerable person evaluates the worry itself as distressing, inef-
fective, uncontrollable, and self- damaging. As discussed by Wells (2006), this nega-
tive evaluation of worry gives rise to “metaworry,” or worrying about worrying. It is
very common for individuals with GAD to acknowledge the deleterious effects of their
worry and start to worry about worrying. Frank, for example, worried about the stock
market and the security of his retirement investments. He often laid awake at night fret-
ting about his investment decisions and their outcome. He came to dread the evenings
because he worried that he would get caught in another frenzy of worry. This, of course,
led to valiant efforts to control or suppress his worries but with little success.
A negative evaluation of worry will lead to efforts to control or suppress worry by
direct thought suppression, rationalization, distraction, or cognitive avoidance (Wells,
1999). Attempts to disengage from worry are rarely successful, especially over the long
term, and may in fact result in a rebound in worry once suppression efforts cease (Wen-
zlaff & Wegner, 2000). Although there is considerable debate on the effects of thought
suppression (Purdon, 1999), at the very least deliberate efforts at control of worry are
rarely successful in GAD. In fact their unintended effect is to increase the salience and
threatening nature of worry, magnify anticipated threat cognitions, and heighten the
perception of uncontrollability.
Finally, Woody and Rachman (1994) have argued that GAD is characterized by a
failure to achieve a sense of safety because of insufficient or ineffective use of safety sig-
nals. Even though they seek to maximize safety and avoid even minimal risk by checking
and seeking reassurance from others, they are rarely successful. As a result they remain
vigilant for threat, apprehensive, and in a persistent search for safety. Although Woody
and Rachman (1994) did not directly implicate worry, their formulation has relevance
for understanding pathological worry in GAD. The futile efforts to generate solutions
to anticipated threatening outcomes can be viewed as an effort to find safety through
worry. For example, when Rebecca was worrying about how she would confront an