What predicts change in generalized anxiety disorder severity? Examining negative beliefs about worry, intolerance of uncertainty, and fear of emotions

Abstract

Metacognitive beliefs about worry, intolerance of uncertainty, and fear of emotions are associated with chronic worry and generalized anxiety disorder (GAD). However, much of the existing research is cross-sectional, which cannot determine whether these beliefs are associated with changes in worry severity and GAD symptoms over time. This study examined whether changes in metacognitive beliefs about worry, intolerance of uncertainty, and fear of emotions are associated with changes in worry severity and GAD symptoms. A university sample of high worriers (N = 372) completed measures of worry severity, GAD symptoms, negative and positive beliefs about worry, intolerance of uncertainty, and fear of emotions. Participants were assessed at baseline and 4-months. Fear of anxiety was associated with worry severity cross-sectionally, while fear of depression was associated with changes in worry. Intolerance of uncertainty was associated with worry severity and GAD symptoms cross-sectionally, as well as changes in worry and GAD symptoms. However, negative beliefs about worry consistently explained the greatest variance in worry severity and GAD symptoms in all analyses. These findings suggest that negative beliefs about worry are a key dysfunctional belief in chronic worry and GAD, and should be a primary focus of GAD treatment.