Exposing Worry’s Deceit: Percentage of Untrue Worries in Generalized Anxiety Disorder Treatment
Open accessAbstract
Theories of cognitive therapy have long proposed that those with generalized anxiety disorder (GAD) have inaccurate expectations. By challenging them with objective evidence, symptoms are thought to decrease. To test these premises, this study used ecological momentary assessment (EMA) during the Worry Outcome Journal (WOJ) treatment to determine the percentage of GAD worries that did not come true. We then analyzed the association between participants' untrue worry percentages and GAD symptom change across treatment. Twenty-nine participants with GAD recorded worries when prompted for 10 days, reviewed them online nightly, and tracked their worry outcomes across 30 days. These recordings were then coded by independent raters. Analyses applied bias-correct bootstrapping path analysis on slopes extracted from longitudinal linear mixed models. Primary results revealed that 91.4% of worry predictions did not come true. Higher percentages of untrue worries significantly predicted lower GAD symptoms after treatment, as well as a greater slope of symptom reduction from pre- to post-trial. Participants' average expected likelihoods of worries coming true were much greater than actual observed likelihoods. The most common percentage of untrue worries per person was 100%. Thus, worries in those with GAD were mostly inaccurate. Greater evidence of this inaccuracy predicted greater improvement in treatment. As theorized, disconfirming false expectations may significantly contribute to treatment's effect.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Individuals with versus without generalized anxiety disorder experienced an increased sense of threat and reduced emotional control.
“They also experienced an increased sense of threat and reduced emotional control [24-26].”
From Treatment condition as a moderator and change in trait mindfulness as a mediator of a brief mindfulness ecological momentary intervention for generalized anxiety disorder (2024) · cites this paper as [24]
The paper’s introductory discussion reports that excessive worrying and GAD have been associated with higher estimates of negative outcomes than in controls, supporting the increased-threat part of the claim. The Methods describe uncontrollable worry as a GAD symptom, but the paper does not report a comparison of emotional control between people with and without GAD. Its study participants all had GAD. (LLM, conf=0.84)
Experimental — accuracy not yet measuredProlonged worry has been causally linked to decreased vagal tone and increased blood pressure.
“Physiologically, prolonged worry has been causally linked to decreased vagal tone [i.e., higher resting heart rate; 24] and increased blood pressure [79].”
From Treatment condition as a moderator and change in trait mindfulness as a mediator of a brief mindfulness ecological momentary intervention for generalized anxiety disorder (2024) · cites this paper as [24]
The Method > Procedure and Results > Descriptive Analyses passages address recorded worries, distress, and whether feared outcomes occurred. Searches for vagal tone, resting heart rate, and blood pressure found no passage linking prolonged worry to either physiological outcome, causally or otherwise. No page numbers were available in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2013) · doi:10.1176/appi.books.9780890425596 · Cited by 116,369 · see citing works
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Preacher, K. J., & Hayes, A. F. (2008) · Behavior Research Methods · doi:10.3758/brm.40.3.879 · Cited by 34,117 · see citing works
Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences
Cohen, P., Cohen, P., West, S. G., & Aiken, L. S. (2014) · Psychology Press eBooks · doi:10.4324/9781410606266 · Cited by 20,819 · see citing works
Diagnostic and Statistical Manual of Mental Disorders(DSM)
Leong, F. T. L. (2008) · Sage eBooks · doi:10.4135/9781412963978.n182 · Cited by 10,858 · see citing works
(1975) · Medical Entomology and Zoology · Cited by 7,245 · see citing works
Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences.
Tufte, E. R., Cohen, J., & Cohen, P. (1979) · Journal of the American Statistical Association · doi:10.2307/2286442 · Cited by 5,214 · see citing works
The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses
Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012) · Cognitive Therapy and Research · doi:10.1007/s10608-012-9476-1 · Cited by 3,445 · see citing works
The empirical status of cognitive-behavioral therapy: A review of meta-analyses
Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006) · Clinical Psychology Review · doi:10.1016/j.cpr.2005.07.003 · Cited by 3,215 · see citing works
(1985) · Cited by 2,882 · see citing works
Empirically supported psychological interventions: Controversies and evidence
Chambless, D. L., & Ollendick, T. H. (2001) · Annual Review of Psychology · doi:10.1146/annurev.psych.52.1.685 · Cited by 2,097 · see citing works
Diagnostic and Statistical Manual of Mental Disorders
Preedy, V., & Watson, R. (2010) · Springer eBooks · doi:10.1007/978-0-387-78665-0_5485 · Cited by 1,146 · see citing works
Kazdin, A. E. (2008) · American Psychologist · doi:10.1037/0003-066x.63.3.146 · Cited by 1,112 · cited 2× · see citing works
“Yet if we want our treatments to be empirically supported throughout, our studies of outcome must be complemented by tests of such core processes (Kazdin, 2008).”
BackgroundCognitive processes in anxiety
Butler, G., & Mathews, A. (1983) · Advances in Behaviour Research and Therapy · doi:10.1016/0146-6402(83)90015-2 · Cited by 738 · see citing works
Newman, M. G., & Llera, S. J. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2011.01.008 · Cited by 598 · see citing works
Self-citationNewman, M. G., Zuellig, A. R., Kachin, K. E., Constantino, M. J., Przeworski, A., Erickson, T., & Cashman-McGrath, L. (2002) · Behavior Therapy · doi:10.1016/s0005-7894(02)80026-0 · Cited by 553 · see citing works
Self-citationBehar, E., DiMarco, I. D., Hekler, E. B., Mohlman, J., & Staples, A. M. (2009) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2009.07.006 · Cited by 505 · see citing works
Cognitive Therapy and the Emotional Disorders
Mott, T. (1980) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-198004000-00012 · Cited by 398 · see citing works
Anxiety disorders and phobias—a cognitive perspective
Rachman, S. (1986) · Behaviour Research and Therapy · doi:10.1016/0005-7967(86)90157-9 · Cited by 328 · see citing works
Arch, J. J., & Craske, M. G. (2008) · Clinical Psychology: Science and Practice · doi:10.1111/j.1468-2850.2008.00137.x · Cited by 310 · see citing works
Arch, J. J., Wolitzky-Taylor, K. B., Eifert, G. H., & Craske, M. G. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.04.007 · Cited by 194 · see citing works
Unrealistic beliefs of clinical couples: Their relationship to expectations, goals and satisfaction
Epstein, N. B., & Eidelson, R. J. (1981) · American Journal of Family Therapy · doi:10.1080/01926188108250420 · Cited by 187 · see citing works
Andersson, G., Paxling, B., Roch-Norlund, P., Östman, G., Norgren, A., Almlöv, J., Georén, L., Breitholtz, E., Dahlin, M., Cuijpers, P. J., et al. (2012) · Psychotherapy and Psychosomatics · doi:10.1159/000339371 · Cited by 181 · see citing works
Worry is reasonable: The role of explanations in pessimism about future personal events.
MacLeod, A. K., Williams, J. M. G., & Bekerian, D. A. (1991) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.100.4.478 · Cited by 181 · see citing works
Worry is reasonable: The role of explanations in pessimism about future personal events.
MacLeod, A. K., Williams, J. M., & Bekerian, D. A. (1991) · Journal of Abnormal Psychology · doi:10.1037//0021-843x.100.4.478 · Cited by 180 · see citing works
Smits, J. A. J., Julian, K., Rosenfield, D., & Powers, M. B. (2012) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0028957 · Cited by 162 · see citing works
Paxling, B., Almlöv, J., Dahlin, M., Carlbring, P., Breitholtz, E., Eriksson, T., & Andersson, G. (2011) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2011.576699 · Cited by 147 · see citing works
Worry and Generalized Anxiety Disorder
Borkovec, T. D., & Newman, M. G. (1998) · Comprehensive Clinical Psychology · doi:10.1016/b0080-4270(73)00201-7 · Cited by 84 · cited 1× · see citing works
“It is an augmented form of worry outcome monitoring, a common technique in CT for GAD (Borkovec & Newman, 1998).”
MethodSelf-citationNewman, M. G., & Fisher, A. J. (2010) · International Journal of Cognitive Therapy · doi:10.1521/ijct.2010.3.3.245 · Cited by 83 · see citing works
Self-citationBehavioural activation: A pilot trial of transdiagnostic treatment for excessive worry
Chen, J., Liu, X., Rapee, R. M., & Pillay, P. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2013.05.010 · Cited by 76 · see citing works
Moore, M., Anderson, N. L., Barnes, J. M., Haigh, E. A. P., & Fresco, D. M. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2013.10.009 · Cited by 70 · see citing works
Perceived threat: Exploring its association with worry and its hypothesized antecedents
Berenbaum, H., Thompson, R. J., & Bredemeier, K. (2007) · Behaviour Research and Therapy · doi:10.1016/j.brat.2007.03.015 · Cited by 65 · see citing works
Westra, H. A., Aviram, A., Barnes, M. E., & Angus, L. E. (2010) · Psychotherapy Research · doi:10.1080/10503301003657395 · Cited by 61 · see citing works
The relation between worrying and concerns: The importance of perceived probability and cost
Berenbaum, H., Thompson, R. J., & Pomerantz, E. M. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2006.03.009 · Cited by 55 · see citing works
Rodebaugh, T., Holaway, R. M., & Heimberg, R. (2008) · Assessment (Odessa, Fla.) · doi:10.1177/1073191107312547 · Cited by 48 · see citing works
Newman, M. G., & Fisher, A. J. (2013) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0031690 · Cited by 45 · see citing works
Self-citationLaFreniere, L. S., & Newman, M. G. (2016) · Depression and Anxiety · doi:10.1002/da.22507 · Cited by 40 · see citing works
Self-citationA metacognitive model and therapy for generalized anxiety disorder
Wells, A. (1999) · Clinical Psychology & Psychotherapy · doi:10.1002/(sici)1099-0879(199905)6:2
Flagged first, then by citations
Cited by
Sorted by citations
LaFreniere, L. S., & Newman, M. G. (2023) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000794 · Cited by 48 · see citing works
Self-citationKim, H., & Newman, M. G. (2023) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2023.102671 · Cited by 43 · see citing works
Self-citationA randomized controlled trial of a smartphone-based application for the treatment of anxiety
Newman, M. G., Jacobson, N. C., Rackoff, G. N., Bell, M. J., & Taylor, C. B. (2021) · Psychotherapy Research · doi:10.1080/10503307.2020.1790688 · Cited by 37 · see citing works
Self-citationLearned uncertainty: The free energy principle in anxiety
McGovern, H. T., De Foe, A., Biddell, H., Leptourgos, P., Corlett, P., Bandara, K., & Hutchinson, B. T. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.943785 · Cited by 33 · see citing works
“The biological system therefore expects that its own modeling and action policies are neither sufficient nor insufficient—and yet still necessary—and generates the belief that the inherent uncertainty will persist across time (see Dickstein et al., 2010; Grupe and Nitschke, 2013; Fonzo and Etkin, 2016; Kannis-Dymand e…”
BackgroundNewman, M. G., Schwob, J. T., Rackoff, G. N., Doren, N. V., Shin, K. E., & Kim, H. (2022) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2022.102634 · Cited by 32 · see citing works
Self-citationBaik, S. Y., & Newman, M. G. (2023) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2023.102679 · Cited by 32 · see citing works
Self-citationLaFreniere, L. S., & Newman, M. G. (2022) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2022.102659 · Cited by 28 · see citing works
Self-citationContrast avoidance model of worry and generalized anxiety disorder: A theoretical perspective
Rashtbari, A., & Saed, O. (2020) · Cogent Psychology · doi:10.1080/23311908.2020.1800262 · Cited by 22 · see citing works
Probabilistic Learning by Positive and Negative Reinforcement in Generalized Anxiety Disorder
LaFreniere, L. S., & Newman, M. G. (2018) · Clinical Psychological Science · doi:10.1177/2167702618809366 · Cited by 22 · see citing works
“…that future negative outcomes would occur (Berenbaum, Thompson, & Pomerantz, 2007; Butler & Mathews, 1983) and that those predictions were highly inaccurate when actual outcomes were monitored in daily life (85%–91% of worries do not come true; Borkovec et al., 1999; LaFreniere & Newman, 2016b).”
BackgroundSelf-citationLaFreniere, L. S., & Newman, M. G. (2024) · Behaviour Research and Therapy · doi:10.1016/j.brat.2024.104541 · Cited by 19 · see citing works
Self-citationLackner, J. M. (2020) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2020.1780118 · Cited by 15 · see citing works
“riers’ never happens [30]) is negatively reinforced by their very nonoccurrence.”
BackgroundBaik, S. Y., & Newman, M. G. (2025) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2025.102982 · Cited by 14 · see citing works
Self-citationZainal, N. H., Tan, H. H., Hong, R. Y. S., & Newman, M. G. (2024) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2024.102858 · Cited by 12 · see citing works
Self-citationCerebellum and Neurorehabilitation in Emotion with a Focus on Neuromodulation
van Dun, K., Manto, M. U., & Meesen, R. (2022) · Advances in experimental medicine and biology · doi:10.1007/978-3-030-99550-8_18 · Cited by 12 · see citing works
Shin, K. E., LaFreniere, L. S., & Newman, M. G. (2018) · Cambridge University Press eBooks · doi:10.1017/9781108140416.019 · Cited by 9 · see citing works
Self-citationContrast avoidance predicts and mediates the effect of trait worry on problem-solving impairment
Llera, S. J., & Newman, M. G. (2023) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2023.102674 · Cited by 8 · see citing works
Self-citationZainal, N. H., Tan, H. H., Hong, R. Y. S., & Newman, M. G. (2024) · JMIR Mental Health · doi:10.2196/53712 · Cited by 7 · see citing works
“Self-monitoring was used in another set of studies that inspired the conceptual foundation of our self-monitoring app [57,58].”
Self-citationLlera, S. J., Shin, K. E., Erickson, T. M., Przeworski, A., & Newman, M. G. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00213-2 · Cited by 6 · see citing works
Self-citationDahlin, M. (2020) · Linköping studies in behavioural science · doi:10.3384/diss.diva-170049 · Cited by 5 · see citing works
Introduction to a special issue on the contrast avoidance model
Newman, M. G., & Przeworski, A. (2024) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2024.102831 · Cited by 5 · see citing works
Self-citationPultsina, K. I., Stroganova, T. A., Kozunova, G. L., Prokofyev, A. O., Miasnikova, A. S., Rytikova, A. M., & Chernyshev, B. V. (2024) · Cognitive Affective & Behavioral Neuroscience · doi:10.3758/s13415-024-01227-3 · Cited by 4 · see citing works
“Moreover, these unjustified worries extended to real life, where such worries did not come true in a majority of carefully monitored outcomes (LaFreniere & Newman, 2020).”
A contemplative perspective on mind wandering
Didriksen, L. S. (2022) · New Perspectives on Mind-Wandering · doi:10.1007/978-3-031-06955-0_10 · Cited by 3 · see citing works
Zainal, N. H., & Newman, M. G. (2024) · European Psychiatry · doi:10.1192/j.eurpsy.2024.1750 · Cited by 3 · see citing works
“The fundamental basis for the SM control condition was drawn and modified from the rationale used in a recent brief app intervention [49, 50].”
MethodSelf-citationWu, Q., Zhou, N., & Cao, H. (2026) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2025.107879 · Cited by 3 · see citing works
Risk estimation in relation to anxiety and depression for low probability negative events
Dev, A. S., Broos, H. C., Llabre, M. M., Saab, P. G., & Timpano, K. R. (2024) · Behaviour Research and Therapy · doi:10.1016/j.brat.2024.104500 · Cited by 3 · see citing works
Zainal, N. H., & Newman, M. G. (2024) · Psychological Medicine · doi:10.1017/s0033291724001958 · Cited by 3 · see citing works
“The core foundation was derived and adapted from the rationale employed in a recent app-based intervention (LaFreniere & Newman, 2016, 2020).”
MethodSelf-citationWarren, R., & Yu, E. A. (2022) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2705 · Cited by 3 · see citing works
Zainal, N. H., Tan, H. H., Hong, R. Y. S., & Newman, M. G. (2025) · JMIR Mental Health · doi:10.2196/67210 · Cited by 6 · see citing works
“A recent and brief app intervention explanation inspired the rationale for SM as a placebo control [103-105].”
Self-citationBaik, S. Y., & Newman, M. G. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-91497-0.00264-2 · Cited by 2 · see citing works
Self-citationFergus, T. A., & Hiraoka, R. (2025) · Journal of Personality Assessment · doi:10.1080/00223891.2025.2485124 · Cited by 1 · see citing works
“Because most worried outcomes never occur (greater than 90%; LaFreniere & Newman, 2020), individuals may experience counterfactual relief.”
Schwob, J. T., & Newman, M. G. (2026) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2026.103160 · Cited by 1 · see citing works
Self-citationDevelopment and Validation of the Chinese Version of the Contrast Avoidance QuestionnairesPreprint
Zhang, J., Llera, S. J., Zhong, H., Tang, M., & Newman, M. G. (2023) · SSRN Electronic Journal · doi:10.2139/ssrn.4646255 · Cited by 1 · see citing works
Self-citationZhan, X., Zeng, J., Zhu, D., Chen, Y., Zhang, J., Li, S., & Huang, L. (2026) · Journal of Visualized Experiments · doi:10.3791/69949
Validation of the Chinese version of the Contrast Avoidance Questionnaires
Zhang, J., Llera, S. J., Tang, M., Zhong, H., & Newman, M. G. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1643139
Self-citationValidierung der deutschen Version des Contrast Avoidance Questionnaire – General Emotion (CAQ-GE-d)
Nadler, S., Llera, S. J., Newman, M. G., & Pedersen, A. (2026) · Diagnostica · doi:10.1026/0012-1924/a000375
Self-citation
- Authors
- LaFreniere, L. S., & Newman, M. G.
- Affiliations
- Pennsylvania State University (US)
- Corresponding author
- LaFreniere, Lucas S.
- Venue
- Behavior Therapy
- Publisher
- Elsevier BV
- Published
- 2020-05
- Volume
- 51
- Issue
- 3
- Pages
- 413-423
- ISSN
- 0005-7894 (ISSN-L)
- PMC
- PMC7233480
- OpenAlex
- W2960669587
- Cited by
- 35
- References
- 36
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 8 · 2023: 6 · 2022: 6 · 2021: 1 · 2020: 4 · 2018: 2
- FWCI
- 3.24
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Behavior Therapy (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- ScholarSphere (Penn State Libraries) (submittedVersion, cc-by-nc-nd)
- ScholarSphere (Penn State Libraries) (submittedVersion, cc-by)
- Funders
- National Institute of Mental Health (R01MH115128)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- generalized anxiety disorder, worry, cognitive therapy, treatment response, symptom change, ecological momentary assessment
- MeSH terms
- Ecological Momentary Assessment, Anxiety, Anxiety Disorders, Humans, Cognitive Behavioral Therapy, Treatment Outcome
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
