Uncontrollability Beliefs Affect Efficacy of Interventions in Generalized Anxiety Disorder

A lack of faith in the ability to control anxiety experienced by patients with generalized anxiety disorder reduced the efficacy of treatment using a Worry Outcome Journal.

A lack of faith in the ability to control anxiety and the worry it causes significantly affects the response in patients with generalized anxiety disorder (GAD) to treatment using a Worry Outcome Journal, according to study results published in the Journal of Anxiety Disorders.

Lucas S, LaFreniere, MS, and Michelle G. Newman, PhD, professor of psychology, both of the Department of Psychology at Pennsylvania State University in University Park, Pennsylvania, conducted a secondary analysis of a randomized controlled trial comparing 2 interventions for GAD: a Worry Outcome Journal and a Thought Log. The investigators believed that higher uncontrollability beliefs would decrease the efficacy of a Worry Outcome Journal but not a Thought Log.

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Belief in the uncontrollability of thoughts is characteristic of GAD, and worry about that uncontrollability is a key criterion for the diagnosis of GAD.

The study included 51 undergraduate students with GAD who engaged in one of the interventions for 10 days. Patients in the Worry Outcome Journal group recorded worries, associated distress, interference, expected outcome probabilities, and whether these worries came true 4 times per day. Patients in the Thought Log group recorded general thoughts, associated distress, and interference 4 times per day. The researchers used bootstrapping path analysis to analyze moderated mediation models.

The investigators’ prediction that higher levels of uncontrollability beliefs would adversely affect the efficacy of a Worry Outcome Journal was supported by study results. Because a Thought Log does not focus on or track worry, the effects on this intervention were not significantly influenced by uncontrollability beliefs. Furthermore, higher levels of uncontrollability beliefs at baseline were associated with higher levels of worry for journal users both immediately after treatment and at 30-day follow-up, and these outcomes were mediated by higher levels of thought-related distress early in treatment. In contrast, effects on outcome with a Thought Log were not mediated by thought-related distress.

The researchers conclude that “faith in one’s capacity to control worry and the distress it provokes can make a significant difference in clients’ response to treatment.”


LaFreniere LS, Newman MG. The impact of uncontrollability beliefs and thought-related distress on ecological momentary interventions for generalized anxiety disorder: a moderated mediation model. J Anxiety Disord. 2019;66:102113.