Generalized Anxiety Disorder 403
The last two schema categories, uncertainty beliefs and metacognition, may seem
more unique to GAD but even these beliefs can be found in other anxiety disorders
like OCD. Dugas and his colleagues have proposed a model of pathological worry and
GAD in which intolerance of uncertainty is a causal factor (Dugas, Buhr, & Ladouceur,
2004). The construct is defined as “the tendency to react negatively on an emotional,
cognitive, and behavioral level to uncertain situations and events” (Dugas et al., 2004,
p. 143). Furthermore, intolerance of uncertainty is associated with difficulty in respond-
ing to ambiguous or uncertain situations and beliefs that uncertainty is negative and
should be avoided. Although initial studies found that intolerance of uncertainty was
elevated in individuals with GAD relative to nonanxious controls or individuals with
panic disorder (Dugas, Gagnon, et al., 1998; Dugas et al., 2005), it was equally appar-
ent in analogue OCD and GAD (Holaway, Heimberg, & Coles, 2006). Thus the cogni-
tive model does not contend that uncertainty beliefs are necessarily unique to GAD but
when activated along with personal threat and vulnerability schemas about important
life goals and concerns, the constellation of beliefs will prime excessive worry. Rebecca
believed that at any moment a district manager might appear and evaluate her store. She
found this uncertainty very troubling because she believed in the importance of being
well organized and prepared for even the unexpected. This led to excessive worry that
“her incompetence” might be discovered at any moment.
table 10.2. schemas that Characterize generalized anxiety Disorders
Schema categories Illustrative examples
General threat
(beliefs about probability and
consequences of threats to one’s physical
or psychological security)
••Negative outcomes (events) that threaten important life
goals are more likely to happen to me.
••If I experience a negative event that threatens an important
life goal, it will have a serious, long-term effect on me.
••The distress and anxiety will be severe if this negative
event happens.Personal vulnerability
(beliefs about helplessness, inadequacy,
lack of personal resources to cope)
••I would be unable to cope with the negative event if it
occurred.
••I can’t control whether this negative event happens or its
effects on me.
••I am weak and helpless in the face of this event.Intolerance of uncertaintya
(beliefs about the frequency, consequence,
avoidance, and unacceptability of
uncertain or ambiguous negative events)
••Uncertainty will increase the stress and adverse effects of
negative events.
••It is important to be ready for any unexpected bad things
that could happen to you.
••If I can reduce the doubt and ambiguity of a potentially
negative situation, I will be better able to cope with it.Metacognition of worryb
(beliefs about the positive and negative
effects of worry and its controllability)
••Worry helps me solve problems and prepare for the worst.
••If I worry, it means that I am taking a situation seriously.
••If I were a stronger person, I would be able to control my
worries.
••I experience a great deal of anxiety and distress because of
uncontrollable worry.aSee Freeston, Rhéaume, Letarte, Dugas, and Ladouceur (1994).
bSee Cartwright-Hatton and Wells (1997).