404 TREATMENT OF SPECIFIC ANXIETY DISORDERS
Wells (1995, 1999) proposed a cognitive model for GAD in which maladaptive
positive and negative beliefs about worry play a key role in a dysfunctional metacogni-
tive process that leads to excessive worry and GAD. According to Wells (1999), “meta-
cognition” refers to appraisals and beliefs about the nature of cognition and our ability
to monitor and regulate our thoughts. The metacognitive beliefs in GAD represent self-
knowledge about the importance of attending to one’s thoughts, a tendency to appraise
self- referent thinking negatively, and the necessity of engaging in thought control efforts
that ultimately prove unhelpful (Wells & Matthews, 2006). In GAD these metacogni-
tive beliefs will generate “metaworry,” or worry about worry, as well as ineffective
efforts to control anxious thinking and worry, attentional biases for threat monitoring,
and maladaptive coping strategies such as emotion- focused coping (Wells & Matthews,
2006). Wells (1999, 2004) argues that positive metacognitive beliefs about worry (e.g.,
“Worry helps me cope”) are activated early in the worry process and are central to ini-
tiating worry as a coping strategy. This results in Type I worry in which the individual
focuses on the potential threat of a situation (e.g., “What if I lose my job?”). The threat
and uncertainty involved in Type I worry will activate negative metacognitive beliefs
about worry. Beliefs about the uncontrollability and negative consequences of worry
lead to Type II worry, or meta-worry, in which the individual becomes focused on trying
to suppress or control worry because of the associated rise in anxiety.
Based on Wells’s fresh insights into the nature of GAD and worry, the present
model proposes that enduring beliefs about the nature of worry, its consequences, and
its control are key to the schematic organization of GAD. These beliefs explain why the
person with GAD seems drawn to worry as a coping strategy, on the one hand, but then,
on the other hand, appears frantic to gain control over the worry process.
Attentional Threat Bias
There is considerable empirical evidence that generalized anxiety and worry are associ-
ated with automatic attentional biases for threat (see MacLeod & Rutherford, 2004;
Mathews & MacLeod, 1994; Matthews & Funke, 2006). We have discussed this topic
in Chapter 3 and in the following section on empirical status we will briefly review
selected studies on attentional processing in GAD. In the meantime an important issue
is whether the attentional bias in GAD is specific to threat or is it a more general bias
for negative emotional information. The latter, of course, would be entirely consistent
with the more general distress nature of GAD.
Threat Interpretation Bias
A final automatic process proposed in the cognitive model is the rapid, unintended selec-
tive bias to interpret ambiguous personally relevant information in a threatening man-
ner. In their review MacLeod and Rutherford (2004) concluded that individuals with
GAD have a tendency to interpret ambiguity in a threatening manner. Given processing
priority for schema- congruent information, it would be expected that the schematic
activation in GAD would lead to threat interpretations. With the information-rich com-
plexities of daily experience, it is not surprising that an automatic threat interpreta-
tion might be rapidly generated by individuals intolerant of ambiguity and uncertainty.
Of course, the automatic processing biases associated with GAD schema activation