Wells (1995) · Generalised anxiety disorder
Wells (1995)
Trigger
A trigger — often an intrusive 'what if...?' thought (e.g. 'what if my partner has an accident?'), or a situation, news item or sensation that starts the worry off.
Positive Metabeliefs About Worry
Positive metabeliefs about worry — beliefs that make worry seem useful, so it is taken up (often without awareness) as a coping strategy: 'worrying helps me prepare and cope', 'if I worry I won't be caught out', 'worrying shows I care'.
Type 1 Worry
Type 1 worry: worry about external situations and everyday problems (health, finances, relationships) and about physical symptoms — the worry recruited by the positive metabeliefs above.
Negative Metabeliefs Activated
Negative metabeliefs about worry are activated — beliefs about uncontrollability ('I can't stop once I start') and danger ('worrying like this could harm me, make me ill, or make me lose my mind').
Type 2 Worry (Meta-Worry)
Type 2 worry (meta-worry): worry about worry itself — 'I can't control this', 'this worrying is damaging me'. This sharply increases anxiety and the sense of threat.
Behavioural Response
Responses that try to manage worry — thought suppression and other control attempts, avoidance of triggers, reassurance-seeking and checking. These backfire: failed control 'proves' worry is uncontrollable, and avoidance prevents the person learning that worry is harmless and can be left alone.
The published model, shown for reference. Switch to “Blank” to see the empty template you complete with a client.
Lots of people worry, but in generalised anxiety the worrying feels endless and hard to control. This model — the metacognitive model — suggests the real problem isn't what you worry about, but your beliefs about worry itself.
It often starts with a 'what if...?' thought. Many people then begin to worry on purpose, without quite realising it, because of positive beliefs about worry — 'if I think it all through, I'll be ready', 'worrying means I care'. This is everyday worry about real-world things.
The difficulty grows when negative beliefs about worry switch on — 'my worrying is out of control', 'all this worry could make me ill or send me mad'. Now you start to worry about worrying. This 'worry about worry' ramps anxiety up sharply.
To cope, people try to control or stop the worry, avoid things that set it off, or seek reassurance. But trying not to think a thought tends to backfire, which seems to prove the worry really is uncontrollable — and avoiding triggers means you never find out that worry is harmless and can be let go. So the beliefs, and the worry, carry on.
How to introduce the model, guided-discovery questions, treatment targets and a behavioural experiment are available to signed-in therapists.
This diagram is a reconstruction of the published model for clinical and educational use, grounded in the sources above.
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