Worry, Metacognition, and GAD: Nature, Consequences, and Treatment

Worrying can be distinguished from other forms of negative thinking, and it is a central feature of Generalised Anxiety Disorder (GAD). It is argued that both the occurrence and the appraisal of worrying have potentially damaging consequences for emotional well-being. Worrying is part of a cognitive-attentional syndrome maintaining emotional disturbance, and negative appraisal of worrying is central in GAD. The maintenance of pathological worrying can be linked to particular metacognitive beliefs about worry. In the metacognitive model of GAD (Wells, 1995), erroneous metacognitive beliefs and negative appraisals concerning worry, and resulting responses, are an engine driving specific disorder maintenance loops. The model has important treatment implications, and has led to the development of a metacognitive-focused treatment for GAD which is described.