# Worry Postponement From the Metacognitive Perspective: A Randomized Waitlist-Controlled Trial

## TL;DR

A study tested if delaying worry using a metacognitive approach helps reduce anxiety in people with generalized anxiety disorder, finding some effectiveness.

## Contribution

This is the first study to test worry postponement with a metacognitive rationale in clinical populations like generalized anxiety disorder.

## Key findings

- Worry postponement reduced worry in generalized anxiety disorder participants with a 40% recovery rate.
- Effects on negative metacognitions were small but significant in generalized anxiety disorder.
- Worry postponement showed limited evidence of effectiveness for hypochondriasis.

## Abstract

Pathological worry is associated with appraisals of worrying as uncontrollable. Worry postponement (WP) with a stimulus control rationale appears to be effective in non-clinical samples. However, preliminary research in participants with generalized anxiety disorder (GAD) does not support its efficacy in reducing negative metacognitions or worry. The aim of this study was to investigate the efficacy of WP with a metacognitive rationale.

Participants with GAD (n = 47) or hypochondriasis (HYP; n = 35) were randomly assigned to either an intervention group (IG) or waitlist (WL). The IG received a two-session long WP intervention aiming at mainly reducing negative metacognitions concerning uncontrollability of worrying. Participants were instructed to postpone their worry process to a predetermined later time during the six days between the two sessions. Participants completed questionnaires of negative metacognitions and worry at pre-assessment, post-assessment, and follow-up.

We observed a significant Time*Group interaction for negative metacognitions and worry. Post-hoc analyses on the total sample and separately for GAD and HYP revealed significantly lower worry scores in the treated GAD sample compared to the WL, representing the only significant effect. In the GAD group, pre-post-effect sizes were small for negative metacognitions and large for worry. Effects persisted to a four-week follow-up.

WP with a metacognitive rationale seems to be effective in reducing worry in participants with GAD. The effectiveness for HYP seems limited, possibly due to the small sample size.

Negative metacognitions about the uncontrollability of worrying maintain pathological worry.WP reduced negative metacognitions in participants with generalized anxiety disorder (GAD).WP further reduced worry in participants with GAD, with a recovery rate of 40%.Evidence for efficacy of WP in hypochondriasis is limited.

Negative metacognitions about the uncontrollability of worrying maintain pathological worry.

WP reduced negative metacognitions in participants with generalized anxiety disorder (GAD).

WP further reduced worry in participants with GAD, with a recovery rate of 40%.

Evidence for efficacy of WP in hypochondriasis is limited.