Category: Adult Anxiety - GAD

PS10- #A21 - Mediation of the Link Between Positive Worry Beliefs and Symptoms by Percentage of Untrue Worries in Treatment for GAD

Saturday, Nov 18
11:00 AM – 12:00 PM
Location: Indigo Ballroom CDGH, Level 2, Indigo Level

Keywords: GAD (Generalized Anxiety Disorder) | Randomized Controlled Trial | Worry

Those with GAD experience worrisome predictions that are often untrue. According to one study, 85% of such worries were not actualized (Borkovec, Hazlett-Stevens, & Diaz, 1999). In a previous study, we designed and tested an ecological momentary intervention for worry in GAD termed the Worry Outcome Journal (WOJ). In the WOJ, those with GAD recorded worries and their costs while tracking worry outcomes. Theoretically, through monitoring those with GAD receive evidence that their worries are unlikely and not worth the distress and interference they create. The WOJ was shown to be superior for reducing worry after 10 days when compared to an active control in an RCT (LaFreniere & Newman, 2016). Yet the mechanism by which the WOJ works has not been directly tested. In theory, the effect of the WOJ should be dependent on the percentage of worries that do not come true, disconfirming faith in worries. Those with GAD report high positive worry beliefs—believing worry has many useful functions (Hebert et al., 2014). If those with higher worry beliefs were to be shown that a large portion of their worries were untrue, they might benefit more. In essence, those with stronger belief in worry’s use have more to gain from seeing their worries disproven than those with weaker beliefs. The current study used bootstrapping regression-based mediation to test a model where higher positive worry beliefs at baseline predicting lower GAD symptoms at post-treatment and follow-up was mediated by a higher percentage of worries that did not come true.


Secondary analysis was conducted on the data of 29 participants in the treatment condition of the WOJ RCT. For 10 days participants recorded worries and tracked their outcomes, rating worry-related distress, thought interference, and expected outcome probabilities. All participants made four entries on paper each day when randomly prompted by text. They then entered journal contents online each night and reviewed their journals for outcomes. After 30 days they reviewed their journals again, noting outcomes. After the trial, two independent raters reviewed the journals to assess whether each worry came true or not; adequate interrater reliability was achieved (ICC(2) = 0.927). We used Mplus to analyze the mediation model stated above with 10,000 bootstraps and full information maximum likelihood estimation.


Findings supported our predictions. 91% of participants’ worries did not come true. Results revealed mediation at the threshold for significance: When those with higher worry beliefs at baseline reported higher percentages of worries that did not come true, they experienced lower GAD symptoms at post-treatment and follow-up (c = -0.064, bootstrap CI =  -.544 – 0.00). The WOJ appears to work as intended via the disconfirmation of worrisome predictions.

Lucas S. LaFreniere

Doctoral Student
The Pennsylvania State University
State College, Pennsylvania

Michelle G. Newman

Professor of Psychology and Psychiatry
The Pennsylvania State University
University Park, Pennsylvania