Do Metacognitions and Intolerance of Uncertainty Predict Worry in Everyday Life? An Ecological Momentary Assessment Study

doi:10.1016/j.beth.2015.05.001

Behavior Therapy

Volume 46, Issue 4, July 2015, Pages 532-543

https://doi.org/10.1016/j.beth.2015.05.001 Get rights and content

Highlights

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We investigated the role of cognitive factors in excessive worry.
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This is the first study in this area using ecological momentary assessment.
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Negative metacognitive beliefs significantly predicted levels of worry.
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Intolerance of uncertainty was also predictive but did not show incremental value.
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The cognitive processes may be promising targets for prevention or treatment.

Abstract

Cognitive models of generalized anxiety disorder (GAD) suggest that excessive worry is due to positive and negative metacognitive beliefs and/or intolerance of uncertainty. Empirical support mainly derives from cross-sectional studies with limited conclusiveness, using self-report measures and thereby possibly causing recall biases. The aim of the present study therefore was to examine the power of these cognitive variables to predict levels of worry in everyday life using Ecological Momentary Assessment (EMA). Metacognitions and intolerance of uncertainty were assessed using well-established self-report questionnaires in 41 nonclinical participants who subsequently completed ratings on worry intensity and burden on a portable device for 1 week at seven times a day once every 2 hours. Results showed significant associations of negative metacognitive beliefs and intolerance of uncertainty, but not positive metacognitive beliefs, with worry in everyday life. In multilevel regression analyses, a substantial proportion of variance of everyday worry could be accounted for by negative metacognitions over and above trait worry and daily hassles. Intolerance of uncertainty likewise emerged as a valid predictor when tested in isolation, but did not explain additional variance once negative metacognitions were controlled. The findings support current cognitive models of excessive worry and highlight the role of negative metacognitions. By using EMA to assess levels of worry in everyday life, they extend earlier findings focusing exclusively on retrospective questionnaire measures.

Section snippets

Participants

Participants were 41 students enrolled at a German university (63.4% female; age: M = 23.08 SD = 2.77, range: 19–32; 39% Psychology students). They were invited to participate in the study using posters and email sign-ups.

Questionnaire Measures

The Penn State Worry Questionnaire (PSWQ; Meyer, Miller, Metzger, & Borkovec, 1990; German version: Stöber, 1995) is a 16-item self-report measure of excessive worry (i.e., “I am always worrying about something”). Responses are rated on a 1- to 5-point Likert scale, ranging from

Descriptive statistics and compliance with ambulatory assessment

The dataset consisted of 41 (persons) * 7 (days) * 7 (measurements) = 2,009 observations, while some of the measurements on the first day were missing as pre-appointments took place at the time. As for the total amount of missing data per day, no significant differences were found using analyses of variance for the remaining days under study, F(5, 200) = .38, p = .86. For the effect of daytime, a significant difference was found, F(6, 240) = 3.43, p < .01. The second measurement at 12:00 significantly

Discussion

The main aim of this study was to test the power of cognitive constructs derived from the metacognitive model and the IoU model to predict worry assessed in daily life via EMA. As expected, negative metacognitions, the core component of the metacognitive model, were significantly and substantially correlated with worry assessed via EMA. When predicting EMA-worry scores using multilevel mixed modeling, time (day and daytime) was not a significant predictor, while trait worry initially, and daily

Conclusions

In light of the study limitations, a replication of our findings is clearly necessary. Nevertheless, a number of preliminary conclusions can be drawn. First, our findings support current cognitive models of worry, especially regarding the role of negative metacognitions in the maintenance of worry. More research is needed to further investigate the added predictive value of IoU and/or positive metacognitions as processes that may be more closely linked to the initiation of worry.

Second, as the

Conflict of Interest Statement

All authors state that they have no actual or potential conflict of interest including any financial, personal or other relationships with other people or organizations within three years of beginning the work submitted that could inappropriately influence or bias their work.

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These methods have also been used in the consideration of metacognitive influences on daily repetitive thinking. Thielsh et al. (2015) found trait-level negative metacognitive beliefs strongly predictive of everyday worry, even when controlling for trait-level worry scores. Similarly, Kubiak et al. (2014) found trait-level positive beliefs about rumination strongly predictive of rumination, measured using an ESM.
A relationship between rumination and suicidal ideation is well-evidenced. A role for thought suppression has also been suggested but under-explored. The present study assessed the relative contribution of rumination and a range of thought control strategies in the understanding of suicidal ideation, within the theoretical framework of the self-regulatory executive function (S-REF) model (Wells & Matthews, 2015). Twenty-four participants who had experienced suicidal ideation in the last two months completed trait-level measures of metacognitive beliefs and momentary sampling measures of thought control strategy use, rumination and suicidal ideation over six days. Maladaptive thought control strategy use (worry and punishment), alongside rumination, predicted suicidal ideation. Adaptive strategies (distraction, social control and reappraisal) emerged as negative predictors. Metacognitive beliefs about the need to control thoughts predicted the use of punishment- but not worry-based thought control strategies. Thought control strategy use is as important in the development of suicidal ideation as rumination. The S-REF model represents a promising new approach to understanding these processes in the development of suicidal ideation.
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Wells (2005) purported that two key metacognitive beliefs about worry are pertinent to anxiety maintenance; that of the uncontrollability and danger of worry. These negative beliefs about worry predict worry in everyday life and state anxiety (Spada, Georgiou & Wells, 2010; Thielsch, Andor & Ehring, 2015), and the development of anxiety in nonclinical populations (Ramos-Cejudo & Martin, 2017; Ryum et al., 2017). Mindfulness processes facilitate a metacognitive mode of information processing and regulation that disengages the negative influence of maladaptive beliefs and enables more flexibility in response styles (Wells, 2002).
Dispositional mindfulness (DM) has been linked to a number of mental health outcomes, including anxiety. Metacognitive models of anxiety posit that an individual's negative beliefs about the danger and uncontrollability of their worry predict the development and maintenance of anxiety disorders. The aim of the present study was to determine whether DM facets predict negative beliefs about worry, and subsequently (via indirect effects) anxiety. Participants (a nonclinical sample of university students; N = 446) volunteered to complete an online survey, which assessed DM, negative beliefs about worry, and anxiety. Multiple regression analyses confirmed that Nonjudgment, Nonreactivity, and Act Aware facets of DM significantly predicted negative beliefs about worry, with negative associations. Furthermore, negative beliefs about worry significantly mediated the relationship between these facets of DM and anxiety symptoms. The Observe facet, however, was not a significant predictor of negative beliefs about worry, nor were any significant indirect effects found with anxiety. The current investigation is the first to investigate the relationship between facets of DM and negative beliefs about worry. Clarification of the roles of DM and negative beliefs about worry in anxiety extends our understanding of metacognitive models of psychopathology, and informs preventative approaches to mental health.
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^☆: The authors would like to thank Tina Poppenborg for help conducting the study.

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Do Metacognitions and Intolerance of Uncertainty Predict Worry in Everyday Life? An Ecological Momentary Assessment Study☆

Highlights

Abstract

Section snippets

Participants

Questionnaire Measures

Descriptive statistics and compliance with ambulatory assessment

Discussion

Conclusions

Conflict of Interest Statement

Clinical Psychology Review

Journal of Behavior Therapy and Experimental Psychiatry

Journal of Anxiety Disorders

Behaviour Research and Therapy

International Journal of Psychophysiology

Journal of Anxiety Disorders

Personality and Individual Differences

Behaviour Research and Therapy

Behaviour Research and Therapy

Personal and Individual Differences

Behaviour Research and Therapy

Clinical Psychology Review

Personality and Individual Differences

Personality and Individual Differences

Behaviour Research and Therapy

Journal of Anxiety Disorders

Behaviour Therapy

Personality and Individual Differences

Behaviour Research and Therapy

Behaviour Research and Therapy

Personality and Individual Differences

Personality and Individual Differences

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Diagnostic and statistical manual of mental disorders (DSM-5)

Psychometrische Gütekriterien des Metakognitionsfragebogens (Kurzversion, MKF-30)

Zeitschrift für Klinische Psychologie und Psychotherapie

An inventory for measuring depression

Archives of General Psychiatry

Cluster size in multilevel models: the impact of sparse data structures on point and interval estimates in two-level models

How low can you go? An investigation of the influence of sample size and model complexity on point and interval estimates in two-level linear models

Methodology: European Journal of Research Methods for the Behavioral and Social Sciences

Intensive longitudinal methods: An introduction to diary and experience sampling research