A metacognitive model and therapy for generalized anxiety disorder

Abstract

In this paper a cognitive model of Generalized Anxiety Disorder (GAD) is described. Evidence for the model is briefly reviewed and the specific form of cognitive therapy (metacognitive therapy) derived from the model is outlined. The model accounts for the disappointing effects of existing cognitive-behavioural treatments of GAD in terms of a failure to focus on key beliefs concerning worry itself. The model asserts that pathological worry in GAD is maintained by positive and negative metacognitive beliefs concerning the advantages and the dangers of worrying. Individuals with GAD tend to use internal information such as a felt sense that they will be able to cope as a signal to terminate worrying. Although worrying is used as a means of coping with anticipated threats, it becomes the object of negative beliefs and appraisals. Several feedback cycles maintain the problem. When worrying is appraised as dangerous anxiety increases and it is difficult for the individual to obtain an internal state signalling that it is safe to stop worrying. Unhelpful behavioural strategies such as avoidance of situations that trigger worry, thought control strategies characterized by a lack of attempts to interrupt ongoing worry sequences, and attempts to suppress thoughts that trigger worrying maintain maladaptive metacognitions and anxiety. Specific strategies for conceptualizing GAD cases, and for modifying key metacognitions are presented. Copyright © 1999 John Wiley & Sons, Ltd.