Age and gender differences in adolescent worry

The purpose of the present study was to explore gender and age differences in adolescent worry. High school students filled out measures of worry, negative problem orientation, intolerance of uncertainty, and general mental health. Girls and boys of different ages were then compared and the relationships between gender, beliefs about worry, intolerance of uncertainty, negative problem orientation and mental health were also examined. Boys reported greater negative problem orientation and intolerance of uncertainty while girls reported more positive beliefs about worry. Findings also revealed certain age trends, indicating that the variables under study may be under the influence of developmental tasks. Regression analysis was performed and positive beliefs about worry emerged as a significant predictor of worry in both sexes. Positive beliefs about worry and negative problem orientation appear to be the key processes in adolescent anxiety and depression.     

Distress intolerance and worry: the mediating role of cognitive variables

Background and Objectives: Distress intolerance (DI) has been identified as a potential risk factor for a variety of maladaptive avoidance behaviors, including worry. However, mechanisms linking DI to specific behaviors remain poorly understood. One hypothesis is that DI is a general vulnerability that confers risk of particular avoidance behaviors via more specific, lower-order vulnerabilities. The current study examined associations between DI and worry-related cognitions. Design: A multiple mediator model tested the hypothesis that worry-related variables (intolerance of uncertainty [IU], cognitive avoidance, beliefs about worry, and negative problem orientation) mediated the association between DI and worry. Methods: An undergraduate student (n = 281) and a clinical (n = 123) sample completed self-report measures. Results: Across samples, worry was associated with higher levels of DI, IU, cognitive avoidance, beliefs about worry, and negative problem orientation. Mediation results differed somewhat between the two samples. In the undergraduate sample, IU, negative beliefs about worry, and positive beliefs about worry mediated the association between DI and worry. In the clinical sample, negative problem orientation and negative beliefs about worry mediated the association between DI and worry. Conclusions: Results provide initial evidence that DI may be associated with worry via unique risk factors.     

Can the components of a cognitive model predict the severity of generalized anxiety disorder?

Over the past decade, a number of well-controlled studies have supported the validity of a cognitive model of generalized anxiety disorder (GAD) that has four main components: intolerance of uncertainty, positive beliefs about worry, negative problem orientation, and cognitive avoidance. Although these studies have shown that the model components are associated with high levels of worry in nonclinical samples and with a diagnosis of GAD in clinical samples, they have not addressed the question of whether the model components can predict the severity of GAD. Accordingly, the present study sought to determine if the model components are related to diagnostic severity, worry severity, and somatic symptom severity in a sample of 84 patients with a primary diagnosis of GAD. All model components were related to GAD severity, although positive beliefs about worry and cognitive avoidance were only modestly associated with the severity of the disorder. Intolerance of uncertainty and negative problem orientation had more robust relationships with the severity of GAD (and with worry severity, in particular). When participants were divided into Mild, Moderate, and Severe GAD groups, intolerance of uncertainty and negative problem orientation distinguished the Moderate and Severe GAD groups from the Mild GAD group, even when age, gender, and depressive symptoms were statistically controlled. Overall, the results lend further support to the validity of the model and suggest that intolerance of uncertainty and negative problem orientation are related to the severity of GAD, independently of sociodemographic and associated clinical factors. The theoretical and clinical implications of the findings are discussed.     

Responsibility to continue thinking and worrying: evidence of incremental validity

This two-part study examined the role of the responsibility to continue thinking, beliefs that one needs prolonged thinking about stressful problems, in the prediction of excessive worry. This construct is considered to reflect high levels of motivation to continue inflexible thinking and the use of rigid stop rules. In Study 1, 122 students completed questionnaires. A regression analysis revealed that responsibility accounted for a unique variance beyond negative meta-cognitive beliefs about worry. One hundred and fifty students participated in Study 2, where worry was regressed on emotional instability (Neuroticism), responsibility, and other worry-related cognitive variables (intolerance of uncertainty, positive/negative meta-cognitive beliefs, poor problem-solving orientation, and cognitive avoidance). Again, responsibility was a significant predictor, after controlling for emotional instability (Neuroticism) and other worry-related cognitions. These results indicate the incremental validity of the responsibility to continue thinking.     

Experience and appraisal of worry among high worriers with and without generalized anxiety disorder

Recent research has revealed that a large number of highly worried individuals do not qualify for a diagnosis of generalized anxiety disorder (GAD). This raises the intriguing question of why some high worriers are more impaired and distressed by their worrying than others, particularly when the severity of their worry is the same. The present investigation sought to address this question by examining whether GAD and non-GAD high worriers differ in their actual worry experiences, their subjective appraisals of worry experiences, or both experiences and appraisals of worry. GAD and non-GAD worriers, selected for matching levels of trait worry severity, completed an attention-focus task with thought sampling before and after a brief worry induction. They also completed questionnaires assessing their experiences during and after the worry induction, as well as their general beliefs about worry. GAD worriers experienced less control over negative intrusive thoughts immediately after worrying, reported greater somatic hyperarousal following worry, and endorsed several negative beliefs about worry more strongly than their worry-matched controls. Results suggest that GAD is associated with unique experiences and appraisals that distinguish it from other forms of severe worry.     

Metacognitions,intolerance of uncertainty and worry: An investigation in adolescents

BackgroundCognitive models of Generalized Anxiety Disorder have mainly been tested in adult samples to date. Studies investigating whether the concepts are also applicable to worry in adolescents are largely lacking. The goal of the present study was to test the relationship between worry and key cognitive variables (positive and negative metacognitions; intolerance of uncertainty) in adolescents.MethodSecondary school students (N = 521) completed self-report measures of worry frequency, metacognitions, intolerance of uncertainty, and depression.ResultsResults showed a significant association between metacognitions, intolerance of uncertainty and worry, even after controlling for depression. In regression analyses, a substantial proportion of the variance of worry could be accounted for by the cognitive variables of interest.ConclusionsThe findings support the relevance of metacognitions and intolerance of uncertainty for understanding cognitive mechanisms underlying worry in adolescents. It appears useful to combine them into a more comprehensive integrated model.     

Individuals Intolerant of Uncertainty: The Maintenance of Worry and Distress Despite Reduced Uncertainty

The intolerance of uncertainty model of worry posits that individuals worry as a means to cope with the discomfort they feel when outcomes are uncertain, but few experimental studies have investigated the causal relationships between intolerance of uncertainty, situational uncertainty, and state worry. Furthermore, existing studies have failed to control for the likelihood of future negative events occurring, introducing an important rival hypothesis to explain past findings. In the present study, we examined how individuals with high and low trait intolerance of uncertainty differ in their behavioral, cognitive, and emotional reactions to situational uncertainty about an upcoming negative event (watching emotionally upsetting film clips), holding constant the likelihood of that negative event taking place. We found that although individuals high in trait prospective intolerance of uncertainty reported a higher degree of belief that being provided with detailed information about the upcoming stressor would make them feel more at ease, they did not experience an actual decrease in distress or state worry upon being provided with more information, during anticipation of the film clips, or during the film clips themselves. Our results suggest that heightened distress regarding negative events may be more central than intolerance of uncertainty to the maintenance of worry.     

Searching for Specificity Between Cognitive Vulnerabilities and Mood and Anxiety Symptoms

Using two large nonclinical samples (N = 725), relations between five targeted cognitive variables [intolerance of uncertainty, negative problem orientation, perfectionism/certainty, responsibility/threat estimation, and importance/control of thoughts] and mood [depression] and anxiety [social anxiety, generalized anxiety, and obsessive–compulsive] symptoms were examined. Analyses provided multiple levels of specificity, including zero-order correlations, partial correlations controlling for the effects of positive and negative affect, regression analyses, and hierarchical structural modeling. Results were that (a) intolerance of uncertainty showed relative specificity to anxiety versus depression symptoms and (b) negative problem orientation was common to mood and anxiety symptoms. Although certain analyses suggested that (c) perfectionism/certainty specifically predicted generalized anxiety and (d) both responsibility/threat estimation and importance/control of thoughts were unique predictors of obsessive–compulsive symptoms, these three cognitive variables inconsistently predicted symptom scores across the two studies. Conceptual and therapeutic implications are discussed.     

Restriction of working memory capacity during worry

The authors report the first direct assessment of working memory capacity when people engage in worry. High and low worriers performed a random key-press task while thinking about a current worry or a positive personally relevant topic. High (but not low) worriers showed more evidence of restricted capacity during worry than when thinking about a positive topic. These findings suggest that high worriers have less residual working memory capacity when worrying than when thinking about other topics and, thus, have fewer attentional resources available to redirect their thoughts away from worry.     

Examining incremental explanatory power in accounting for worry severity: negative metacognitive beliefs uniquely predict worry severity following a worry episode

Background and Objectives: Contemporary conceptual models posit that different core variables contribute to worry, including intolerance of uncertainty (IU), metacognitive beliefs, and experiential avoidance. To date, a concurrent investigation of the incremental explanatory power of these variables in accounting for worry severity remains unexamined. The present study sought to address that gap in the literature.

Design/Methods: Participants endorsing frequent worry (N?=?127) completed self-report measures assessing IU, metacognitive beliefs, and experiential avoidance during an online session. Participants later attended an in-person lab-based session where they completed a worry episode and in-vivo worry severity was assessed following the worry episode.

Results: IU, negative metacognitive beliefs, and experiential avoidance each shared a bivariate association with post-episode worry severity. However, in multivariate analyses, only baseline worry severity and negative metacognitive beliefs surrounding the dangerousness and uncontrollability of worry predicted post-episode worry severity.

Conclusions: The present results further underscore links between negative metacognitive beliefs and worry.     

Maladaptive Core Beliefs and their Relation to Generalized Anxiety Disorder

Research has demonstrated that individuals with generalized anxiety disorder (GAD) hold unhelpful beliefs about worry, uncertainty, and the problem-solving process. Extant writings (e.g., treatment manuals) also suggest that other types of maladaptive beliefs may characterize those with GAD. However, these other beliefs have received limited empirical attention and are not an explicit component of cognitive theories of GAD. The present study examined the extent to which dysfunctional attitudes, early maladaptive schemas, and broad self-focused and other-focused beliefs explain significant variance in GAD symptoms, over and above negative and positive beliefs about worry, negative beliefs about uncertainty, and negative beliefs about problems. N = 138 participants classified into Probable GAD and Non-GAD groups completed self-report measures. After controlling for trait anxiety and depressive symptoms, only beliefs about worry, negative beliefs about uncertainty, and schemas reflecting unrelenting standards (e.g., “I must meet all my responsibilities all the time”), the need to self-sacrifice (e.g., “I'm the one who takes care of others”), and less positive views of other people and their intentions (e.g., lower endorsement of views such as “other people are fair”), were unique correlates of Probable GAD versus Non-GAD or GAD severity. Theoretical and clinical implications are discussed.     

The Metacognitive Model of Generalized Anxiety Disorder in Children and Adolescents

Worry is a common phenomenon in children and adolescents, with some experiencing excessive worries that cause significant distress and interference. The metacognitive model of generalized anxiety disorder (Wells 1995, 2009) was developed to explain cognitive processes associated with pathological worry in adults, particularly the role of positive and negative beliefs about worry. This review evaluates the application of the model in understanding child and adolescent worry. Other key issues reviewed include the link between cognitive and metacognitive development and worry, and the measurement of worry and metacognitive worry in young people. Implications of these findings and directions for future research are discussed.     

Intolerance of Uncertainty Mediates the Relation Between Generalized Anxiety Disorder Symptoms and Anger

Previous research has shown that individuals with generalized anxiety disorder (GAD) report elevated anger compared with nonanxious individuals; however, the pathways linking GAD and anger are currently unknown. We hypothesized that negative beliefs about uncertainty, negative beliefs about worry and perfectionism dimensions mediate the relationship between GAD symptoms and anger variables. We employed multiple mediation with bootstrapping on cross-sectional data from a student sample (N = 233) to test four models assessing potential mediators of the association of GAD symptoms to inward anger expression, outward anger expression, trait anger and hostility, respectively. The belief that uncertainty has negative personal and behavioural implications uniquely mediated the association of GAD symptoms to inward anger expression (confidence interval [CI] = .0034, .1845, P_M = .5444), and the belief that uncertainty is unfair and spoils everything uniquely mediated the association of GAD symptoms to outward anger expression (CI = .0052, .1936, P_M = .4861) and hostility (CI = .0269, .2427, P_M = .3487). Neither negative beliefs about worry nor perfectionism dimensions uniquely mediated the relation of GAD symptoms to anger constructs. We conclude that intolerance of uncertainty may help to explain the positive connection between GAD symptoms and anger, and these findings give impetus to future longitudinal investigations of the role of anger in GAD.     

Preliminary exploration of worry: some characteristics and processes

The present paper reports two questionnaire studies and an experimental investigation of worrying. Worry correlated more highly than general tension reports with a variety of affect scales and was characterized by: (a) feelings of anxiety, tension and apprehension; (b) moderate awareness of somatic cues including muscle tension and upset stomach; and (c) concerns over future rather than past or present situations. Self-labeled worriers were most distinguished from non-worriers by their reported uncontrollability of cognitive intrusions once worrying was initiated. In the experimental study, worriers and non-worriers were assessed for their ability to focus their attention on a monotonous (breathing) stimulus before and after 0, 15 or 30 min of worrying. Worriers reported significantly higher anxiety. depression and hostility, a lower frequency of focused attention and a greater frequency of negative thought intrusions than did non-worriers prior to the worry period. For both worriers and non-worriers. 15 min of worry resulted in an apparent incubation of negative cognitive intrusions on the subsequent attention-focusing task.     

Cognitive variables related to worry among adolescents: avoidance strategies and faulty beliefs about worry

Studies aiming to better understand worry have neglected children and adolescents. This constitutes an important limitation considering that excessive worry is frequent among adolescents and that patients suffering from excessive worries associate the beginning of their disorder with adolescence. This study evaluates the cognitive variables associated with worry in a sample of 777 adolescents. It attempts to determine whether cognitive avoidance and false beliefs about the usefulness of worries are present and associated with worries in adolescence. The results showed that participants with a high level of worry used more avoidance strategies and held more beliefs about worry. The results also revealed that avoidance of stimuli that trigger unpleasant thoughts and thought substitution were the major avoidance strategies related to worry among adolescents. The belief that worry helps to avoid future negative events was also related to worry. These findings may suggest that adolescents' worries are maintained by processes similar to those observed among adults.     

Metacognitions in Triathletes: Associations With Attention,State Anxiety,and Relative Performance

This study investigated how metacognitive beliefs in triathletes covary with state anxiety dimensions, prior to competition. It also examined how metacognitions relate to concentration, after controlling for state anxiety. Regression analyses revealed that specific metacognitive beliefs were differentially predictive of state anxiety dimensions and concentration. When accounting for the state anxiety variables in a hierarchical model predicting concentration, positive beliefs about worry, negative beliefs about worry, and cognitive anxiety remained as significant predictors. Metacognitive beliefs were also found to differ across time-to-event intervals. Overall, the results demonstrated that a metacognitive framework is a viable pathway for future sporting research.     

Applicability of the cognitive model of generalized anxiety disorder to adolescents’ sleep quality: A cross-sectional and longitudinal analysis

BackgroundPoor sleep quality is a prevalent health issue among adolescents, and few studies have examined the variables affecting adolescents’ sleep quality from the perspective of the co-occurrence of sleep issues and anxiety disorders. Therefore, the current study investigated whether the cognitive model of generalized anxiety disorder applies to adolescents’ sleep quality.MethodIn Study 1, a total of 2042 adolescents were recruited and they completed questionnaires relating to worry, intolerance of uncertainty (IU), negative problem orientation (NPO), cognitive avoidance (CA), and sleep quality. In Study 2, a total of 379 adolescents participated in a six-month longitudinal survey to verify the model that was obtained in Study 1.ResultsStudy 1 showed the modified cognitive model of generalized anxiety disorder can be applied to adolescents’ sleep quality. Specifically, IU was a higher-order vulnerability factor that directly affected worry, and indirectly fostered worry via NPO and CA, where worry only mediated the relationships between IU, NPO, and sleep quality. However, CA exerted no independent effect on worry or sleep quality beyond the influences of IU and NPO, therefore, it dropped out of the final model. Study 2 partially confirmed the above model again from the longitudinal perspective.ConclusionThe present study constructs a new model to explain adolescents’ sleep quality, providing a foundation for future interventions.     

Negative problem orientation (Part II): construct validity and specificity to worry

Negative problem orientation, a dysfunctional set of attitudes related to problem-solving ability, has been implicated as a process variable in several psychological disorders, notably depression and generalized anxiety disorder (GAD). The goal of the present study was two-fold: (1) to further examine the construct validity of a new measure of negative problem orientation, the negative problem orientation questionnaire (NPOQ), through its relationship to conceptually similar variables, and (2) to investigate the specificity of negative problem orientation to worry, the cardinal feature of GAD, compared to depression. The sample consisted of 148 university students who completed six questionnaires, the NPOQ and measures of worry, depression, pessimism, self-mastery, and neuroticism. Multiple hierarchical regressions revealed that when entered in the last step following demographic information and personality variables (pessimism, self-mastery, and neuroticism), the NPOQ accounted for 5.6% of the variance in worry scores compared to 1.6% of the variance in depression scores. It was concluded that the NPOQ shows evidence of construct validity, and that the process variable of negative problem orientation appears to have greater specificity to worry than depression. Implications for the understanding of worry and GAD are discussed.     

Generalisierte Angststörung

The core features of generalized anxiety disorder (GAD) are excessive worry about various topics which are perceived as uncontrollable and mostly last for at least 6 months. Worrying is accompanied by a number of symptoms (e.g. muscle tension and irritability). Various etiological models suggest that avoidance of internal processes (e.g. cognitive, emotional, and physical) by worrying is central to the development and maintenance of GAD. Empirically well supported cognitive-behavioral interventions are worry exposure, applied relaxation, treating metacognitions, intolerance of uncertainty and negative problem orientation. Initial studies indicate the efficacy of mindfulness and acceptance-based approaches as well as psychodynamic approaches to treat GAD. The present article reports central diagnostic procedures, important differential diagnoses and illustrates actual (psycho) therapeutic treatment options.