Cognitive Therapy and Research, Vol. 29, No.

1, February 2005 (

C 2005), pp. 107–121

DOI: 10.1007/s10608-005-1652-0

The Metacognitive Model of GAD: Assessment

of Meta-Worry and Relationship With DSM-IV
Generalized Anxiety Disorder
Adrian Wells1

The metacognitive model of GAD places negative metacognitive beliefs and meta-
worry as central in the development and maintenance of disorder. The present study
examined the psychometric properties of the Meta-worry Questionnaire (MWQ) and
used it to test hypotheses derived from the metacognitive model in the context of
DSM-IV GAD. The MWQ was found to possess very good internal reliability, and
both frequency and belief scales were found to consist of single factors. The scales
correlated meaningfully with existing measures of worry and metacognition. Consis-
tent with hypotheses individuals meeting criteria for GAD showed significantly higher
meta-worry frequency scores than individuals classified as somatic anxiety or no anxi-
ety. Meta-worry belief distinguished the GAD group from the non-anxious group but
not the somatic anxiety group. These effects remained when Type 1 worry (social and
health worry) was controlled. The results provide further support for the metacogni-
tive model. Relationship between meta-worry frequency, belief, and GAD status was
explored using path analysis. The relationship between meta-worry belief and GAD
classification was dependent on meta-worry frequency.
KEY WORDS: generalized anxiety disorder; metacognition; worry; meta-worry; assessment.

INTRODUCTION

There is an upsurge of interest in formulating the mechanisms underlying GAD

and pathological worry. Some of the earliest pioneering work in the area emerged
from Borkovec and colleagues, who went on to postulate mechanisms that could
contribute to the spiraling of worry in this disorder (Borkovec, 1994; Borkovec &
Inz, 1990). Borkovec and Inz (1990) proposed that worrying was used to suppress
more emotionally laden imagery, and that the reduced arousal associated with such
an effect acted as a negative reinforcer for the worry process. From a different
1 AcademicDivision of Clinical Psychology, University of Manchester, Rawnsley Building, MRI,
Manchester, M13 9Wl, UK; e-mail: adrian.wells@man.ac.uk.

107
0147-5916/05/0200-0107/0

C 2005 Springer Science+Business Media, Inc.
108 Wells

perspective, Wells and Matthews (1994) advanced their Self-Regulatory model of

emotional disorder, proposing that worry and rumination is a general component of
psychological disorder that is driven by metacognitive beliefs. This led to a search
for the metacognitive factors that could initiate and drive persistent worrying. It
became apparent that people with GAD appear to hold both positive and negative
metacognitive beliefs about worrying and that the negative metacognitions in partic-
ular appeared to be central in the etiology and maintenance of the disorder (Wells,
1994a). The resulting metacognitive model (Wells, 1994a, 1995) attempts to account
for the repetitive, generalized, and seemingly uncontrollable worrying of GAD suf-
ferers, and it places metacognitive beliefs at center stage. More recently, other the-
orists have incorporated positive beliefs (but not negative beliefs) about worry in
their theories of GAD, and provide an additional emphasis on concepts such as in-
tolerance of uncertainty (Dugas, Gagnon, Ladouceur, & Freeston, 1998). Riskind
and Williams (in press) suggest that the Looming Maladaptive style, a schema that
represents threat as dynamic and intensifying is a generic vulnerability for anxiety
disorders. It confers vulnerability to GAD by impairing mental control mechanisms
for dealing with upsetting thoughts, increasing attention to threat, and it leads in-
dividuals to engage in catastrophic and looming mental simulations of mundane
events.
The meta-cognitive model makes an important distinction between two differ-
ent types of worry in GAD. Of particular importance is the type called meta-worry
(Wells, 1994a, 1995) that emerges from negative metacognitive beliefs about worry
itself. Meta-worry (also known as Type 2 worry) is a variable consisting of the neg-
ative appraisal of worry. A useful way to think of meta-worry is as worry about
worry. The occurrence and content of meta-worry is thought to be closely linked to
underlying negative beliefs (trait variables) that individuals have about the nature
and consequences of worrying. For example, some individuals believe that worrying
is uncontrollable and harmful, and beliefs of this kind, it is proposed, are of par-
ticular significance in understanding the development of GAD. Meta-worry can be
distinguished from Type 1 worrying, which is worry about non-cognitive events such
as external situations or internal physical symptoms.
This paper reports the development and psychometric properties of a scale
to assess meta-worry. This scale was used to test predictions of the metacognitive
model, which assigns central status to meta-worry in the development and persis-
tence of GAD.

The Metacognitive Model of GAD

The metacognitive model is depicted diagrammatically in Fig. 1. The model
proposes that repetitive, uncontrollable worry in GAD is linked to individuals
metacognitive beliefs about worrying. Two broad classes of belief are important,
positive beliefs about worry and negative beliefs. Individuals with GAD, by virtue
of positive beliefs about worrying, use worrying as a predominant means of apprais-
ing and dealing with threat. For these people worrying is a coping strategy, in which
chains of negative “what-if” catastrophising questions are asked and the individual
attempts to generate ways of coping. In the absence of distracters this Type 1 worry
Meta-Worry and GAD 109

Fig. 1. A schematic representation of the metacogni-

tive model of GAD. Reproduced from Wells, A. 1997
(p. 204).

typically proceeds until the person with GAD meets their subjective goal of wor-
rying, which is the sense that s/he will be able to cope. The goal is often equated
with achieving a desired internal feeling state, or the sense of knowing that all pos-
sible angles have been covered. Once the goal is achieved worrying is suspended
until another trigger for worrying is encountered. Triggers that activate positive be-
liefs and the need to worry include intrusive negative thoughts, such as an image of
one’s child being hit by a car, and/or external factors such as news about negative
events. Holding positive beliefs about worry is not considered unique to GAD or
sufficient to lead to GAD. In fact, it is likely that this state of affairs is quite nor-
mal. However, people with GAD tend to inflexibly use worrying as a predominant
means of coping. Thus, in these individuals positive beliefs are associated with a
tendency to select worrying as a predominant coping strategy. Type 1 worry leads
to anxiety as catastrophising unfolds but can also decrease anxiety depending on
whether internal goals are met, as depicted by the arrow linking it to emotion in
Fig. 1.
It is the development of negative beliefs about worrying that contributes cen-
trally to the transition to GAD. These beliefs lead to negative appraisal of Type 1
worrying (i.e. Type 2 worry or meta-worry results). There are several ways in which
negative beliefs may develop. For instance, the act of engaging in Type 1 worry
can have negative consequences for emotional regulation in some circumstances,
and this can lead people to appraise their worrying negatively. In addition exter-
nal sources of information and social learning experiences can lead individuals to
negatively appraise their worrying. For example, the idea that stress and worry is
110 Wells

harmful is dispersed throughout some cultures. Two broad negative metacognitive

belief themes are central in the model, these include the belief that worry is uncon-
trollable, and the belief that it is dangerous. Whilst these domains are correlated it
is useful to separate them for individual attention in treatment. Danger beliefs typi-
cally concern themes of mental and physical catastrophe resulting from worry. Once
these beliefs and associated meta-worry develop their activation leads to intensifi-
cation of anxiety, and anxiety symptoms can themselves be interpreted as a sign of
danger or loss of control due to worrying. This process is represented by the cyclical
link between meta-worry and emotion in Fig. 1.
Two further processes contribute to GAD maintenance. Behavioral strategies
are developed that are intended to control or avoid the need to worry, and include
avoidance of situations, reassurance seeking, use of alcohol, distraction, and sub-
tle avoidance of information. These behaviors can maintain meta-worry and neg-
ative beliefs in several ways. For instance, the avoidance of worrying prevents the
individual from discovering that worry is not dangerous, the termination of worry
through reassurance prevents the person discovering that they can control worry
themselves, and may provide conflicting information that acts as a further trigger for
worrying.
Another type of strategy is thought control. Because people with GAD are
effectively in two minds about worrying (i.e. both positive and negative beliefs
co-exist) one way to resolve this conflict is to attempt not to think thoughts that
may trigger worrying. Unfortunately thought suppression strategies of this kind
are rarely successful as indicated by suppression research (e.g. Wegner, Schneider,
Carter, & White, 1997; Purdon, 1999) and their failure reinforces belief in uncon-
trollability. In addition GAD patients often do not attempt to interrupt the catas-
trophising worry sequence by themselves once activated since this would be equiva-
lent to not attempting to cope. Thus, they have limited experience of discontinuing
the process of worrying, an activity that would normally challenge negative beliefs
about uncontrollability. A double bind exists in GAD, often the person will not be
highly motivated to attempt to disengage the worry process or will choose ineffec-
tive strategies, thereby reducing experiences that could challenge uncontrollability
beliefs. However, even if the person does successfully control worrying this does not
provide evidence that worrying is harmless.
The model has implications for developing more effective treatments. The
model implies that treatment should focus on conceptualizing and modifying the
metacognitive appraisals and beliefs that contribute to the development and persis-
tence of GAD. This shifts the emphasis of treatment away from the more traditional
approach of challenging the content of individual Type 1 worries and teaching re-
laxation skills, a treatment approach that has produced disappointing results (see
Fisher & Durham, 1999 for an analysis of previous treatment effectiveness).

Empirical Support for the Model

Research on non-patient worriers and on individuals meeting criteria for DSM-
III-R GAD provides data that are consistent with the model. Individuals meeting
criteria for GAD report positive reasons for worrying (Borkovec & Roemer, 1995),
Meta-Worry and GAD 111

as do non-patients (Tallis, Davey, & Capuzzo, 1995). Proneness to pathological

worry characteristic of GAD is positively associated with both negative and posi-
tive beliefs about worry (Cartwright-Hatton & Wells, 1997; Wells & Papageorgiou,
1998). Wells and Carter (1999) tested the assertion that Type 2 worry should
be a stronger predictor of pathological worrying than Type 1 worry in a college
sample. They found this to be the case, and continued to be so even when the
uncontrollability of worry and trait anxiety were also entered as predictors of
pathological worrying. More recently, Wells and Carter (2001) demonstrated that
patients meeting criteria for DSM-III-R GAD could be significantly distinguished
from patients with panic disorder, social phobia, or non-patients by their elevated
levels of negative beliefs about worry and meta-worry. Nassif (1999) examined the
causal role of negative metacognitions in the development of DSM-III-R GAD, and
found that negative beliefs about uncontrollability and danger predicted the devel-
opment of GAD 12–15 weeks later in non-patients.
Purdon (2000) examined the effects of in-vivo appraisals of worrying in non-
patients. Whilst negative appraisal of worry was associated with greater attempts at
thought control, positive beliefs about worry were concurrent predictors of reduced
motivation to get rid of thoughts. These results provide support for the idea that
positive and negative metacognitions are associated with differential and potentially
conflicting motivations and thought control responses.
The model suggests that the use of worrying as a coping strategy can have
problematic consequences for self-regulation, and these effects can contribute to
the development of negative metacognitions. Results of studies that have used the
thought control questionnaire show that individual differences in the tendency to
use worry to deal with upsetting thoughts is positively correlated with a range
of emotional vulnerability measures, and post-traumatic stress reactions (Wells &
Davies, 1994; Warda & Bryant, 1998; Holeva, Tarrier, & Wells, 2001). Borkovec,
Robinson, Pruzinsky and DePree (1983) and York, Borkovec, Vasey and Stern
(1987) demonstrated that brief periods of worry increase the frequency of subse-
quent negative thought intrusions. In experimental studies of exposure to stress
brief periods of worrying following exposure appear to increase the frequency of
subsequent intrusive thoughts about the stressor over a subsequent three-day pe-
riod (Butler, Wells, & Dewick, 1995; Wells & Papageorgiou, 1995). These data are
consistent with the idea that worrying as a strategy may be problematic. It is likely
that such effects would contribute to the development of negative beliefs and ap-
praisals of mental control and of emotional status resulting from worry.

Measurement of Meta-Worry
Previous studies of meta-worry have used the Anxious Thoughts inventory
(AnTI: Wells, 1994b) which measures three dimensions of worry proneness: social
worry, health worry and meta-worry on separate subscales. A limitation of this in-
strument is that the meta-worry subscale focuses predominantly on the sense of un-
controllability associated with thinking, and less on the concept of danger associated
with the act of worrying. Apart from the AnTI, the Metacognitions Questionnaire
112 Wells

(MCQ: Cartwright-Hatton & Wells, 1997) offers a multidimensional (5-factor) mea-

sure of metacognitions of which three subscales measure beliefs about worry and
intrusive thoughts. This measure, like the AnTI is a trait measure, and uncontrolla-
bility and danger-related beliefs load on a single factor/subscale.
To test predictions of the metacognitive model in the context of DSM-IV GAD
a new measure of meta-worry is required that is capable of measuring common
themes in meta-worry focusing on the danger domain. Because uncontrollability
appraisals are now a feature of the diagnosis of GAD, a cross-sectional evaluation
of the hypothesized relationship between meta-worry and DSM-IV GAD must rely
on assessment of the meta-worry danger rather than uncontrollability domain. Since
meta-worry is considered as a central cognitive component of GAD two hypotheses
were tested: (1) that individuals with GAD would show significantly higher meta-
worry scores than individuals with somatic anxiety or no-anxiety; (2) even when dif-
ferences in the frequency of Type 1 worry are controlled across groups, meta-worry
will be significantly higher in the GAD group compared to the somatic anxiety, or
no-anxiety groups.
Two aspects of meta-worry can be partitioned for attention: (1) meta-worry fre-
quency, and (2) the extent to which the person believes the meta-worry at its time of
occurrence. According to the model meta-worry frequency should be the more di-
rect cause of GAD since frequency represents the number of conscious activations
of negative beliefs and each occurrence is linked to elevated distress and unhelpful
coping strategies. It is likely that frequency of meta-worry mediates the relation-
ship between belief in meta-worry and GAD, where belief level is more likely to be
representative of the underlying schema. Therefore, a subsidiary and exploratory
path analysis of associations between MWQ frequency, MWQ belief, and the pres-
ence/absence of GAD was planned.

Preliminary Evaluation of the Meta-Worry Questionnaire (MWQ)

Overview of Scale Construction

Items for the MWQ were derived from transcripts of treatment sessions with
nine patients undergoing meta-cognitive therapy for GAD. All patients met DSM-
IV criteria for GAD as the primary diagnosis. There was considerable overlap be-
tween themes in meta-worry in the uncontrollability and danger domains. Seven
items reflecting the common danger themes in patients’ meta-worry were devised.
Two response scales were constructed for each item, one designed to assess the
frequency of each meta-worry and the other designed to assess the belief in each
meta-worry at its time of occurrence. The frequency scale was a four-point scale
ranging from (1–4) with each point labeled as follows: Never; sometimes; often; al-
most always. The belief scale ranged from 0–100 with anchor points labeled at each
extreme as follows: I do not believe this thought at all, and I am completely convinced
this thought is true. Subscale scores are obtained by summating responses to their re-
spective items. The items of the MWQ are presented at the end of this manuscript.
Instructions for respondents were presented in two parts. At the top of the MWQ
Meta-Worry and GAD 113

the instructions read: “This questionnaire assesses thoughts and ideas about worry-
ing. Listed below are some thoughts that you may have about worrying when you
notice yourself worrying. Indicate how often each thought occurs by placing a circle
around a number in the LEFT hand column.” At the bottom of the scale the follow-
ing instructions were presented: When you are worrying how much do you believe
each of these thoughts? Please rate your belief by choosing a number from the scale
below and put the number on the line at the RIGHT of each thought.”

METHOD

Participants
One hundred and seventy-four undergraduate, postgraduate and occupa-
tional/physiotherapy students participated in the study. The sample consisted of
63 men and 111 women and the ages of participants ranged from 18–32 years (mean
19.6 years, SD = 2.19).

Measures and Procedure

A battery of measures was administered along with the MWQ. The additional
measures were selected as a means of assessing the validity of the MWQ and as
a means of testing specific hypotheses derived form the metacognitive model. The
additional measures were as follows:
Anxious Thoughts Inventory (AnTI: Wells, 1994b). This instrument consists of
three subscales that assess Type 1 and Type 2 worry. There are two type 1 worry sub-
scales: social worry and health worry, and one meta-worry subscale which assesses
worry about worry, predominantly in the uncontrollability domain. The subscales
show good reliability and validity and a stable factor structure. Subscale alpha’s
range from 0.75–0.84.
Metacognitions Questionnaire (MCQ: Cartwright-Hatton & Wells, 1997). This
instrument is comprised of five subscales: (1) positive beliefs about worry (e.g. wor-
rying helps me cope); (2) negative beliefs about worry concerning uncontrollabil-
ity and danger (e.g. My worrying is dangerous for me); (3) cognitive competence
(e.g. My memory can mislead me at times); (4) general negative beliefs including
superstition, punishment and responsibility (e.g. I will be punished for not control-
ling certain thoughts); (5) cognitive self-consciousness (e.g. I constantly examine
my thoughts). The scale and subscales have good reliability and validity and a stable
factor structure. Subscale alpha’s range from 0.72–0.89. The positive and negative
belief subscale alpha’s are 0.87 and 0.89, respectively.
Generalized Anxiety Disorder Questionnaire (GAD-Q: Roemer, Borkovec,
Posa, & Borkovec, 1995). The GAD-Q is a 6-item instrument designed to assess the
presence of GAD in accordance with DSM-III-R and DSM-IV criteria. The scale
is accurate in discrimination and identification of GAD cases and very accurate at
identifying the absence of GAD. Roemer et al. (1995) report an agreement of 80%
between diagnosis of DSM-IV GAD based on the questionnaire and the ADIS-R in
114 Wells

students. Participants can be classified as meeting criteria for GAD, partial GAD,
somatic anxiety, or no-anxiety on the basis of GAD-Q responses.

RESULTS

Overview of Data Analyses

Statistical analyses were carried out using SPSS for windows version 10.1.
Initial analyses focused on assessing the properties of the MWQ. For this purpose
reliability analyses were undertaken and Principle Components Factor Analysis was
performed to identify possible latent structure. Correlational analyses were used to
establish the validity of the MWQ scales.
Cronbach alpha coefficients of the MWQ were .88 for the frequency scale and
.95 for the belief scale, indicating that both were internally consistent in the present
sample. The corrected item-total correlations for items of each subscale are pre-
sented in Table I.
The suitability of the MWQ data for factor analysis was explored by examin-
ing the Kaiser–Meyer–Olkin (KMO) measure of sampling adequacy (Kaiser, 1970).
The value for the MWQ frequency subscale was 0.87, and for the belief subscale
it was 0.93, satisfying respectively the “meritorious” and “marvelous” criteria sug-
gested by Kaiser and Rice (1974). Bartlett’s Test of sphericity (Bartlett, 1954) was
also applied to examine the extent to which the correlation matrices departed from
orthogonality, Bartlett’s test statistic was highly significant for both the frequency
and belief variables (p < .0005) confirming that the variables were inter-correlated
and therefore suitable for factoring. The items of each subscale of the MWQ were
subjected to separate principal components analysis which showed one factor with
an eigenvalue exceeding 1 for each of the frequency and belief subscales. The load-
ings of items are presented in Table I. The frequency factor accounted for 58.1% of
the variance, whilst the single belief factor accounted for 78.4% of the variance.

Table I. Item Loadings, Communalities and Item-Total Correlation Statistics For

Meta-Worry Frequency and Belief Items (n = 174)
Item number Loadings Communalities Corrected item-total correlations
Frequency scale
1 .73 .53 .62
2 .73 .53 .62
3 .80 .63 .70
4 .70 .49 .59
5 .80 .64 .71
6 .77 .59 .67
7 .81 .65 .71
Belief scale
1 .88 .77 .83
2 .89 .78 .84
3 .86 .74 .81
4 .88 .77 .83
5 .89 .80 .85
6 .89 .80 .85
7 .92 .84 .88
Meta-Worry and GAD 115

Before commencing further analyses, mean scores for the MWQ frequency and
belief scales were transformed using Log10 transformations as the distributions were
positively skewed. Since some participants had a mean score of zero on the belief
sub-scale a numerical constant was added to all scores on this sub-scale prior to Log
transformation. The transformations were successful in correcting the distribution
of scores.
The next step concerned validation of the MWQ scales. For this purpose the
frequency and belief scales were correlated with existing measures of meta-worry,
Type 1 worry, and metacognitive beliefs. The MWQ subscales should be positively
associated with AnTI meta-worry. Moreover, there should be some specificity of
correlations such that MWQ subscales should correlate more highly with AnTI
meta-worry, than with Social worry, or health worry. Furthermore, the correlation
between MWQ subscales and MCQ negative beliefs (uncontrollability and danger)
should be of a greater magnitude than the correlation between the MWQ and the
MCQ positive beliefs about worry subscale.
The results of Pearson correlations are presented in Table II. Both the MWQ
frequency and the MWQ belief subscales were positively correlated with the AnTI
meta-worry subscale, and with negative beliefs about worry measured with the
MCQ. MWQ scales also correlated with social worry, health worry, and posi-
tive worry beliefs but to a lesser degree. In order to test for the significance of
differences between correlations as predicted above, Steiger’s (1980) formula for
dependent correlations was used. The correlation between MWQ frequency and
AnTI meta-worry was significantly greater than that between MWQ frequency and
health worry (p < 0.01), but did not differ significantly from the correlation be-
tween MWQ frequency and social worry. The association between MWQ belief
and AnTI meta-worry was significantly greater than that between either MWQ
belief and social worry (p < 0.05) or health worry (p < 0.01). Finally, MWQ fre-
quency had a significantly stronger correlation with negative beliefs about worry
than with positive beliefs about worry (p < 0.01), a pattern that also held true for
MWQ beliefs (p < 0.01). In summary, five out of six comparisons of correlation
coefficients showed predicted specificity of relationships between MWQ scales and

Table II. Pearson Correlations for Transformed MWQ

Subscales with Measures of Worry and Metacognition, and
Untransformed MWQ Descriptives for Males and Females
Measures MWQ freq. MWQ bel.
AnTI
Meta-worry .64∗∗ .50∗∗
Social-worry .55∗∗ .38∗∗
Health-worry .26∗∗ .18∗
MCQ
Positive beliefs .23∗∗ .23∗∗
Negative beliefs .65∗∗ .55∗∗
Mean (SD)
Males 9.22 (2.50) 132.13 (185.22)
Females 10.05 (3.59) 105.03 (129.74)
∗p < .02; ∗∗ p < .0005; n = 174.
116 Wells

other measures. These results add support to the validity of the MWQ scales as
measures of negative metacognitions concerning worry.
Finally, gender differences in MWQ scores were examined. Males and females
were found not to differ significantly on each of the sub-scales. Descriptive statistics
for men and women are presented in Table II.
In summary, the preliminary analyses of the MWQ suggest that both the fre-
quency and belief scales are internally reliable, each composed of a single fac-
tor structure, and meaningfully correlated with other measures of metacognition.
However, scores on the scales were not normally distributed in the present sample,
and showed a positive skew. Whilst this is fairly typical of measures of “abnormal”
states this may have implications for the use of the MWQ in subsequent research on
non-patients.

Hypothesis Testing
We now turn to testing hypotheses emerging from the metacognitive model of
GAD. An advantage of the MWQ over the measure of meta-worry provided by
the AnTI is that the MWQ assesses danger-related meta-worry themes and not ap-
praisals of the uncontrollability of worrying. Thus, it enables a test of the role of
meta-worry in GAD as defined by DSM-IV whilst avoiding circularity (i.e. GAD
is defined partly by the uncontrollable nature of worry in DSM-IV). Such an anal-
ysis contributes to the database that has evaluated predictions of the model in the
context of DSM-III-R GAD.
It was hypothesized that individuals with GAD should endorse higher levels of
meta-worry than individuals with somatic anxiety or no-anxiety. To test this hypoth-
esis three groups of individuals meeting a classification of GAD, somatic anxiety,
and no-anxiety were selected from the overall sample on the basis of the GAD-Q.
To be classified as GAD the following criteria were used: individuals responded
“yes” to the experience of both excessive and uncontrollable worry; at least two
worry topics were listed; the individual responded “yes” to being bothered by worry
for more days than not in the past 6 months; at least three symptoms from the six
specified in DSM-IV were endorsed. To be classified as somatic anxiety individuals:
responded “no” to experiencing excessive or uncontrollable worry; responded “no”
to being bothered by worry in the past 6 months, but endorsed six or more symp-
toms which had bothered them when anxious in the past 6 months. Individuals were
classified as non-anxious when they responded “no” to the experience of excessive
or uncontrollable worry; responded “no” to being bothered by worry in the past 6
months, and reported being bothered by less than six symptoms in the past 6 months
when anxious.
Individuals meeting criteria for partial GAD (e.g. duration of worry less than
6 months, or meeting criteria for GAD except worry not rated as excessive) were
not included in this analysis as these individuals show some but not all features of
DSM-IV GAD. To test for the hypothesized differences one-way between groups
ANOVA’s were computed on the transformed meta-worry scores, and Tukey’s
HSD tests were used for pair-wise comparisons. There was a significant difference
between the three groups in MWQ frequency (F (2, 142) = 25.5 , p < .0005), and
Meta-Worry and GAD 117

Table III. Descriptive Statistics for Untransformed MWQ Frequency and

MWQ Belief Scores Across Groups
MWQ
Freq. Bel.
Group N M SD M SD
1. GAD 11 14.45a 4.78 242.28a 166.68
2. Somatic anxiety 22 10.95b 3.44 149.54a 168.94
3. No anxiety 112 8.63c 2.40 76.10b 130.11
Note. Column means with different superscripts differ significantly (p < .02).

in MWQ belief (F (2, 142) = 11.47 , p < .0005). The effect sizes (Eta squared) for
differences in mean frequency and belief were large (0.26 and 0.14, respectively).
Tukey’s tests revealed that the GAD group had significantly higher MWQ fre-
quency scores than the somatic anxiety (p = 0.009), and the non-anxious group (p <
0.0005). The somatic anxiety group had higher scores than the non-anxious group
(p < 0.0005). The GAD group did not differ significantly from the somatic anxi-
ety group in MWQ belief, however the GAD group did show significantly higher
scores than the non-anxious group (p < 0.0005). The somatic anxiety group were
also significantly higher in MWQ belief than the non-anxious group (p = 0.012).
Untransformed means and standard deviations for each group are displayed in
Table III.
It was also hypothesized that individuals with GAD should endorse higher
meta-worry scores even when covariances with Type 1 worry were controlled. Con-
trolling for Type 1 worry (social and health) did not change the pattern of findings
reported in Table III.
Finally, a path analysis was undertaken to test for the relative contributions
of MWQ frequency and MWQ belief to GAD. The metacognitive model suggests
that it is the frequency of meta-worry that is the most proximal cause of GAD and
mediates the relationship between beliefs and disorder. The greater the frequency
of meta-worry the greater the frequency of anxiety and frequency of pathological
worry episodes. Thus, assuming that MWQ belief is more representative of under-
lying metacognitive beliefs, then frequency is a mechanism linking such beliefs to
GAD.
One way to evaluate this is to assume a path model in which meta-worry fre-
quency is directly associated with GAD whilst the relationship between meta-worry
belief and GAD is mediated by meta-worry frequency. Following the guidelines
of Baron and Kenny (1986) for testing mediation, three regressions were run: (1)
regressing the mediator (MWQ frequency) on the independent variable (MWQ be-
lief); (2) regressing the dependent variable (GAD status) on the independent vari-
able; (3) regressing the dependent variable on both the independent variable and
the mediator.
The analyses were run on the GAD and non-anxious groups treated as the bi-
nary criterion (dependent) variable and a combination of linear and logistic regres-
sions were used. The unstandardized regression coefficients were interpreted and
plotted in Fig. 2 as a path diagram.
118 Wells

Fig. 2. Path diagram of the relationships between meta-worry (MWQ) dimensions and group status
(GAD vs. non-anxious).

The results of this analysis show that the relationship between MWQ belief
and GAD was mediated by MWQ frequency. It can be seen in Figure 2 that MWQ
belief affects MWQ frequency, it also emerged that MWQ belief affects GAD (B =
0.005, p = 0.001), however when MWQ frequency was controlled the relationship
between MWQ belief and GAD decreased and became non-significant as can be
seen in Fig. 2. These results show that the relationship between MWQ belief and
GAD is mediated by MWQ frequency.

DISCUSSION

The study reported here set out to evaluate the psychometric properties of a
new instrument the Meta-worry questionnaire (MWQ) designed to measure two as-
pects (frequency and belief) of worry about worry. The principal purpose of devel-
oping the scale was to test predictions based on the metacognitive model of GAD,
specifically that individuals with GAD would show elevated meta-worry scores com-
pared to individuals with somatic anxiety or no-anxiety.
Preliminary data on properties of the MWQ suggest that the items assessed on
the two scales (frequency and belief) have a high level of homogeneity. Each scale
is composed of a single factor, and the factors correlate meaningfully with measures
of worry and metacognition. Mean scores on the MWQ were positively skewed in
the present sample, which may impose limitations on the use of the instrument to
evaluate meta-worries in non-patients. Further studies are required to examine the
psychometric properties of the MWQ in clinical samples.
Using the MWQ enabled a test of the relationship between meta-worry and
GAD that overcomes a potential confounding of meta-worry content assessed with
measures such as the AnTI with the uncontrollability criterion in the DSM-IV clas-
sification. Earlier studies that have used measures such as the AnTI have avoided
this problem since they were based on testing the model in the context of patholog-
ical worry in general or in relation to DSM III-R defined GAD. The results of the
Meta-Worry and GAD 119

univariate and multivariate analyses support the hypothesized relationship between

meta-worry and DSM-IV GAD. The GAD group had significantly higher MWQ
frequency scores than the somatic anxiety or no-anxiety groups. MWQ belief was
also highest in the GAD group, however the difference between the GAD and so-
matic group was not statistically significant. One possible explanation for this is that
a proportion of the somatic anxiety group may have been in the process of devel-
oping GAD or in remission. The metacognitive model would predict that negative
belief level would be elevated in such cases before an increase in the frequency of
meta-worry and the occurrence or re-occurrence of GAD.
The results of the path analysis supported the idea that the association between
meta-worry belief and GAD was dependent on meta-worry frequency. This analysis
was performed on the basis of the prediction that belief level as measured by the
MWQ is a reflection of underlying metacognitive schemas or beliefs that are linked
to pathology by the occurrence and frequency of negative thoughts about worry.
The analysis showed that meta-worry frequency was directly associated with the
presence of GAD, whilst the affect of meta-worry belief on GAD was mediated by
meta-worry frequency. These data provide a preliminary and tantalizing glimpse of
the possible structure of relationships between metacognitive dimensions and GAD.
In conclusion, the results of this study extend those of previous studies, which
have demonstrated a relationship between negative metacognitions, DSM-III-R
GAD, and pathological worrying. Meta-worry frequency is positively associated
with DSM-IV GAD, discriminates this group from somatic anxiety, and non-
anxiety, and this effect appears independent of variability in the frequency Type 1
worry. GAD may be as much characterized by worry about the dangers of worrying
as it is characterised by worry about the uncontrollability of worrying, both of these
metacognitive content domains are relevant in the metacognitive model of the de-
velopment and maintenance of the disorder. The clinical implications of this model
are that measurement of meta-worry should be included in the formal assessment of
cognition in GAD, and treatment should focus on modifying the mechanisms that
give rise to meta-worry. In the metacognitive focused therapy based on the model
(Wells, 1997; 1999), strategies are used to postpone the worry process and by doing
so challenge underlying stable beliefs (metacognitive schemas) about the uncontrol-
lability and dangers of worrying. Negative beliefs about uncontrollability and dan-
ger are an initial target for re-attribution since these schemas are conceptualized as
driving the activation of meta-worry.

ITEMS OF THE META-WORRY QUESTIONNAIRE (MWQ)

1. I am going crazy with worrying.

2. My worrying will escalate and I’ll cease to function.
3. I’m making myself ill with worry.
4. I’m abnormal for worrying.
5. My mind can’t take the worrying.
6. I’m losing out in life because of worrying.
7. My body can’t take the worrying.
120 Wells

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