Meta worry and generalized anxiety disorder

Abstract

Worry is predominantly a language-based activity that involves thoughts about anticipating and preventing negative outcomes. In generalized anxiety disorder, worry is conceptualized as pathological due to its chronic use and deleterious effects. Meta-worry, which involves beliefs about the positive and negative effects of worry, is considered to have a functional role in the development and maintenance of GAD. The present research was conducted to elucidate the relation between worry beliefs and GAD. Worry beliefs of 263 undergraduate students were used to predict excessive worry as measured by the Penn State Worry Questionnaire (PSWQ), pathological worry as measured by the Generalized Anxiety Disorder Questionnaire for DSM-IV (GAD-Q-IV), and a diagnosis of GAD as assessed by the Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV). Continuous and dichotomous means of scoring the PSWQ and the GAD-Q-IV were used as criteria. The Consequences of Worrying Scale (COWS) was used to measure five worry beliefs, including beliefs that worry disrupts performance, exaggerates problems, causes emotional distress, helps analytical thinking, and motivates behavior. Particular meta-worries, as assessed by the COWS, were differentially associated with pathological features of GAD. Excessive worry, as measured by the PSWQ, was predicted by beliefs that worry exaggerates problems and helps analytical thinking. Pathological worry, as measured by the GAD-Q-IV, was predicted by beliefs that worry exaggerates problems and disrupts performance. For selected participants administered a semi-structured interview, only the belief that worry disrupts performance was predictive of a diagnosis of GAD. Beliefs that worry motivates behavior and causes emotional distress were non-specific, i.e., these beliefs were associated with both normative and pathological worry. These findings have implications about the beliefs that are most relevant to GAD pathology and to treatment of GAD. Criterion-related diagnostic validity of the questionnaires was also examined for each of the five GAD-Q-IV scoring methods (i.e., dichotomous, continuous cutoff, sum total response cutoff, continuous, and sum total response) and the two PSWQ scoring methods (i.e., continuous and continuous cutoff). Dichotomous GAD-Q-IV scoring was most specific of a diagnosis of GAD and continuous cutoff GAD-Q-IV scoring was the most sensitive. The highest overall predictive power was shown by continuous cutoff GAD-Q-IV scoring and sum total cutoff GAD-Q-IV scoring. These findings about diagnosis of GAD have implications about the use of the GAD-Q-IV and the PSWQ in participant selection and in clinical screening.