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Meta-Cognition and Worry: A Cognitive Model of Generalized Anxiety Disorder

Published online by Cambridge University Press:  16 June 2009

Adrian Wells
University of Oxford


A meta-cognitive classification and analysis of factors contributing to the development of problematic worry is presented. Dimensions of meta-beliefs, meta-worry, cognitive consciousness, and strategies can be distinguished. A cognitive model of Generalized Anxiety Disorder is advanced based on this framework in which GAD results from an interaction between the motivated use of worry as a coping strategy, negative appraisal of worry, and worry control attempts. These factors result from combinations of dysfunctional meta-beliefs and contribute to subjectively diminished cognitive control. The model presents new implications for a cognitive therapy of GAD, and these are illustrated with a single case treatment study.

Research Article
Copyright © British Association for Behavioural and Cognitive Psychotherapies 1995

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American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Washington DC: American Psychiatric Association.Google Scholar
Borkovec, T.D. (1994). The nature, functions, and origins of worry. In Davey, G.C.L. and Tallis, F. (Eds). Worrying: Perspectives on Theory, Assessment and Treatment. Chichester: John Wiley.Google Scholar
Borkovec, T.D. and Inz, J. (1990). The nature of worry in Generalized Anxiety Disorder: a predominance of thought activity. Behaviour Research and Therapy 28, 153158.CrossRefGoogle ScholarPubMed
Borkovec, T.D., Robinson, E., Pruzinski, T. and DePree, J.A. (1983). Preliminary exploration of worry: some characteristics and processes. Behaviour Research and Therapy 21, 916.CrossRefGoogle ScholarPubMed
Butler, G., Wells, A. and Dewick, H. (in press). Effects of worry and imagery after exposure to a stressful stimulus: a pilot study. Behavioural and Cognitive Psychotherapy.Google Scholar
Cartwright-Hatton, S. and Wells, A. (submitted). Beliefs about worry and intrusions: the meta-cognitions questionnaire and its correlates.Google Scholar
Clark, D.A. and Purdon, C. (1993). New perspectives for a cognitive theory of obsessions. Australian Psychologist 28, 161167.CrossRefGoogle Scholar
Clark, D.M., Ball, S. and Pape, D. (1991). An experimental investigation of thought suppression. Behaviour Research and Therapy 29, 253257.CrossRefGoogle ScholarPubMed
Craske, M.G., Rapee, R.M., Jackel, L. and Barlow, D.H. (1989). Qualitative dimensions of worry in DSM-III-R Generalized Anxiety Disorder subjects and non-anxious controls. Behaviour Research and Therapy 27, 397402.CrossRefGoogle Scholar
Davey, G.C.L. (1994). Pathological worrying as exacerbated problem solving. In Davey, G.C.L. and Tallis, F. (Eds). Worrying: Perspectives on Theory, Assessment and Treatment. Chichester: John Wiley.Google Scholar
Fenigstein, A., Scheier, M.F. and Buss, A.H. (1975). Public and private self-consciousness: assessment and theory. Journal of Consulting and Clinical Psychology 43, 522527.CrossRefGoogle Scholar
Flavell, J.H. (1979). Metacognition and cognitive monitoring: a new area of cognitive- developmental enquiry. American Psychologist 34, 906911.CrossRefGoogle Scholar
Foa, E.B. and Kozac, M.J. (1986). Emotional processing and fear: exposure to corrective information. Psychological Bulletin 99, 2035.CrossRefGoogle ScholarPubMed
Ingram, R.E. (1990). Self-focused attention in clinical disorders: review and a conceptual model. Psychological Bulletin 107, 156176.CrossRefGoogle Scholar
McNally, R.J. and Kohlbeck, P.A. (1993). Reality monitoring in obsessive-compulsive disorder. Behaviour Research and Therapy 31, 249253.CrossRefGoogle ScholarPubMed
Purdon, C. and Clark, D.A. (1994). Perceived control and appraisal of obsessional intrusive thoughts: a replication and extension. Behavioural and Cognitive Psychotherapy 22, 269285.CrossRefGoogle Scholar
Rachman, S. (1980). Emotional processing. Behaviour Research and Therapy 18, 5160.CrossRefGoogle ScholarPubMed
Rachman, S. and de Silva, P. (1978). Abnormal and normal obsessions. Behaviour Research and Therapy 16, 233248.CrossRefGoogle ScholarPubMed
Salkovskis, P.M. (1985). Obsessional-compulsive problems: a cognitive-behavioural analysis. Behaviour Research and Therapy 23, 571583.CrossRefGoogle ScholarPubMed
Salkovskis, P.M. (1989). Cognitive-behavioural factors and the persistence of intrusive thoughts in obsessional problems. Behaviour Research and Therapy 27, 677682.CrossRefGoogle ScholarPubMed
Salkovskis, P.M., Richards, H.C. and Forrester, E. (1995). The relationship between obsessional problems and intrusive thoughts. Behavioural and Cognitive Psychotherapy 23, 281299.CrossRefGoogle Scholar
Tallis, F., Davey, G.C.L. and Capuzzo, N. (1994). The phenomenology of nonpathological worry: a preliminary investigation. In Davey, G.C.L. and Tallis, F. (Eds). Worrying: Perspectives on Theory, Assessment and Treatment. Chichester: John Wiley.Google Scholar
Tallis, F., Eysenck, M.W. and Mathews, A. (1992). A questionnaire for the measurement of nonpathological worry. Personality and Individual Differences 13, 161168.CrossRefGoogle Scholar
Turner, S.M., Beidel, D.C. and Stanley, M.A. (1992). Are obsessional thoughts and worry different cognitive phenomena? Clinical Psychology Review 12, 257270.CrossRefGoogle Scholar
Wegner, D.M., Schneider, D.J., Carter, S.R. and White, T.L. (1987). Paradoxical effects of thought suppression. Journal of Personality and Social Psychology 5, 513.CrossRefGoogle Scholar
Wells, A. (1985). Relationship between private self-consciousness and anxiety scores in threatening situations. Psychological Reports 57, 10631066.CrossRefGoogle ScholarPubMed
Wells, A. (1987). Self-attentional processes in anxiety: an experimental study. Unpublished PhD thesis. Aston University, England.Google Scholar
Wells, A. (1994a). A multi-dimensional measure of worry: development and preliminary validation of the Anxious Thoughts Inventory. Anxiety, Stress and Coping 6, 289299.CrossRefGoogle Scholar
Wells, A. (1994b). Attention and the control of worry. In Davey, G.C.L. and Tallis, F. (Eds). Worrying: Perspectives on Theory, Assessment and Treatment. Chichester: John Wiley.Google Scholar
Wells, A. and Carter, K. (in prep). Predictors of problematic worry: tests of a meta-cognitive model.Google Scholar
Wells, A. and Davies, M. (1994). The Thought Control Questionnaire: a measure of individual differences in the control of unwanted thoughts. Behaviour Research and Therapy 32, 871878.CrossRefGoogle ScholarPubMed
Wells, A. and Hackmann, A. (1993). Imagery and core belief in health anxiety: content and origins. Behavioural and Cognitive Psychotherapy 21, 265273.CrossRefGoogle Scholar
Wells, A. and Matthews, G. (1994). Attention and Emotion: A Clinical Perspective. Hove, UK: Lawrence Erlbaum.Google Scholar
Wells, A. and Papageorgiou, C. (1995). Worry and the incubation of intrusive images following stress. Behaviour Research and Therapy 33, 579583.CrossRefGoogle ScholarPubMed
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