Metacognitive Theory and Therapy for Worry and Generalized Anxiety Disorder: Review and Status

The metacognitive model of pathological worry and Generalized Anxiety Disorder (GAD) makes a crucial distinction between two types of worry and explains the persistence and uncontrollability of negative thinking as an effect of specific metacognitions. The negative appraisal of worry (meta-worry) and negative beliefs about worry are central to the development of GAD. Furthermore, GAD is associated with paradoxes in mental control such as the use of extended thinking to reduce thinking. Evidence is reviewed that supports major tenets of the model. A specific treatment, metacognitive therapy is described that focuses on modifying metacognitive beliefs and reducing the use of worry to cope with thoughts. The empirical status of the model is reviewed and evidence from recent trials of this treatment is summarized. The treatment appears to be effective and initial trials suggest it is associated with greater levels of recovery than approaches comprised of applied relaxation or cognitive-behavioural treatment focused on intolerance of uncertainty.