Generalized Anxiety Disorder: Does the Emotion Dysregulation Model Predict Symptoms Beyond the Metacognitive Model?

Journal of Rational-Emotive & Cognitive-Behavior Therapy https://doi.org/10.1007/s10942-022-00479-7 Generalized Anxiety Disorder: Does the Emotion Dysregulation Model Predict Symptoms Beyond the Metacognitive Model? Kendall A. Deleurme1 · Sydney A. Parkinson1 · Alexander M. Penney1 Accepted: 5 September 2022 © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022 Abstract While the Metacognitive Model (MCM) of generalized anxiety disorder (GAD) is well-established, the Emotion Dysregulation Model (EDM) of GAD has received less attention. This study examined whether the EDM helps explain GAD above and beyond the MCM. The influence of gender was also explored. A non-clinical university sample (N = 626) completed measures of GAD symptoms, worry severity, the MCM, and the EDM. In support of the EDM, it was found that fear of depression predicted GAD symptoms for men, while fear of anxiety predicted GAD symptoms for women. However, across genders, the strongest predictor of GAD symptoms and worry severity was negative beliefs about worry. While these findings support the MCM view that holding the beliefs that worry is harmful and dangerous is the strongest predictor of GAD overall, incorporating aspects of the EDM into our understanding and treatment of GAD may be beneficial. Keywords Generalized anxiety disorder · Metacognition · Emotion dysregulation · Negative beliefs about worry · Fear of emotion · Gender differences Introduction Generalized anxiety disorder (GAD) consists of excessive anxiety and uncontrollable worry lasting at least six months, with the worry not limited to a single type or context (American Psychiatric Association, 2013). It has been estimated that GAD has a 1–2% past-year and a 3–6% lifetime prevalence rate (Alegria et al., 2010), with women being twice as likely as men to receive a diagnosis (Eaton et al., 2012). There are a number of cognitive-behavioral models of GAD, two of which are the Metacognitive Model (MCM; Wells, 1995) and the Emotional Dysregulation Model * Alexander M. Penney 1 Department of Psychology, MacEwan University, Edmonton, AB, Canada 13 Vol.:(0123456789) K. A. Deleurme et al. (EDM; Mennin et al., 2002). Further information regarding the other cognitivebehavioural models of GAD, such as the Cognitive Avoidance Model, the Intolerance of Uncertainty Model, and the Acceptance-Based Model, can be found in Behar et al. (2009) and McCabe-Bennett et al. (2018). The MCM (Wells, 1995) has extensive empirical support (McCabe-Bennett et al., 2018). This model focuses on how metacognitions, the thoughts that an individual has towards their own thoughts and thought process, play a role in GAD. Within the MCM, both positive beliefs about worry (i.e., believing that worry is beneficial) and negative beliefs about worry (i.e., believing that worry is uncontrollable and dangerous) are believed to contribute to the development and maintenance of GAD. However, it is negative beliefs about worry, and the resulting meta-worry, that are considered the most critical to GAD (Belloch et al., 2007; Davis & Valentiner, 2000; Ruscio & Borkovec, 2004; Wells & Carter, 1999, 2001). Individuals high in negative beliefs about worry think a lot about their worrying thoughts, and believe that they cannot ignore nor control their worrying thoughts. These negative beliefs about one’s thinking are key in differentiating between individuals who chronically worry without experiencing significant GAD symptoms from individuals with significant GAD symptoms (Penney et al., 2013; Ruscio & Borkovec, 2004; Wells & Carter, 2001). However, some studies have also found that positive beliefs about worry independently contribute to worry and GAD symptoms even when negative beliefs about worry are accounted for (Khawaja & Chapman, 2007; Koerner et al., 2015). Further, the negative metacognitive belief that one needs to be in control of their thoughts at all times, has also been shown to mediate the relationship between chronic worry and GAD symptoms alongside negative beliefs about worry (Penney et al., 2013). This belief is measured separately from negative beliefs about worry and focuses on the belief that one needs to always control and constantly monitor their thoughts (Wells & Cartwright-Hatton, 2004). The negative belief that one needs to be in control of their thoughts focuses on thoughts more broadly, while the negative beliefs about worry focus more specifically on thoughts about worrying. The EDM (Mennin et al., 2002) lacks the same degree of empirical support for its utility in explaining GAD compared to other models (McCabe-Bennett et al., 2018). While the MCM focuses on beliefs about worry in maintaining GAD symptoms, the EDM concentrates on beliefs about emotions and emotional dysregulation (Mennin et al., 2002). Specifically, the EDM suggests individuals with GAD experience emotions in higher intensity, are unable to distinguish between their emotions, and lack the strategies to regulate their emotions (Mennin et al., 2002, 2005). It is theorized that this dysregulation leads the individual to develop negative beliefs about their emotions and fear of their emotions, which refers to the apprehension of both losing control over one’s emotions and one’s reaction to experiencing intense emotions. Fear of emotions encompasses a range of emotions (e.g., anxiety, anger, positive emotions), and the EDM argues that fear of emotions overall contributes to GAD. However, individuals may have one or more specific fears, such as a fear of anxiety or a fear of depression. Due to a fear of emotional experiences, individuals with GAD then attempt to avoid their emotions through worry. However, the negative reinforcement of worry contributes to a continuous cycle of intense emotional experiences, anxiety due to emotions, and ongoing worry to control the anxiety, which 13 Generalized Anxiety Disorder: Does the Emotion Dysregulation… maintains the emotion dysregulation (Mennin et al., 2002). Additionally, previous research has shown that negative beliefs regarding fear, depression, anger, and positive emotions correlate with worry and GAD symptoms (Sugiura, 2017). The relationship between fear of emotions and GAD is consistent in the research and has been previously connected to avoidance of emotional experiences (Buhr & Dugas, 2012; Mennin et al., 2005; Roemer & Orsillo, 2002). An emotion regulation approach to GAD may offer additional strategies for understanding and conceptualizing GAD beyond the primarily cognitive models, such as the MCM. Though emotions have been included in all major conceptualizations of GAD, the EDM proposes that emotion dysregulation and maladaptive beliefs about emotions are the driving factors in GAD. While the EDM focuses on the beliefs about one’s emotions and fear of emotions, the MCM focuses on the beliefs about one’s thoughts and worries. Although both models focus on the role o (...truncated)