Meta-Worry, Worry, and Anxiety in Children and Adolescents: Relationships and Interactions

Abstract

The metacognitive model has increased our understanding of the development and maintenance of generalized anxiety disorders in adults. It states that the combination of positive and negative beliefs about worry creates and sustains anxiety. A recent review argues that the model can be applied to children, but empirical support is lacking. The aim of the 2 presented studies was to explore the applicability of the model in a childhood sample. The first study employed a Danish community sample of youth (n = 587) ages 7 to 17 and investigated the relationship between metacognitions, worry and anxiety. Two multiple regression analyses were performed using worry and metacognitive processes as outcome variables. The second study sampled Danish children ages 7 to 12, and compared the metacognitions of children with a GAD diagnosis (n = 22) to children with a non-GAD anxiety diagnosis (n = 19) and nonanxious children (n = 14). In Study 1, metacognitive processes accounted for an additional 14% of the variance in worry, beyond age, gender, and anxiety, and an extra 11% of the variance in anxiety beyond age, gender, and worry. The Negative Beliefs about Worry scale emerged as the strongest predictor of worry and a stronger predictor of anxiety than the other metacognitive processes and age. In Study 2, children with GAD have significantly higher levels of deleterious metacognitions than anxious children without GAD and nonanxious children. The results offer partial support for the downward extension of the metacognitive model of generalized anxiety disorders to children.

Negative Thoughts and Metacognitions in Anxious Children Following CBT

“…Support for the factor structure, concurrent validity, and satisfactory internal consistency has been demonstrated (Esbjørn et al 2013). A study using the intake data from a sample related to the sample of the current study has demonstrated acceptable internal consistencies for younger children with anxiety disorders, aged 7-8 years (Esbjørn, Lønfeldt et al, 2015). Alphas for the current sample were 0.75, 0.86, and 0.86 at pretreatment, posttreatment and follow-up, respectively.…”

The Metacognitive Model of Anxiety in Children: Towards a Reliable and Valid Measure

“…The total scale displayed excellent internal consistency and all subscales displayed adequate to good internal consistency, providing encouraging evidence that all constructs of the metacognitive model can be consistently measured in young children. These results represent an improvement over both the MCQ-C, for which subscale alphas ranged from .25 to .64 among 7-12 year old children (Smith and Hudson 2013), and the MCQ-C30, for which the Need to Control Thoughts (SPR Beliefs) and Cognitive Confidence subscales displayed questionable internal consistency among a small clinical sample of 7-8 year olds (Esbjorn et al 2014).…”

“…These results are consistent with the relationships found in adult (Cartwright-Hatton and Wells 1997;Wells and Cartwright-Hatton 2004) and adolescent (Ellis and Hudson 2011) non-clinical samples, and provide the first reported evidence of the associations between negative metacognitive beliefs and specific anxiety disorder symptoms amongst young non-clinical children. While a recent study found that 7-12 year olds diagnosed with GAD had higher scores on the MCQ-C30 than those with other anxiety disorders or controls (Esbjorn et al 2014), results for those with other anxiety disorders were not separated by diagnosis, therefore further research is warranted to examine whether the above relationships also apply to children with a clinical diagnosis of OCD.…”

“…''If I did not get a worry thought out of my head and then something bad happened, it would be my fault''). Although the MCQ-C30 and some of its subscales demonstrated adequate internal consistency amongst a small sample of 7-8 year olds, the internal consistency of both the Cognitive Confidence and Need to Control Thoughts (SPR Beliefs) subscales were questionable (Esbjorn et al 2014). Further, the construct, concurrent and convergent validities of this scale have not been evaluated amongst children under 9 years, as it was hypothesised that they would not possess the reading skills required to complete the questionnaires unassisted.…”

“…They were, however, significantly associated with a measure of OCD symptoms (Irak 2011) and the Screen for Child Anxiety Related Emotional Disorders (SCARED-R; Muris et al 1999), a measure of general anxiety (Esbjorn et al 2013). Positive Meta-worry, by comparison, was weakly but significantly correlated with measures of anxiety, OCD symptoms and general emotional difficulties (Esbjorn et al 2013;Irak 2011;Smith and Hudson 2013), but was not predictive of SCARED-R scores in a multiple regression analysis (Esbjorn et al 2014). Due to its exclusion from the MCQ-C, only one study to date has examined the relationship between Cognitive Confidence and anxiety in children, finding a weak but significant positive correlation (Esbjorn et al 2013).…”