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Responsibility to continue thinking and worrying: Evidence of incremental validity
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Behaviour Research and Therapy 45 (2007) 1619–1628 www.elsevier.com/locate/brat
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Responsibility to continue thinking and worrying: Evidence of incremental validity Yoshinori Sugiura Department of Cognitive and Behavioral Sciences, Graduate School of Arts and Sciences, The University of Tokyo, 3-8-1 Komaba, Meguroku, Tokyo 153-8902, Japan Received 4 March 2006; received in revised form 10 July 2006; accepted 1 August 2006
Abstract This two-part study examined the role of the responsibility to continue thinking, beliefs that one needs prolonged thinking about stressful problems, in the prediction of excessive worry. This construct is considered to reflect high levels of motivation to continue inflexible thinking and the use of rigid stop rules. In Study 1, 122 students completed questionnaires. A regression analysis revealed that responsibility accounted for a unique variance beyond negative metacognitive beliefs about worry. One hundred and fifty students participated in Study 2, where worry was regressed on emotional instability (Neuroticism), responsibility, and other worry-related cognitive variables (intolerance of uncertainty, positive/negative meta-cognitive beliefs, poor problem-solving orientation, and cognitive avoidance). Again, responsibility was a significant predictor, after controlling for emotional instability (Neuroticism) and other worry-related cognitions. These results indicate the incremental validity of the responsibility to continue thinking. r 2006 Elsevier Ltd. All rights reserved. Keywords: Worry; Incremental validity; Persistence; Responsibility
Introduction Worry is a chain of negative and uncontrollable thoughts (Borkovec, Robinson, Pruzinsky, & DePree, 1983). It is a cognitive process common in normal populations and is also associated with a wide range of emotional disorders (Borkovec & Sharpless, 2004). Specifically, pathological worry is the central feature of generalized anxiety disorder (GAD; American Psychiatric Association, 2000). Several etiological factors of pathological worrying and/or GAD have been proposed: cognitive avoidance of emotion (Borkovec, Alcaine, & Behar, 2004), positive and negative beliefs about worry (Wells, 2000), poor problem-solving orientation (Davey, 1994), intolerance of uncertainty (Dugas, Buhr, & Ladouceur, 2004), and emotional dysregulation (Mennin, Heimberg, Turk, & Fresco, 2005). It is conceivable that all of these factors are involved in the etiology of worrying (Dugas, Marchand, & Ladouceur, 2005). However, many theorists agree on the importance of positive beliefs about worry Corresponding author at. Faculty of Arts, Shinshu University, 3-1-1 Asahi, Nagano Prefecture, Matsumoto-City 390-8621, Japan. Tel.: +81 263 33 4908; fax: +81 263 37 2235. E-mail address: [email protected].
0005-7967/$ - see front matter r 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.brat.2006.08.001
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(Borkovec, Hazlett-Stevens, & Diaz, 1999; Davey, Tallis, & Capuzzo, 1996; Francis & Dugas, 2004; Wells, 2000). Positive beliefs represent a view that worry is a useful coping strategy and lead to the inflexible use of worrying strategy (Wells, 2000). An advantage of focusing on positive beliefs is to remind worriers of the strategic nature of worry: worry reflects controlled processing. Another advantage is that positive beliefs may be related to diverse theoretical factors in a meaningful way. Scales measuring positive beliefs are mostly comprised of items representing problem-solving motivation associated with worrying (Cartwright-Hatton & Wells, 1997; Davey et al., 1996; Francis & Dugas, 2004). In addition, intolerance of uncertainty may lead to worry because worriers have positive beliefs such as ‘‘I do my clearest thinking when I am worrying’’ (Cartwright-Hatton & Wells, 1997; see also Dugas et al., 2004). Intolerance of uncertainty represents negative emotional, cognitive, and behavioral reactions to uncertainty (e.g., a tendency to be distressed by ambiguity, to have difficulty in uncertain situations, and to believe that unexpected events are negative and should be avoided) (Dugas et al., 2004, 2005). People may find worrying to be a useful strategy for dealing with uncertainty (Dugas et al., 2004, 2005). Therefore, we regard positive beliefs as a convenient portal to the understanding and treatment of worrying. However, it is unlikely that worry becomes extremely persistent merely because people believe it to be useful. Studies have failed to find a relation between positive beliefs and GAD status (Davis & Valentiner, 2000; Ruscio & Borkovec, 2004; Wells & Carter, 2001). Wells and Carter (2001) suggested that positive beliefs were common to both normal and clinical worry, and would not lead to persistent thinking in a non-clinical population. In a non-clinical population, the relation of worrying with positive beliefs was relatively weak compared to that with negative beliefs that worry is uncontrollable and/or harmful (Davey et al., 1996; Wells & Papageorgiou, 1998). In this regard, we need to elucidate a process variable related to positive beliefs (thus to the motivation to worry) but having stronger predictive power. A few studies suggest a potential candidate. Davey and Levy (1999) and Sugiura and Tanno (1998) independently developed questionnaires to measure on-line metaappraisals about stressful thinking processes, focusing on those leading to prolonged worry. Sugiura (2005) suggested that these scales covered similar content and could be categorized into two broad groups: (a) cognitions reflecting a lack of confidence in problem-solving or generalized low self-esteem and (b) cognitions reflecting the effort to continue thinking about the problem. Sugiura (2005) developed the problem-solving related meta-cognitions questionnaire, which contains items from both Davey and Levy’s (1999) and Sugiura and Tanno’s (1998) questionnaires, and confirmed this view by extracting two factors corresponding to the above categories. The two factors were called the lack of satisfaction with the problem-solving process (LACK) and the responsibility to continue thinking (RESP). RESP is the beliefs that one needs prolonged thinking about stressful problems, while LACK represents a negative appraisal of the problem-solving process. Sugiura (2004b, 2005) found that these two factors mediated the relationship of problem-focused coping strategies and worry by using structural equation modeling. LACK and RESP are meta-cognitive appraisals of problem-solving, therefore they are somewhat different from beliefs about worry itself or metaworry (worry about worry) (Wells, 2000). LACK is a negative view of one’s own problem-solving process, while negative meta-cognitive beliefs are about the aversive effects of worrying. Although both positive beliefs and RESP are beliefs that motivate worrying, the latter is distinctive in its focus on continued thinking, while the former is a belief in the utility of worrying without particular focus on perseverance. Therefore, RESP is a relative of positive beliefs, but may have a unique feature expected to enhance the prediction. RESP may be related to high levels of motivation to continue inflexible thinking and the use of rigid stop rules. Graham Davey and colleagues demonstrated the importance of responsibility in the worrying process. Startup and Davey (2003) found that high worriers reported an elevated sense of responsibility to think through problems both at the beginning and throughout the catastrophizing experiment (Vasey & Borkovec, 1992). In addition, experimentally induced responsibility enhanced perseverance in catastrophizing when participants were in a negative mood. Davey, Startup, MacDonald, Jenkins, and Patterson (2005) developed a self-report measure of the use of the ‘‘as many as can’’ rule to stop worry and found that it was related to self-report of worry-proneness and to the number of steps in the catastrophizing experiment. These studies converge on the responsibility to continue thinking as a factor that makes worrying persistent. Although Davey et al. found a positive relation between the use of the ‘‘as many as can’’ rule and positive and negative beliefs about worrying, they did not examine the relative predictive power of these cognitive variables.
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This study aims to clarify the predictive value of the responsibility to continue thinking. It is predicted that the responsibility to continue thinking is positively related to positive beliefs but explains the additional variance of worry. In addition, it is explored whether the responsibility enhances the prediction of worry beyond other existing cognitive variables. Study 1 included negative beliefs about worry in addition to positive beliefs since they strongly predicted worrying (Wells, 2000). Therefore, this was expected to be a more stringent test of incremental validity. Study 2 further added Neuroticism, intolerance of uncertainty, problemsolving orientation, and cognitive avoidance, thus extending Study 1 (for a fuller discussion of these variables, see Study 2.) Study 1 Method Participants One hundred and twenty-two Japanese college students voluntarily completed questionnaires during the class (52% women), with a mean age of 19.50 years (SD ¼ 1.92). Instruments Penn State worry questionnaire (PSWQ; Meyer, Miller, Metzger, & Borkovec, 1990). The PSWQ is a 16-item questionnaire with excellent psychometric properties for measuring the frequency and intensity of worry (Molina & Borkovec, 1994). The Japanese version by Sugiura and Tanno (2000) has psychometric properties compatible with the original version: good internal consistency (a ¼ :92) and positive correlations with anxiety and depression among the student population. In addition, it demonstrated good discrimination from obsessive symptoms. Meta-cognitions questionnaire (MCQ; Cartwright-Hatton & Wells, 1997). The MCQ is a 65-item questionnaire concerning beliefs about worry and intrusive thoughts, with established psychometric properties including the relation to worrying (Cartwright-Hatton & Wells, 1997). It has five subscales: positive beliefs about worry; negative beliefs about the uncontrollability and danger of worry; lack of cognitive confidence; negative beliefs about thoughts in general, including themes of superstition, punishment, responsibility, and need for control; and cognitive self-consciousness. Sugiura, Sugiura, and Umaoka (2003) translated the MCQ into Japanese and confirmed good reliability (a4:80) for each subscale, compatible with the original version. Of the five MCQ subscales, only the positive and negative beliefs were used in the analyses because these two are the most central to the meta-cognitive model of GAD (Wells & Carter, 2001; Wells & Papageorgiou, 1998). Problem-solving related meta-cognitions (Sugiura, 2005). This was developed to measure the meta-cognitive appraisals that occurred during a stressful problem-solving process, with exclusive focus on those appraisals leading to prolonged worry. Participants were asked to rate how often these meta-cognitions occurred while they were solving stressful problems. Items were rated on a 5-point scale, 1 (none) to 5 (very frequent). It has two subscales: lack of satisfaction with the problem-solving process (LACK) and the responsibility to continue thinking (RESP). LACK has 19 items (e.g., ‘‘I don’t know how to solve this problem.’’; ‘‘Despite much effort, I can’t understand the cause of this problem.’’) and RESP has 14 items (e.g., ‘‘I should continue thinking until I find out better solutions.’’; ‘‘It is irresponsible to stop thinking.’’). Sugiura (2005) reported adequate reliability (a4:88) and validity (e.g., RESP was correlated with perfectionism and active problem-solving; LACK with poor problem-solving confidence). All scales exhibited good to excellent reliability (a ¼ :86 :91) in Study 1, and all cognitive variables were positively correlated with the PSWQ (Table 1), replicating the previous findings using these measures. Results and discussion As predicted, positive beliefs and RESP were positively correlated (r ¼ :37, po:001). To determine the incremental validity of the responsibility to continue thinking, a hierarchical regression analysis was
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Table 1 Simple statistics, internal consistencies, and correlations with worry (PSWQ) of Study 1 variables (N ¼ 122Þ
MCQ positive beliefs MCQ negative beliefs RESP LACK PSWQ
M
SD
a
Correlation with the PSWQ
37.56 39.04 45.36 54.71 53.93
9.05 10.33 10.26 13.71 12.94
.86 .90 .86 .90 .91
.22 .68 .44 .54 —
Note: PSWQ ¼ Penn State worry questionnaire; MCQ ¼ meta-cognitions questionnaire; RESP ¼ responsibility to continue thinking; LACK ¼ lack of satisfaction with the problem-solving process. po.05. po.001.
Table 2 Hierarchical regression analysis predicting worry (PSWQ) by cognitive variables (N ¼ 122) Steps
Predictors
DR2
b
1
MCQ positive beliefs MCQ negative beliefs RESP LACK
.48
.05 .53 .20 .12
2
.05
Note: PSWQ ¼ Penn State worry questionnaire; MCQ ¼ meta-cognitions questionnaire; RESP ¼ responsibility to continue thinking; LACK ¼ lack of satisfaction with the problem-solving process. po.01. po.001.
conducted (Table 2). In the first step, positive and negative beliefs about worry were entered, explaining 48% of the variance of the PSWQ.1 In the second step, RESP and LACK were entered together, explaining 5% of the additional variance. Negative beliefs and RESP emerged as significant predictors.2 Thus, the incremental validity of the responsibility to continue thinking was shown beyond the variance explained by meta-cognitive beliefs. Considering that negative beliefs have high predictive power (Ruscio & Borkovec, 2004; Wells, 2000), it was concluded that the role of RESP as a promising construct was supported. Study 2 Study 2 was an extended replication of Study 1. The following extensions were made. (a) A different measure of beliefs about worry, the consequences of worry scale (COWS; Davey et al., 1996), was included for cross-validation. (b) Emotional instability (Neuroticism) was added as a covariate. Sexton, Norton, Walker, and Norton (2003) found that both Neuroticism and specific vulnerability factors (e.g., intolerance of uncertainty) have unique influences on specific anxiety symptoms (e.g., worry, panic). The cognitive variables in this study are specific vulnerability factors, and thus are expected to have unique effects beyond Neuroticism. Therefore, Neuroticism was controlled for in the first step of the regressions. (c) Other cognitive factors related to worry were also included: intolerance of uncertainty, problem-solving orientation, and cognitive avoidance. Dugas et al. (2005) presented support for a comprehensive model of GAD, which included the above three variables in addition to positive beliefs. Dugas et al. (2005) found that all of these 1
Neither the skewness nor the kurtosis of the PSWQ exceeded the absolute value of .29 in Study 1 and .49 in Study 2, suggesting the normality of the PSWQ scores. Therefore, it was considered appropriate to use it as a dependent variable. 2 Using all five MCQ subscales did not change the results: no MCQ subscales other than negative beliefs were significant in either Study 1 or 2.
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factors were related to clinical worrying. Intolerance of uncertainty was given a central role and discriminated GAD from panic disorder with agoraphobia. Intolerance of uncertainty may motivate continued thinking and be related to RESP (Davey et al., 2005). However, RESP will have a stronger influence on worrying, because intolerance of uncertainty is a general attitude toward ambiguity and does not directly specify continued thinking. Problem-solving orientation represents attitudes toward problem-solving. Davey (1994) found that poor problem-solving confidence and poor perceived control over the problem-solving process are related to worrying. LACK can be construed as the on-line manifestation of such poor problem-solving orientation. Therefore, poor problem-solving orientation may be related to LACK. Cognitive avoidance includes avoidance of somatic anxiety and more distressing cognitions (Borkovec et al., 2004) and suppression of unwanted thoughts (Robichaud, Dugas, & Conway, 2003). This is rather different from factors related to problem-solving (e.g., positive beliefs, RESP), thus there is no preconceived hypothesis about its relation to RESP and its relative predictive power. Method Participants One hundred and fifty Japanese college students (56% women), with a mean age of 19.58 years (SD ¼ 1.05) participated in exchange for a partial course credit. The measures of problem-solving orientation and cognitive avoidance were completed by the only portion of the sample (n ¼ 77), because of a time constraint. Instruments In addition to the PSWQ, the MCQ3, and problem-solving related meta-cognitions, the following measures were included. Consequences of worry scale (COWS; Davey et al., 1996). This measures beliefs about the consequences of worry with 29 items. It has two broad subscales: negative and positive consequences, each having three and two suborder scales. To be consistent with Study 1, only the broad subscales were used. Items were carefully translated into Japanese. Both negative and positive consequences were related to poor mental health, including worry (Davey et al., 1996), but these relations were stronger for negative consequences. Consistent with these findings, only negative consequences were related to worrying in Study 2 (Table 3). One item for negative consequences was omitted due to a printing error (‘‘Worrying gets me worked up.’’). Intolerance of uncertainty scale (IUS; Freeston, Rhe´aume, Letarte, Dugas, & Ladouceur, 1994). The IUS is a well-validated measure of the intolerance of uncertainty with 27 items, shown to be reliable and to predict worrying and GAD status (Dugas et al., 2004, 2005). Items were carefully translated into Japanese. Problem-solving inventory (PSI; Heppner & Peterson, 1982). The PSI measures an individual’s style of solving personal problems using three subscales: approach-avoidance style, problem-solving confidence, and personal control. A high score indicates a maladaptive problem-solving style. It has both convergent and divergent validity. The Japanese version was provided by P. P. Heppner (personal communication, May 27, 2003). Only problem-solving confidence and personal control were used in the analysis because these two were related to worry, but not approach-avoidance style (Davey, 1994). White bear suppression inventory (WBSI; Wegner & Zanakos, 1994). The WBSI uses 15 items to measure the tendency to suppress unwanted thoughts. It is widely used and well-validated, including the relation to worrying (Muris, Merckelbach, & Horselenberg, 1996; Robichaud et al., 2003). However, some items measure the uncontrollability of thoughts. To avoid the confounding of predicting worry by worry, only items representing suppression were used, as suggested by Robichaud et al. (2003) 3 The MCQ used in Study 2 had slightly different wording because the survey was conducted while the Japanese version was being finalized. However, this small modification is unlikely to change the results. In fact, the Study 1 results were basically replicated using the Study 2 data.
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Table 3 simple statistics, internal consistencies, and correlations with worry (PSWQ) of Study 2 variables (N ¼ 150)
Neuroticism MCQ positive beliefs MCQ negative beliefs COWS positive consequences COWS negative consequences IUS PSI CONFa PSI CONTa WBSIa,b RESP LACK PSWQ
M
SD
a
Correlation with the PSWQ
54.31 43.20 41.61 27.18 45.86 71.81 37.30 18.21 19.97 44.60 50.40 50.96
12.90 8.12 8.62 8.15 13.22 17.47 5.95 3.79 6.73 10.70 12.37 11.20
.92 .85 .89 .87 .94 .92 .81 .60 .88 .88 .91 .93
.72 .17 .73 .14 .58 .47 .33 .28 .44 .48 .47 –
Note: PSWQ ¼ Penn State worry questionnaire; MCQ ¼ meta-cognitions questionnaire; COWS ¼ consequences of worry scale; IUS ¼ intolerance of uncertainty scale; PSI ¼ problem-solving inventory; CONF ¼ problem-solving confidence; CONT ¼ personal control; WBSI ¼ white bear suppression inventory; RESP ¼ responsibility to continue thinking; LACK ¼ lack of satisfaction with the problem-solving process. po.05. po.01. po.001. a n ¼ 77. b Using seven items directly depicting suppression (see footnote 4).
and Sugiura (1998).4 The WBSI was translated into Japanese by Sugiura (1998). Cognitive avoidance related to worry includes not only thought suppression but also the avoidance of emotional imagery by verbal thinking (Robichaud et al., 2003). However, because only the WBSI was available in Japan when this study was conducted, this study measured only thought suppression. The big five scale (BFS; Wada, 1996). The BFS was developed to measure the Big Five personality traits, whose items are based on the adjective check list (ACL; Gough & Heilbrun, 1983). A series of factor analyses of 198 theoretically selected ACL items resulted in the 60-item BFS. Each of the five factors contains 12 trait adjectives. Each subscale evidenced good to excellent internal consistency (a4:84). Items were rated on a 7point scale, 1 (not at all true) to 7 (very true). Kashiwagi (1997) suggested that the ACL items (Japanese version) on which the BFS is based could be theoretically classified under the five domains of the NEO PI-R (Costa & McCrae, 1992), the most widely used measure of the Big Five. Only the Neuroticism subscale was used in the analysis (e.g., nervous, feelings easily upset, tense). In Study 2, all measures demonstrated good to excellent reliability (a ¼ :812:94) except for the personal control subscale of the PSI (a ¼ :60). In addition, all cognitive variables except the COWS positive consequences were positively correlated with the PSWQ (Table 3), basically replicating the previous findings using these measures. Results and discussion As predicted, positive beliefs and RESP were positively correlated (r ¼ :36 with the MCQ; r ¼ :37 with the COWS, both po:001). In addition, the IUS and RESP were also correlated (r ¼ :43, po:001). While personal control was significantly correlated with LACK (r ¼ :43, po:001), problem-solving confidence was not (r ¼ :15, p4:10). Because only a small portion of participants completed the PSI and the WBSI, the main analyses were run without them (Table 4). Additional analyses including these measures were subsequently reported. Analyses 4
Based on Sugiura (1998), Items 1, 6, 8, and 10–13 were retained.
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Table 4 Hierarchical regression analyses predicting worry (PSWQ) by cognitive variables (N ¼ 150) Steps predictors MCQ used as a belief measure 1. Neuroticism 2. MCQ positive beliefs MCQ negative beliefs IUS 3. RESP LACK COWS used as a belief measure 1. Neuroticism 2. COWS positive consequences COWS negative consequences IUS 3. RESP LACK
DR2
b
.52 .12
.46 .03 .36 .05 .32 .11
.06 .52 .06 .07
.61 .03 .17 .00 .34 .08
Note: PSWQ ¼ Penn State worry questionnaire; MCQ ¼ meta-cognitions questionnaire; IUS ¼ intolerance of uncertainty; RESP ¼ responsibility to continue thinking; LACK ¼ lack of satisfaction with the problem-solving process; COWS ¼ consequences of worry scale. po.05. po.001.
were conducted separately using the MCQ or the COWS as a measure of beliefs about worry. In the first step, Neuroticism was entered and explained 52% of the variance of the PSWQ (see footnote 1). In the second step, negative and positive beliefs and intolerance of uncertainty were entered simultaneously and explained an additional 12% when the MCQ was used; 6% was explained when the COWS was used. In the final step, RESP and LACK were entered together and explained 6% of the additional variance when the MCQ was used; 7% was explained when the COWS was used. Neuroticism, negative beliefs, and RESP were significant predictors of worry across two belief measures in the final regression (see footnote 2). Finally, the regressions in Table 4 were replicated adding the two PSI subscales (problem-solving confidence and personal control) and the WBSI in the second step. In neither regression (using the MCQ or the COWS), did the PSI subscales or the WBSI emerge as significant predictors. Again, RESP was a significant predictor of worry beyond Neuroticism and other cognitive variables.
General discussion Two studies demonstrate that the responsibility to continue thinking explains the unique variance of excessive worry beyond emotional instability (Neuroticism) and other worry-related cognitive variables. Especially impressive is the finding that responsibility accounted for the variance of worry beyond negative meta-cognitive beliefs and intolerance of uncertainty, factors shown to have high predictive value. The effect of the responsibility to continue thinking is consistent with a series of studies by Davey and colleagues who demonstrated the role of inflated responsibility and the ‘‘as many as can’’ stop rules in catastrophic worrying (Davey et al., 2005; Startup & Davey, 2003). While Startup and Davey (2003) demonstrated that the effect of the stop rules emerged only when participants were in a negative mood, Davey et al. found that the ‘‘as many as can’’ stop rules influenced worrying on their own. The present results are especially consistent with the latter finding. The results are also consistent with Wells (2000), who suggested that the stop rules used by worries are often arbitrary or rigid. People who chronically worry often use internal cues such as a ‘‘felt sense’’ or superstitious reasons to stop the worry cycle. Wells (2000) considered that positive beliefs lead to inflexible worrying. Intolerance of uncertainty may also be related to stop rules (Davey et al.). Responsibility was positively related to both positive beliefs and intolerance of uncertainty, but is a more direct index of persistent thinking and had unique explanatory power beyond these. Therefore, this study has advanced previous models.
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The uniqueness of this study is the inclusion of multiple predictors. First, the strong effect of Neuroticism is consistent with recent psychopathological models that emphasize general vulnerability (e.g., Sexton et al., 2003). Second, Study 2 may be the first to compare negative meta-cognitive beliefs and intolerance of uncertainty, two prominent factors. Negative beliefs (MCQ) were a strong cognitive predictor, while intolerance of uncertainty was not significant. Therefore, the results support the meta-cognitive model (Wells, 2000), in which negative beliefs play a central role. However, the present results should not be interpreted as denying the role of intolerance of uncertainty, etc. in the development and maintenance of worry. Remember that this study was specifically designed to demonstrate the incremental validity (the unique contribution) of the responsibility to continue thinking in a rather rigorous manner. In fact, all of the cognitive variables were positively correlated with worrying (except for the COWS positive beliefs). An examination of the interrelationships among worry-related variables, with a path analysis, is needed for future study.5 The independent predictors found in this study may mediate the effects of the others. The therapeutic implication of the present results is that we should focus on the perceived utility of persistent thinking rather than on the utility of worry in general. When we treat worry, ‘‘why continue?’’ is more important than ‘‘why worry?’’ Therefore, rigidity or inflexibility is the chief focus of intervention. This is consistent with the recent development of cognitive-behavioral therapy for GAD (Borkovec & Sharpless, 2004). The responsibility to continue thinking may not be the same as responsibility in obsessive-compulsive disorder, a belief in one’s pivotal power to cause or prevent negative outcomes (Salkovskis et al., 2000; cf. Davey et al., 2005). To summarize, this study revealed a construct that is related to existing models (especially Wells’ and Davey’s) but enhances explanatory power for pathological worrying. This warrants future investigation with a clinical population. Acknowledgments This research was supported by Grant-in-Aid for JSPS Fellows. Parts of the data were presented at the 11th Biennial Meeting of the International Society for the Study of Individual Differences, Graz, Austria, July 2003 and the World Congress of Behavioral and Cognitive Therapies 2004, Kobe, Japan, July 2004. However, data analysis is quite different.
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Gender differences in worry and associated cognitive-behavioral variables. Journal of Anxiety Disorders, 17, 501–516. Ruscio, A. M., & Borkovec, T. D. (2004). Experience and appraisal of worry among high worriers with and without generalized anxiety disorder. Behaviour Research and Therapy, 42, 1469–1482. Salkovskis, P. M., Wroe, A. L., Gledhill, A., Morrison, N., Forrester, E., Richards, C., et al. (2000). Responsibility attitudes and interpretations are characteristics of obsessive-compulsive disorder. Behaviour Research and Therapy, 38, 347–372. Sexton, K. A., Norton, P. J., Walker, J. R., & Norton, G. R. (2003). Hierarchical model of generalized and specific vulnerabilities in anxiety. Cognitive Behaviour Therapy, 32, 82–94. Startup, H. M., & Davey, G. C. L. (2003). Inflated responsibility and the use of stop rules for catastrophic worrying. Behaviour Research and Therapy, 41, 495–503. Sugiura, T., Sugiura, Y., & Umaoka, K. (2003). Nintiteki tousei to kanren suru youin: Seikaku tokusei, meta-ninti to taisho style (Correlates of cognitive control: Personality traits, meta-cognitions, and coping styles). Journal of the Graduate School: Home Economics, Human Life Sciences, 9, 13–23. Sugiura, Y. (1998). Fuan no ninti teki assessment (Cognitive assessment of anxiety). Archives of Psychiatric Diagnostics and Clinical Evaluation, 9, 469–478. Sugiura, Y. (2004a). Positive and negative beliefs about worry: Not paradoxical coexistence. In: Y. Tanno, P. M. Salkovskis, Y. Sugiura, T. Hasegawa (Chairs), Catastrophic misinterpretations in anxiety: Maintenance and modification. Symposium conducted at the world congress of behavioral and cognitive therapies, 2004, Kobe, Japan. Sugiura, Y. (2004b). Problem focused coping and worry: The mediating role of meta-cognitions. In S. P. Shohov (Ed.), Advances in psychology research, Vol. 26 (pp. 3–18). New York: Nova Science Publishers. Sugiura, Y. (2005). Problem-solving model of worrying. Tokyo: Kazama Shobo. Sugiura, Y., Tanno, Y. (1998). Shinpai no gomokutekisei to byorisei: Jiyukijyutu no bunseki to shakudo no kaihatu (Goal-directed and pathological aspects of worry: Analysis of descriptive data and the development of a scale). Poster session presented at the 17th meeting of the Association of Japanese Clinical Psychology, Nagoya, Japan. Sugiura, Y., & Tanno, Y. (2000). Kyohaku shojyo no jiko kinyusiki situmonhyo: Nihongoban Padua Inventory no sinraisei to datosei no kentou (Self-report inventory of obsessive-compulsive symptoms: Reliability and validity of the Japanese version of the Padua Inventory). Archives of Psychiatric Diagnostics and Clinical Evaluation, 11, 175–189. Vasey, M. W., & Borkovec, T. D. (1992). A catastrophizing assessment of worrisome thoughts. Cognitive Therapy and Research, 16, 505–520. Wada, S. (1996). Seikaku-tokuseigo wo motiita Big Five shakudo no sakusei (Construction of the Big Five scales of personality trait terms and concurrent validity with NPI). Japanese Journal of Psychology, 67, 61–67. Wegner, D. M., & Zanakos, S. (1994). Chronic thought suppression. Journal of Personality, 62, 615–640.
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Wells, A. (2000). Emotional disorders and metacognition. Chichester, UK: Wiley. Wells, A., & Carter, K. (2001). Further tests of a cognitive model of generalized anxiety disorder: Metacognitions and worry in GAD, panic disorder, social phobia, depression, and non-patients. Behavior Therapy, 32, 85–102. Wells, A., & Papageorgiou, C. (1998). Relationships between worry, obsessive-compulsive symptoms and meta-cognitive beliefs. Behaviour Research and Therapy, 36, 899–913.
Behaviour Research and Therapy 45 (2007) 1619–1628 www.elsevier.com/locate/brat
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Responsibility to continue thinking and worrying: Evidence of incremental validity Yoshinori Sugiura Department of Cognitive and Behavioral Sciences, Graduate School of Arts and Sciences, The University of Tokyo, 3-8-1 Komaba, Meguroku, Tokyo 153-8902, Japan Received 4 March 2006; received in revised form 10 July 2006; accepted 1 August 2006
Abstract This two-part study examined the role of the responsibility to continue thinking, beliefs that one needs prolonged thinking about stressful problems, in the prediction of excessive worry. This construct is considered to reflect high levels of motivation to continue inflexible thinking and the use of rigid stop rules. In Study 1, 122 students completed questionnaires. A regression analysis revealed that responsibility accounted for a unique variance beyond negative metacognitive beliefs about worry. One hundred and fifty students participated in Study 2, where worry was regressed on emotional instability (Neuroticism), responsibility, and other worry-related cognitive variables (intolerance of uncertainty, positive/negative meta-cognitive beliefs, poor problem-solving orientation, and cognitive avoidance). Again, responsibility was a significant predictor, after controlling for emotional instability (Neuroticism) and other worry-related cognitions. These results indicate the incremental validity of the responsibility to continue thinking. r 2006 Elsevier Ltd. All rights reserved. Keywords: Worry; Incremental validity; Persistence; Responsibility
Introduction Worry is a chain of negative and uncontrollable thoughts (Borkovec, Robinson, Pruzinsky, & DePree, 1983). It is a cognitive process common in normal populations and is also associated with a wide range of emotional disorders (Borkovec & Sharpless, 2004). Specifically, pathological worry is the central feature of generalized anxiety disorder (GAD; American Psychiatric Association, 2000). Several etiological factors of pathological worrying and/or GAD have been proposed: cognitive avoidance of emotion (Borkovec, Alcaine, & Behar, 2004), positive and negative beliefs about worry (Wells, 2000), poor problem-solving orientation (Davey, 1994), intolerance of uncertainty (Dugas, Buhr, & Ladouceur, 2004), and emotional dysregulation (Mennin, Heimberg, Turk, & Fresco, 2005). It is conceivable that all of these factors are involved in the etiology of worrying (Dugas, Marchand, & Ladouceur, 2005). However, many theorists agree on the importance of positive beliefs about worry Corresponding author at. Faculty of Arts, Shinshu University, 3-1-1 Asahi, Nagano Prefecture, Matsumoto-City 390-8621, Japan. Tel.: +81 263 33 4908; fax: +81 263 37 2235. E-mail address: [email protected].
0005-7967/$ - see front matter r 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.brat.2006.08.001
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(Borkovec, Hazlett-Stevens, & Diaz, 1999; Davey, Tallis, & Capuzzo, 1996; Francis & Dugas, 2004; Wells, 2000). Positive beliefs represent a view that worry is a useful coping strategy and lead to the inflexible use of worrying strategy (Wells, 2000). An advantage of focusing on positive beliefs is to remind worriers of the strategic nature of worry: worry reflects controlled processing. Another advantage is that positive beliefs may be related to diverse theoretical factors in a meaningful way. Scales measuring positive beliefs are mostly comprised of items representing problem-solving motivation associated with worrying (Cartwright-Hatton & Wells, 1997; Davey et al., 1996; Francis & Dugas, 2004). In addition, intolerance of uncertainty may lead to worry because worriers have positive beliefs such as ‘‘I do my clearest thinking when I am worrying’’ (Cartwright-Hatton & Wells, 1997; see also Dugas et al., 2004). Intolerance of uncertainty represents negative emotional, cognitive, and behavioral reactions to uncertainty (e.g., a tendency to be distressed by ambiguity, to have difficulty in uncertain situations, and to believe that unexpected events are negative and should be avoided) (Dugas et al., 2004, 2005). People may find worrying to be a useful strategy for dealing with uncertainty (Dugas et al., 2004, 2005). Therefore, we regard positive beliefs as a convenient portal to the understanding and treatment of worrying. However, it is unlikely that worry becomes extremely persistent merely because people believe it to be useful. Studies have failed to find a relation between positive beliefs and GAD status (Davis & Valentiner, 2000; Ruscio & Borkovec, 2004; Wells & Carter, 2001). Wells and Carter (2001) suggested that positive beliefs were common to both normal and clinical worry, and would not lead to persistent thinking in a non-clinical population. In a non-clinical population, the relation of worrying with positive beliefs was relatively weak compared to that with negative beliefs that worry is uncontrollable and/or harmful (Davey et al., 1996; Wells & Papageorgiou, 1998). In this regard, we need to elucidate a process variable related to positive beliefs (thus to the motivation to worry) but having stronger predictive power. A few studies suggest a potential candidate. Davey and Levy (1999) and Sugiura and Tanno (1998) independently developed questionnaires to measure on-line metaappraisals about stressful thinking processes, focusing on those leading to prolonged worry. Sugiura (2005) suggested that these scales covered similar content and could be categorized into two broad groups: (a) cognitions reflecting a lack of confidence in problem-solving or generalized low self-esteem and (b) cognitions reflecting the effort to continue thinking about the problem. Sugiura (2005) developed the problem-solving related meta-cognitions questionnaire, which contains items from both Davey and Levy’s (1999) and Sugiura and Tanno’s (1998) questionnaires, and confirmed this view by extracting two factors corresponding to the above categories. The two factors were called the lack of satisfaction with the problem-solving process (LACK) and the responsibility to continue thinking (RESP). RESP is the beliefs that one needs prolonged thinking about stressful problems, while LACK represents a negative appraisal of the problem-solving process. Sugiura (2004b, 2005) found that these two factors mediated the relationship of problem-focused coping strategies and worry by using structural equation modeling. LACK and RESP are meta-cognitive appraisals of problem-solving, therefore they are somewhat different from beliefs about worry itself or metaworry (worry about worry) (Wells, 2000). LACK is a negative view of one’s own problem-solving process, while negative meta-cognitive beliefs are about the aversive effects of worrying. Although both positive beliefs and RESP are beliefs that motivate worrying, the latter is distinctive in its focus on continued thinking, while the former is a belief in the utility of worrying without particular focus on perseverance. Therefore, RESP is a relative of positive beliefs, but may have a unique feature expected to enhance the prediction. RESP may be related to high levels of motivation to continue inflexible thinking and the use of rigid stop rules. Graham Davey and colleagues demonstrated the importance of responsibility in the worrying process. Startup and Davey (2003) found that high worriers reported an elevated sense of responsibility to think through problems both at the beginning and throughout the catastrophizing experiment (Vasey & Borkovec, 1992). In addition, experimentally induced responsibility enhanced perseverance in catastrophizing when participants were in a negative mood. Davey, Startup, MacDonald, Jenkins, and Patterson (2005) developed a self-report measure of the use of the ‘‘as many as can’’ rule to stop worry and found that it was related to self-report of worry-proneness and to the number of steps in the catastrophizing experiment. These studies converge on the responsibility to continue thinking as a factor that makes worrying persistent. Although Davey et al. found a positive relation between the use of the ‘‘as many as can’’ rule and positive and negative beliefs about worrying, they did not examine the relative predictive power of these cognitive variables.
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This study aims to clarify the predictive value of the responsibility to continue thinking. It is predicted that the responsibility to continue thinking is positively related to positive beliefs but explains the additional variance of worry. In addition, it is explored whether the responsibility enhances the prediction of worry beyond other existing cognitive variables. Study 1 included negative beliefs about worry in addition to positive beliefs since they strongly predicted worrying (Wells, 2000). Therefore, this was expected to be a more stringent test of incremental validity. Study 2 further added Neuroticism, intolerance of uncertainty, problemsolving orientation, and cognitive avoidance, thus extending Study 1 (for a fuller discussion of these variables, see Study 2.) Study 1 Method Participants One hundred and twenty-two Japanese college students voluntarily completed questionnaires during the class (52% women), with a mean age of 19.50 years (SD ¼ 1.92). Instruments Penn State worry questionnaire (PSWQ; Meyer, Miller, Metzger, & Borkovec, 1990). The PSWQ is a 16-item questionnaire with excellent psychometric properties for measuring the frequency and intensity of worry (Molina & Borkovec, 1994). The Japanese version by Sugiura and Tanno (2000) has psychometric properties compatible with the original version: good internal consistency (a ¼ :92) and positive correlations with anxiety and depression among the student population. In addition, it demonstrated good discrimination from obsessive symptoms. Meta-cognitions questionnaire (MCQ; Cartwright-Hatton & Wells, 1997). The MCQ is a 65-item questionnaire concerning beliefs about worry and intrusive thoughts, with established psychometric properties including the relation to worrying (Cartwright-Hatton & Wells, 1997). It has five subscales: positive beliefs about worry; negative beliefs about the uncontrollability and danger of worry; lack of cognitive confidence; negative beliefs about thoughts in general, including themes of superstition, punishment, responsibility, and need for control; and cognitive self-consciousness. Sugiura, Sugiura, and Umaoka (2003) translated the MCQ into Japanese and confirmed good reliability (a4:80) for each subscale, compatible with the original version. Of the five MCQ subscales, only the positive and negative beliefs were used in the analyses because these two are the most central to the meta-cognitive model of GAD (Wells & Carter, 2001; Wells & Papageorgiou, 1998). Problem-solving related meta-cognitions (Sugiura, 2005). This was developed to measure the meta-cognitive appraisals that occurred during a stressful problem-solving process, with exclusive focus on those appraisals leading to prolonged worry. Participants were asked to rate how often these meta-cognitions occurred while they were solving stressful problems. Items were rated on a 5-point scale, 1 (none) to 5 (very frequent). It has two subscales: lack of satisfaction with the problem-solving process (LACK) and the responsibility to continue thinking (RESP). LACK has 19 items (e.g., ‘‘I don’t know how to solve this problem.’’; ‘‘Despite much effort, I can’t understand the cause of this problem.’’) and RESP has 14 items (e.g., ‘‘I should continue thinking until I find out better solutions.’’; ‘‘It is irresponsible to stop thinking.’’). Sugiura (2005) reported adequate reliability (a4:88) and validity (e.g., RESP was correlated with perfectionism and active problem-solving; LACK with poor problem-solving confidence). All scales exhibited good to excellent reliability (a ¼ :86 :91) in Study 1, and all cognitive variables were positively correlated with the PSWQ (Table 1), replicating the previous findings using these measures. Results and discussion As predicted, positive beliefs and RESP were positively correlated (r ¼ :37, po:001). To determine the incremental validity of the responsibility to continue thinking, a hierarchical regression analysis was
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Table 1 Simple statistics, internal consistencies, and correlations with worry (PSWQ) of Study 1 variables (N ¼ 122Þ
MCQ positive beliefs MCQ negative beliefs RESP LACK PSWQ
M
SD
a
Correlation with the PSWQ
37.56 39.04 45.36 54.71 53.93
9.05 10.33 10.26 13.71 12.94
.86 .90 .86 .90 .91
.22 .68 .44 .54 —
Note: PSWQ ¼ Penn State worry questionnaire; MCQ ¼ meta-cognitions questionnaire; RESP ¼ responsibility to continue thinking; LACK ¼ lack of satisfaction with the problem-solving process. po.05. po.001.
Table 2 Hierarchical regression analysis predicting worry (PSWQ) by cognitive variables (N ¼ 122) Steps
Predictors
DR2
b
1
MCQ positive beliefs MCQ negative beliefs RESP LACK
.48
.05 .53 .20 .12
2
.05
Note: PSWQ ¼ Penn State worry questionnaire; MCQ ¼ meta-cognitions questionnaire; RESP ¼ responsibility to continue thinking; LACK ¼ lack of satisfaction with the problem-solving process. po.01. po.001.
conducted (Table 2). In the first step, positive and negative beliefs about worry were entered, explaining 48% of the variance of the PSWQ.1 In the second step, RESP and LACK were entered together, explaining 5% of the additional variance. Negative beliefs and RESP emerged as significant predictors.2 Thus, the incremental validity of the responsibility to continue thinking was shown beyond the variance explained by meta-cognitive beliefs. Considering that negative beliefs have high predictive power (Ruscio & Borkovec, 2004; Wells, 2000), it was concluded that the role of RESP as a promising construct was supported. Study 2 Study 2 was an extended replication of Study 1. The following extensions were made. (a) A different measure of beliefs about worry, the consequences of worry scale (COWS; Davey et al., 1996), was included for cross-validation. (b) Emotional instability (Neuroticism) was added as a covariate. Sexton, Norton, Walker, and Norton (2003) found that both Neuroticism and specific vulnerability factors (e.g., intolerance of uncertainty) have unique influences on specific anxiety symptoms (e.g., worry, panic). The cognitive variables in this study are specific vulnerability factors, and thus are expected to have unique effects beyond Neuroticism. Therefore, Neuroticism was controlled for in the first step of the regressions. (c) Other cognitive factors related to worry were also included: intolerance of uncertainty, problem-solving orientation, and cognitive avoidance. Dugas et al. (2005) presented support for a comprehensive model of GAD, which included the above three variables in addition to positive beliefs. Dugas et al. (2005) found that all of these 1
Neither the skewness nor the kurtosis of the PSWQ exceeded the absolute value of .29 in Study 1 and .49 in Study 2, suggesting the normality of the PSWQ scores. Therefore, it was considered appropriate to use it as a dependent variable. 2 Using all five MCQ subscales did not change the results: no MCQ subscales other than negative beliefs were significant in either Study 1 or 2.
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factors were related to clinical worrying. Intolerance of uncertainty was given a central role and discriminated GAD from panic disorder with agoraphobia. Intolerance of uncertainty may motivate continued thinking and be related to RESP (Davey et al., 2005). However, RESP will have a stronger influence on worrying, because intolerance of uncertainty is a general attitude toward ambiguity and does not directly specify continued thinking. Problem-solving orientation represents attitudes toward problem-solving. Davey (1994) found that poor problem-solving confidence and poor perceived control over the problem-solving process are related to worrying. LACK can be construed as the on-line manifestation of such poor problem-solving orientation. Therefore, poor problem-solving orientation may be related to LACK. Cognitive avoidance includes avoidance of somatic anxiety and more distressing cognitions (Borkovec et al., 2004) and suppression of unwanted thoughts (Robichaud, Dugas, & Conway, 2003). This is rather different from factors related to problem-solving (e.g., positive beliefs, RESP), thus there is no preconceived hypothesis about its relation to RESP and its relative predictive power. Method Participants One hundred and fifty Japanese college students (56% women), with a mean age of 19.58 years (SD ¼ 1.05) participated in exchange for a partial course credit. The measures of problem-solving orientation and cognitive avoidance were completed by the only portion of the sample (n ¼ 77), because of a time constraint. Instruments In addition to the PSWQ, the MCQ3, and problem-solving related meta-cognitions, the following measures were included. Consequences of worry scale (COWS; Davey et al., 1996). This measures beliefs about the consequences of worry with 29 items. It has two broad subscales: negative and positive consequences, each having three and two suborder scales. To be consistent with Study 1, only the broad subscales were used. Items were carefully translated into Japanese. Both negative and positive consequences were related to poor mental health, including worry (Davey et al., 1996), but these relations were stronger for negative consequences. Consistent with these findings, only negative consequences were related to worrying in Study 2 (Table 3). One item for negative consequences was omitted due to a printing error (‘‘Worrying gets me worked up.’’). Intolerance of uncertainty scale (IUS; Freeston, Rhe´aume, Letarte, Dugas, & Ladouceur, 1994). The IUS is a well-validated measure of the intolerance of uncertainty with 27 items, shown to be reliable and to predict worrying and GAD status (Dugas et al., 2004, 2005). Items were carefully translated into Japanese. Problem-solving inventory (PSI; Heppner & Peterson, 1982). The PSI measures an individual’s style of solving personal problems using three subscales: approach-avoidance style, problem-solving confidence, and personal control. A high score indicates a maladaptive problem-solving style. It has both convergent and divergent validity. The Japanese version was provided by P. P. Heppner (personal communication, May 27, 2003). Only problem-solving confidence and personal control were used in the analysis because these two were related to worry, but not approach-avoidance style (Davey, 1994). White bear suppression inventory (WBSI; Wegner & Zanakos, 1994). The WBSI uses 15 items to measure the tendency to suppress unwanted thoughts. It is widely used and well-validated, including the relation to worrying (Muris, Merckelbach, & Horselenberg, 1996; Robichaud et al., 2003). However, some items measure the uncontrollability of thoughts. To avoid the confounding of predicting worry by worry, only items representing suppression were used, as suggested by Robichaud et al. (2003) 3 The MCQ used in Study 2 had slightly different wording because the survey was conducted while the Japanese version was being finalized. However, this small modification is unlikely to change the results. In fact, the Study 1 results were basically replicated using the Study 2 data.
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Table 3 simple statistics, internal consistencies, and correlations with worry (PSWQ) of Study 2 variables (N ¼ 150)
Neuroticism MCQ positive beliefs MCQ negative beliefs COWS positive consequences COWS negative consequences IUS PSI CONFa PSI CONTa WBSIa,b RESP LACK PSWQ
M
SD
a
Correlation with the PSWQ
54.31 43.20 41.61 27.18 45.86 71.81 37.30 18.21 19.97 44.60 50.40 50.96
12.90 8.12 8.62 8.15 13.22 17.47 5.95 3.79 6.73 10.70 12.37 11.20
.92 .85 .89 .87 .94 .92 .81 .60 .88 .88 .91 .93
.72 .17 .73 .14 .58 .47 .33 .28 .44 .48 .47 –
Note: PSWQ ¼ Penn State worry questionnaire; MCQ ¼ meta-cognitions questionnaire; COWS ¼ consequences of worry scale; IUS ¼ intolerance of uncertainty scale; PSI ¼ problem-solving inventory; CONF ¼ problem-solving confidence; CONT ¼ personal control; WBSI ¼ white bear suppression inventory; RESP ¼ responsibility to continue thinking; LACK ¼ lack of satisfaction with the problem-solving process. po.05. po.01. po.001. a n ¼ 77. b Using seven items directly depicting suppression (see footnote 4).
and Sugiura (1998).4 The WBSI was translated into Japanese by Sugiura (1998). Cognitive avoidance related to worry includes not only thought suppression but also the avoidance of emotional imagery by verbal thinking (Robichaud et al., 2003). However, because only the WBSI was available in Japan when this study was conducted, this study measured only thought suppression. The big five scale (BFS; Wada, 1996). The BFS was developed to measure the Big Five personality traits, whose items are based on the adjective check list (ACL; Gough & Heilbrun, 1983). A series of factor analyses of 198 theoretically selected ACL items resulted in the 60-item BFS. Each of the five factors contains 12 trait adjectives. Each subscale evidenced good to excellent internal consistency (a4:84). Items were rated on a 7point scale, 1 (not at all true) to 7 (very true). Kashiwagi (1997) suggested that the ACL items (Japanese version) on which the BFS is based could be theoretically classified under the five domains of the NEO PI-R (Costa & McCrae, 1992), the most widely used measure of the Big Five. Only the Neuroticism subscale was used in the analysis (e.g., nervous, feelings easily upset, tense). In Study 2, all measures demonstrated good to excellent reliability (a ¼ :812:94) except for the personal control subscale of the PSI (a ¼ :60). In addition, all cognitive variables except the COWS positive consequences were positively correlated with the PSWQ (Table 3), basically replicating the previous findings using these measures. Results and discussion As predicted, positive beliefs and RESP were positively correlated (r ¼ :36 with the MCQ; r ¼ :37 with the COWS, both po:001). In addition, the IUS and RESP were also correlated (r ¼ :43, po:001). While personal control was significantly correlated with LACK (r ¼ :43, po:001), problem-solving confidence was not (r ¼ :15, p4:10). Because only a small portion of participants completed the PSI and the WBSI, the main analyses were run without them (Table 4). Additional analyses including these measures were subsequently reported. Analyses 4
Based on Sugiura (1998), Items 1, 6, 8, and 10–13 were retained.
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Table 4 Hierarchical regression analyses predicting worry (PSWQ) by cognitive variables (N ¼ 150) Steps predictors MCQ used as a belief measure 1. Neuroticism 2. MCQ positive beliefs MCQ negative beliefs IUS 3. RESP LACK COWS used as a belief measure 1. Neuroticism 2. COWS positive consequences COWS negative consequences IUS 3. RESP LACK
DR2
b
.52 .12
.46 .03 .36 .05 .32 .11
.06 .52 .06 .07
.61 .03 .17 .00 .34 .08
Note: PSWQ ¼ Penn State worry questionnaire; MCQ ¼ meta-cognitions questionnaire; IUS ¼ intolerance of uncertainty; RESP ¼ responsibility to continue thinking; LACK ¼ lack of satisfaction with the problem-solving process; COWS ¼ consequences of worry scale. po.05. po.001.
were conducted separately using the MCQ or the COWS as a measure of beliefs about worry. In the first step, Neuroticism was entered and explained 52% of the variance of the PSWQ (see footnote 1). In the second step, negative and positive beliefs and intolerance of uncertainty were entered simultaneously and explained an additional 12% when the MCQ was used; 6% was explained when the COWS was used. In the final step, RESP and LACK were entered together and explained 6% of the additional variance when the MCQ was used; 7% was explained when the COWS was used. Neuroticism, negative beliefs, and RESP were significant predictors of worry across two belief measures in the final regression (see footnote 2). Finally, the regressions in Table 4 were replicated adding the two PSI subscales (problem-solving confidence and personal control) and the WBSI in the second step. In neither regression (using the MCQ or the COWS), did the PSI subscales or the WBSI emerge as significant predictors. Again, RESP was a significant predictor of worry beyond Neuroticism and other cognitive variables.
General discussion Two studies demonstrate that the responsibility to continue thinking explains the unique variance of excessive worry beyond emotional instability (Neuroticism) and other worry-related cognitive variables. Especially impressive is the finding that responsibility accounted for the variance of worry beyond negative meta-cognitive beliefs and intolerance of uncertainty, factors shown to have high predictive value. The effect of the responsibility to continue thinking is consistent with a series of studies by Davey and colleagues who demonstrated the role of inflated responsibility and the ‘‘as many as can’’ stop rules in catastrophic worrying (Davey et al., 2005; Startup & Davey, 2003). While Startup and Davey (2003) demonstrated that the effect of the stop rules emerged only when participants were in a negative mood, Davey et al. found that the ‘‘as many as can’’ stop rules influenced worrying on their own. The present results are especially consistent with the latter finding. The results are also consistent with Wells (2000), who suggested that the stop rules used by worries are often arbitrary or rigid. People who chronically worry often use internal cues such as a ‘‘felt sense’’ or superstitious reasons to stop the worry cycle. Wells (2000) considered that positive beliefs lead to inflexible worrying. Intolerance of uncertainty may also be related to stop rules (Davey et al.). Responsibility was positively related to both positive beliefs and intolerance of uncertainty, but is a more direct index of persistent thinking and had unique explanatory power beyond these. Therefore, this study has advanced previous models.
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The uniqueness of this study is the inclusion of multiple predictors. First, the strong effect of Neuroticism is consistent with recent psychopathological models that emphasize general vulnerability (e.g., Sexton et al., 2003). Second, Study 2 may be the first to compare negative meta-cognitive beliefs and intolerance of uncertainty, two prominent factors. Negative beliefs (MCQ) were a strong cognitive predictor, while intolerance of uncertainty was not significant. Therefore, the results support the meta-cognitive model (Wells, 2000), in which negative beliefs play a central role. However, the present results should not be interpreted as denying the role of intolerance of uncertainty, etc. in the development and maintenance of worry. Remember that this study was specifically designed to demonstrate the incremental validity (the unique contribution) of the responsibility to continue thinking in a rather rigorous manner. In fact, all of the cognitive variables were positively correlated with worrying (except for the COWS positive beliefs). An examination of the interrelationships among worry-related variables, with a path analysis, is needed for future study.5 The independent predictors found in this study may mediate the effects of the others. The therapeutic implication of the present results is that we should focus on the perceived utility of persistent thinking rather than on the utility of worry in general. When we treat worry, ‘‘why continue?’’ is more important than ‘‘why worry?’’ Therefore, rigidity or inflexibility is the chief focus of intervention. This is consistent with the recent development of cognitive-behavioral therapy for GAD (Borkovec & Sharpless, 2004). The responsibility to continue thinking may not be the same as responsibility in obsessive-compulsive disorder, a belief in one’s pivotal power to cause or prevent negative outcomes (Salkovskis et al., 2000; cf. Davey et al., 2005). To summarize, this study revealed a construct that is related to existing models (especially Wells’ and Davey’s) but enhances explanatory power for pathological worrying. This warrants future investigation with a clinical population. Acknowledgments This research was supported by Grant-in-Aid for JSPS Fellows. Parts of the data were presented at the 11th Biennial Meeting of the International Society for the Study of Individual Differences, Graz, Austria, July 2003 and the World Congress of Behavioral and Cognitive Therapies 2004, Kobe, Japan, July 2004. However, data analysis is quite different.
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