A Brief Measure of Worry Severity (BMWS): personality and clinical correlates of severe worriers

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Abstract

This report describes the development of a brief and valid self-report measure to assess severe and dysfunctional worry (the Brief Measure of Worry Severity or BMWS). Using three independent subject groups (clinical and non-clinical), the measure was used to examine the differential severity of worry in depression and anxiety and to examine the clinical and personality correlates of severe worriers. Preliminary psychometric evaluation revealed that the BMWS possesses good construct and clinical discriminant validity. Subjects reporting greater worry severity tended to be more “introverted” and “obsessional,” but less “agreeable” and “conscientious.” Subjects with depression only, reported less problems with worrying compared to those with co-morbid anxiety disorders. However, among the anxiety disorders, severe and dysfunctional worry was not exclusively experienced by subjects with generalized anxiety disorder (GAD). This study suggests that pathological worry is not only relevant for patients with GAD, but may be an equally detrimental cognitive activity for patients with panic disorder and obsessive–compulsive disorder.

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.

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