Metacognitive Model of GAD
Wells (1995) · Generalised anxiety disorder
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
Wells's metacognitive model of GAD (1995) holds that the problem is not what a client worries about but what they believe about worry: positive beliefs that recruit it, and negative beliefs about its uncontrollability and danger.
Metacognitive Model of GAD
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.
Understanding the model
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.
Questions therapists ask about this model.
Frequently asked questions
What maintains worry in the metacognitive model?
A what-if thought arrives, and positive beliefs about worry — that thinking it through prepares you, that worrying shows you care — make worrying feel worth doing, producing everyday worry about real-world matters. Negative beliefs then switch on: that the worry is out of control, or could do harm. Worry about worry raises anxiety sharply, and attempts to suppress it, avoid triggers or seek reassurance tend to backfire, since failed control seems to prove the worry cannot be stopped.
How does it differ from the intolerance-of-uncertainty model?
They agree that what a client worries about is not what maintains the problem, and differ on what does. Wells points at beliefs about worry itself — that it is useful, and that it is uncontrollable or dangerous. Dugas and colleagues point at intolerance of uncertainty — the sense that not knowing is unbearable or a sign that something bad will happen. Both are formulated for generalised anxiety disorder, which NICE CG113 covers.
Is the metacognitive model specific to generalised anxiety?
This version is. Wells (1995) proposed it for generalised anxiety disorder, and Wells (2005) examined how meta-worry — worry about worry — relates to that diagnosis. The wider idea, that beliefs about thinking keep distress going, was later developed into metacognitive therapy for other anxiety presentations and for depression (Wells, 2009), so the distinction between Type 1 and Type 2 worry may be familiar from that broader work.
Worksheets and reading for this model
Using this model in session — for therapists
How to introduce the model, guided-discovery questions, treatment targets and a behavioural experiment are available to signed-in therapists.
References
- Wells, A. (1995). Meta-cognition and worry: A cognitive model of generalized anxiety disorder. Behavioural and Cognitive Psychotherapy, 23(3), 301–320.
- Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. Wiley.
- Wells, A. (2005). The metacognitive model of GAD: Assessment of meta-worry and relationship with DSM-IV generalized anxiety disorder. Cognitive Therapy and Research, 29(1), 107–121.
- Wells, A. (2009). Metacognitive therapy for anxiety and depression. Guilford Press.
This diagram is a reconstruction of the published model for clinical and educational use, grounded in the sources above.
Cite this page (APA 7)
Vermani, T. (2026). Metacognitive Model of GAD. Formulate. https://formulatetools.co.uk/tools/formulation/gad-metacognitive-model
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