Anxiety: A Very Short Introduction - Daniel Freeman, Jason Freeman 2012

Theories of worry
Generalized anxiety disorder

The metacognitive model

The word ’metacognitive’ means the beliefs we hold about our thoughts. And the theory developed by Adrian Wells puts metacognitive beliefs about worry firmly at the centre of GAD.

Wells highlights two types of metacognitive beliefs: positive and negative. Like many people, whether they have an anxiety problem or not, individuals with GAD tend to see worry as beneficial. They may believe, for instance, that worrying helps them to anticipate and solve problems; that it provides the motivation necessary to tackle those problems; or that it prepares them for the worst if a solution can’t be found. Despite realizing that it is pure superstition, they may even feel that by worrying about an event they can prevent it occurring.

Clearly, someone who thinks of worry in such positive terms may do rather a lot of it. But people with GAD, unlike other anxious individuals, also hold a number of negative views of worry: principally, that worry is uncontrollable — once you start, it’s almost impossible to stop; and that worry is dangerous — as a sign of looming insanity, for example.

It’s this painful combination of positive and negative views about worry that distinguishes GAD — and makes life such a misery for those who suffer from it. These people worry because they feel it’s the right thing to do; and yet worrying is a source of huge distress. Indeed, as this theory has helped reveal, people with GAD even worry about worry.

The cognitive avoidance theory

Rather differently, Tom Borkovec of Penn State University argues that worry is principally an avoidance strategy. What we’re avoiding is the present, and we do this when we worry by focusing on the future. Borkovec suggests that this avoidance takes three forms.

First, we worry because we believe it will help us to prevent disaster occurring or, if it does happen, to cope with it.

Next, worry about relatively superficial or unlikely threats distracts us from more distressing problems. Borkovec notes, for instance, that people with GAD report more trauma in their lives, and worse relationships.

Finally, worry suppresses feelings, allowing us to avoid the full emotional impact of a feared event. Worry, argues Borkovec, is essentially verbal thought. And verbal thought is not a good medium for emotions. To really feel something, we need to visualize it, but worry distracts us from such images. Borkovec cites research indicating that worry reduces bodily arousal (such as heart rate) in response to threatening images. He concludes:

In sum, worriers may escape fearful imagery by focusing on the verbal channel while thinking about the future in more abstract terms, e.g. ’something awful will happen’, with few concrete details.

Intolerance of uncertainty

For Naomi Koerner and Michel Dugas, GAD is founded on intolerance of uncertainty:

Individuals who are intolerant of uncertainty believe that uncertainty is stressful and upsetting, that being uncertain about the future is unfair, that unexpected events are negative and should be avoided, and that uncertainty interferes with one’s ability to function.

Worry, almost by definition, is an attempt to anticipate and control uncertain future events. It seems logical, then, that people with a strong intolerance of uncertainty will become persistent worriers.

Koerner and Dugas speculate that the progression from intolerance of uncertainty to worry may be influenced by three factors. First are the positive beliefs about worry we touched on when discussing the metacognitive model. Second are the forms of cognitive avoidance identified by Borkovec. And third is the belief, held by many people with GAD, that they are poor at solving problems: ’because some degree of uncertainty is inherent to most problems, it is easy to see how individuals with GAD could become frustrated and overwhelmed with solving even minor problems’ — which only increases their anxiety and fuels their worry.

The mood-as-input theory

The mood-as-input theory of worry was formulated by the British psychologist Graham Davey, though it’s nicely demonstrated by an experiment carried out by other researchers a few years earlier. Half of the participants in the experiment were put into a bad mood, and the other half into a good mood. Then they were each asked to come up with a list of birds’ names. Half were told they could stop when they felt like it (the ’feel like continuing’ stop rule) and half to continue until they could think of no more names (the ’as many as can’ stop rule).

The participants’ response to those stop rules depended on their mood. For the ’feel like continuing’ group, those feeling upbeat persevered longer than those in a negative mood. But the situation was reversed in the ’as many as can’ group: those in a bad mood were more likely to persist with the task.

Davey argues that this experiment encapsulates two essential features of severe worry. First is the fact that our sense of whether or not we’ve completed a task satisfactorily is often based on our mood, rather than any objective measurement. This is particularly true for tasks which don’t have an obvious end point, such as worrying. A negative mood indicates that the task hasn’t been completed. So someone who feels anxious or unhappy — as people suffering from GAD generally are — is likely to feel that they haven’t yet worried enough.

The second point is that persistent worriers tend to use the ’as many as can’ stop rule. This may be partly because there seems to be a natural tendency to opt for such a rule when we’re feeling down, and partly because worriers often hold some fairly rigid beliefs: for example, that worrying is essential if disaster is to be averted; that only perfection will do; and that uncertainty is undesirable. But the ’as many as can’ stop rule can be a tough one to follow. And with activities as open-ended as worry, an obvious conclusion is rarely in sight.