A Brief Measure of Worry Severity (BMWS): personality and clinical correlates of severe worriers
Introduction
Worry is both a common cognitive activity as well as a symptom correlated with psychological disturbance capable of reaching marked intensity. Depending on severity, worry may either be a general marker for anxiety proneness or a significant component of more clinically meaningful anxiety, such as generalized anxiety disorder (GAD) where it is recognized as the cardinal diagnostic feature (APA, 1994). Worry activity can also be conceptualized as a “spectrum,” from commonplace potentially useful “worrying,” which may possess a motivational quality, to problematic worry characterized by repetitive catastrophic speculation. which is detrimental to performance and debilitating. The perceived uncontrollability of worry, its pervasiveness and disruption to daily functioning, and the presence of “meta-worry” (or worrying about worry), are all features considered to characterize more severe or “pathological” worry (Gladstone & Parker, 2003).
Interest in the phenomenology and function of worry has led the way to developments in its measurement. Thus, various self-report instruments have been designed to measure one or more components of worry or related cognitive phenomena (e.g., Cartwright-Hatton & Wells, 1997; Wells, 1994). Some instruments have focused on the assessment of what people actually worry about (content), like the Worry Domains Questionnaire (WDQ; Tallis, Eysenck, & Mathews, 1992), including those for specific populations, such as the Worry Scale (Wisocki, Haden, & Morse, 1986) for elderly respondents, and the Student Worry Scale (SWS; Davey, Hamptom, Farrell, & Davidson, 1992). Other instruments have focused on worry as a trait, such as the well-known Penn State Worry Questionnaire or PSWQ (Meyer, Miller, Metzger, & Borkovec, 1990), designed to assess the frequency and intensity of worrying in general. There is currently no single brief measure of worry, which includes items defining differential key markers for dysfunctional and severe worry (e.g., uncontrollability, thwarted problem solving, associated mood disturbance, meta-worry).
The extent to which pathological worrying constitutes an important component of different psychological disorders has gained recent attention in the literature, with particular interest in the degree to which severe and uncontrollable worrying is experienced by patients with differing anxiety disorders. Although pathological worry is regarded as the hallmark feature of GAD (APA, 1994), “anxious apprehension” (Barlow, 1988), described as a negative, future-orientated emotional state, whereby feared outcomes are anticipated, is taken to be characteristic of all anxiety disorders (Brown, O’Leary, & Barlow, 1993). Thus, worry has gained preferential status in GAD, with studies suggesting that the worry in GAD is both more severe (i.e., frequent and uncontrollable) (Brown, Antony, & Barlow, 1992) and more pervasive in focus (Gross & Eifert, 1990) than in other anxiety disorders. Chelkminski and Zimmerman (2003), for example, compared worrying (using PSWQ scores) in patients with different anxiety disorders and found that patients with GAD scored significantly higher on the PSWQ than those with social phobia, specific phobia, panic disorder and post-traumatic stress disorder, but not obsessive–compulsive disorder (OCD). Excessive and “unprovoked” worrying about minor matters, along with greater concern about lack of control over the worry, are usually taken to be factors which distinguish the worrying in GAD from similar cognitive processes in other anxiety disorders (Craske, Rapee, Jackel, & Barlow, 1989).
Repetitive cognitive processes, like worry, are also commonly experienced by patients with major depression (Starcevic, 1994). Also described in terms of depressive rumination (Morrow & Nolen-Hoeksema, 1990), such repetitive thought processes usually involve preseverative and static cognitions (rather than elaborative worry) geared toward the depressive illness itself (e.g., “Why did this happen to me?”). One study (Diefenbach et al., 2001), however, identified that the worrisome thoughts of depressed patients were particularly related to “aimless future” themes—cognitions clearly linked to depressed mood. Studies have demonstrated that ruminations work to maintain and exacerbate depressed affect, both for those with experimentally induced low mood (Morrow & Nolen-Hoeksema, 1990) and those with clinical depression (Nolen-Hoeksema & Morrow, 1993).
However, the degree to which worrisome and other repetitive cognitions differ in severity for those with depressed and anxious mood states has received limited empirical attention, with the few existing studies showing contrasting results. One study by Starcevic (1994) using the PSWQ, found no differences in worry scores between patients with GAD compared to patients with major depression, concluding that not only was pathological worrying not restricted to GAD sufferers, but it was also a feature of depression, and was equally severe in both disorders. However, the study by Chelkminski and Zimmerman (2003), which also included a comparison between patients with GAD only and major depression only, found that worry posed a significantly greater problem for those with GAD compared to those with depression.
A small amount of research has examined the personality correlates of people who worry excessively. Severe worriers also tend to be more self-evaluative, more socially anxious and more perfectionistic. They also tend to feel more time-pressured, and report more obsessional symptoms (Meyer et al., 1990; Pruzinsky & Borkovec, 1990). One study (Pruzinsky & Borkovec, 1990) found a greater tendency for negative daydreaming, along with poorer attentional control among chronic worriers. This finding might be accounted for by the view that worrying requires considerable attentional resources and results in poorer problem solving efforts and interrupted task completion (Dugas, Letarte, Rheaume, Freeston, & Ladouceur, 1995). Further research is needed to better understand the relationship between worry and related constructs such as conscientiousness, perfectionism and obsessionality, particularly in relation to differentiating between so called “functional” and “dysfunctional” worrying.
The present study reports the development of a short (8-item) self-report questionnaire of worry severity and dysfunction, with items designed to measure the central components of pathological worry identified in the research literature as being particularly relevant in the demarcation between “normal,” volitional worrying and dysfunctional worry which is detrimental to performance and linked to emotional disturbance (see Gladstone & Parker, 2003). Using clinical and non-clinical samples, the aim of this study is to provide an initial assessment of the psychometric properties of the new measure (the Brief Measure of Worry Severity; BMWS); to further examine the differential severity of worry in major depression and differing anxiety disorders, and finally, to provide further insight into the clinical and personality correlates of severe worriers.
Section snippets
Participants and procedures
One-hundred and seventeen subjects including 28 medical students and 89 patients receiving psychiatric treatment, were used to develop a Brief Measure of Worry Severity. The mean age for the student group was 22.4 years (S.D. = 0.68) with 18 males and 10 females. The 89 patients included those attending our Mood Disorders Unit (MDU) for outpatient assessment (n = 35); MDU inpatients (n = 4) and those visiting MDU psychiatrists privately (n = 50), of whom most had anxious or depressive disorders, with a
Results
Based on subjects’ responses to each of the four global worry questions, all subjects endorsed worrying in general at least to some degree. Interestingly, no subject reported they never worried.
Discussion
This study reports the development and initial validation of a new Brief Measure of Worry Severity. Application of factor analytic techniques to a set of worry items produced a single worry factor accounting for most of the variance, with this factor structure retained when examined in two independent samples. The measure includes 8 items each measuring a key characteristic of pathological or dysfunctional worry, and each predictive of three “global” subjective judgments about worrying (i.e.,
Acknowledgments
We thank the National Health and Medical Research Council (Program grant 2223208), the NSW Centre for Mental Health for infrastructure funding, Chris Boyd for data management and Karen Saint for collection of data for the antenatal clinic sample.
References (28)
- et al.
Psychometric properties of the Penn State Worry Questionnaire in a clinical anxiety disorder sample
Behaviour Research and Therapy
(1992) - et al.
Beliefs about worry and intrusions: the meta-cognitions questionnaire and its correlates
Journal of Anxiety Disorders
(1997) - et al.
Qualitative dimensions of worry in DSM-III-R generalized anxiety disorder subjects and nonanxious controls
Behaviour Research and Therapy
(1989) - et al.
Some characteristics of worrying: evidence for worrying and anxiety as separate constructs
Personality and Individual Differences
(1992) - et al.
Components of generalized anxiety: the role of intrusive thoughts vs. worry
Behaviour Research and Therapy
(1990) - et al.
Somatic symptoms of generalized anxiety disorder from the DSM-IV: associations with pathological worry and depressive symptoms in a nonclinical sample
Journal of Anxiety Disorders
(1999) Why worry? The cognitive function of anxiety
Behaviour Research and Therapy
(1990)- et al.
Development and validation of the Penn State Worry Questionnaire
Behaviour Research and Therapy
(1990) - et al.
Cognitive and personality characteristics of worriers
Behaviour Research and Therapy
(1990) - et al.
A questionnaire for the measurement of nonpathological worry
Personality and Individual Differences
(1992)
Anxiety and its disorders
Pathological worry in depressed and anxious patients
Journal of Anxiety Disorders
Cited by (68)
"I would never be able to forgive myself if it ended up having consequences for the child": A qualitative study of perceptions of stress and worries among healthy first-time pregnant Danish women
2022, MidwiferyCitation Excerpt :Similar results were found in a Danish study (Maimburg et al., 2013). Worrying is a cognitive process helping the individual find and prepare coping strategies, ranging from everyday worrying, a normal psychological state, to problematic worry, characterised by recurring uncontrolled speculation, a key symptom in generalised anxiety (Gladstone et al., 2005). Worry is reported to be an essential part of the transition to parenthood (Maimburg et al., 2013) and is most pronounced in early pregnancy, declining in mid-pregnancy and increasing again at the end (Peñacoba-Puente et al., 2011).
High worry in pregnancy predicts postpartum depression
2021, Journal of Affective DisordersHumor and anxiety: The relationship between the comic styles, worry and general well-being
2021, Personality and Individual DifferencesCitation Excerpt :Using mockery to highlight weaknesses in the world may lead to negatively influencing well-being by lowering the quality of relationships (Ruch, Wagner, & Heintz, 2018). Moreover, a significant relationship was found between worry and personality qualities, such as cynicism (Gladstone et al., 2005). Individuals who are more prone to a critical attitude are also more concerned about potential dangers and threats to personal safety (Mathews, 1990).
Worries among pregnant Danish women with chronic medical conditions – A cross sectional study with data from the Copenhagen pregnancy cohort
2021, Sexual and Reproductive HealthcareExamining characteristics of worry in relation to depression, anxiety, and suicidal ideation and attempts
2018, Journal of Psychiatric Research