Generalized Anxiety Disorder 411
Hypothesis 4
Pathological worry is characterized by negative appraisal of worry and the presence of
“metaworry” (i.e., worry about worry).
As depicted in Figure 10.1 the cognitive model proposes that metacognitive pro-
cesses play a critical role in the persistence of worry. A number of researchers have com-
pared how pathological worriers and nonworriers appraise their worrisome thoughts in
an effort to specify the faulty metacognitive processing in GAD. Vasey and Borkovec
(1992) found that chronic worriers engaged in more catastrophizing during the worry
process than nonworriers and on average they believed that the catastrophe was more
likely to occur. Others have also found that increased subjective risk bias (i.e., estimated
probability that the feared outcome will occur) or catastrophizing is associated with
propensity to worry (e.g., Constans, 2001; Molina et al., 1998). Furthermore, GAD
worriers experience more negative intrusions as a result of worrying, have less per-
ceived control over their worries, and believe that failure to control worry would lead to
greater harm or danger (Ruscio & Borkovec, 2004).
A number of researchers have compared subjective appraisal of worry with other
negative thoughts like obsessions or rumination. Langlois, Freeston, and Ladouceur
(2000a) used the Cognitive Intrusions Questionnaire to compare individuals’ appraisals
of their most frequent worry versus obsessional intrusive thought. Worry was consid-
ered significantly more difficult to control, more attention grabbing, more unpleasant
and interfering, more ego- syntonic, and considered more likely to come true (see also
Wells & Morrison, 1994, for similar results). In a similar study D. A. Clark and Clay-
bourn (1997) found that worry was rated as more disturbing and more closely linked
to the perceived consequences of real-life negative events. Studies comparing appraisal
of worry with depressive rumination found that most of the appraisals are similar in
the two types of cognition (e.g., ratings of reduced control, increased disapproval, and
negative consequences) but worry was uniquely characterized as more focused on the
consequences of the worry topic, more future- oriented, and more disturbing than rumi-
nation (Watkins, 2004; Watkins, Moulds, & Mackintosh, 2005).
Another important metacognitive process in the maintenance of pathological worry
is Wells’s concept of metaworry, or worrying about worrying. Wells and colleagues
developed the Anxious Thoughts Inventory (AnTi) to assess various process character-
istics of worry (Wells, 1994a). Factor analysis revealed that seven AnTi items formed
a coherent dimension of metaworry. Subsequent research reveals that scores on meta-
worry correlate with trait anxiety and worry measures, and analogue samples of GAD
score higher on metaworry than nonanxious controls (Wells, 1994a, 2005b; Wells &
Carter, 1999).
The distorted and faulty appraisal evident in pathological worry shares more simi-
larities than differences with how individuals appraise other types of unwanted repeti-
tive thoughts such as obsessions or depressive rumination. However, there is emerging
evidence that certain metacognitive processes may be especially critical to the persis-
tence of worry. A tendency to catastrophize, to believe that negative outcomes are likely
to occur and will lead to significant negative effects in one’s life, and to perceive worry
itself as a highly uncontrollable, disturbing, and dangerous process are metacognitive
appraisals that are likely to contribute to an escalation of the worry process. Although