CoChat
Sign Up
Cited by 6Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and AssessmentsPsychotherapy Techniques and Applications

Wann sind Sorgen pathologisch?

Open access
Hoyer, Jürgen, Heidrich, Sabrina·2009·Verhaltenstherapie
DOI 10.1159/000201938
Open this paper in CoChat — free accountOpen PDF

Abstract

Pathological worries have not yet been clearly defined. As a consequence, practically relevant questions remain open: Which characteristics distinguish worries relevant for treatment from those which are not? What kind of worries has to be treated in which way? And: What kind of worries is rather to be accepted? We propose a simple rationale which helps the therapist and the patient to identify pathological worries. According to this working model, different treatment strategies result depending on whether worries are central or not, whether they relate to a problem which can be solved or not, and whether they seem proportionate or exaggerated. The presented worksheet is meant to strengthen the perceived control of the patient and to help facilitate psychoeducation for generalised anxiety disorder. Copyright © 2009 S. Karger AG, Basel.

AI snapshot

Written from the paper’s full text.

TL;DR

The paper argues that pathological worry is not clearly demarcated from everyday worry and proposes a practical three-question heuristic to identify treatment-relevant worries. It links different worry categories to differential strategies, especially worry exposure for exaggerated worries about unsolvable problems, and illustrates the approach with a GAD case.

Key findings

  • Worry appears dimensional rather than categorical: clinical and nonclinical worries differ in intensity, controllability, emotional impact, physical symptoms, and time spent—GAD worries involved about ten times more time in the cited study—but not in content or kind.
  • The authors propose sorting worries by importance/centrality, solvability of the underlying problem, and proportionality; only important worries are pursued, solvable problems suggest problem-solving training, and exaggerated worries about unsolvable problems are targets for worry exposure.
  • Worries tied to acute severe stressors may be uncontrollable and emotion-regulating but are not necessarily typical pathological worries; exposure may be too demanding in such situations.
  • A worksheet is intended to help patients and therapists organize worries, increase perceived control, and support psychoeducation for GAD; a case of a 56-year-old woman is described as improving after using the scheme, problem solving, and exposure.

Methods

  • Practice-oriented conceptual article, not a new empirical study; it synthesizes models of worry and GAD and proposes a functional-condition analytic heuristic.
  • It presents a patient worksheet with three sorting questions and a case example of a 56-year-old woman with persistent anxiety, nervousness, sleep and concentration problems, and excessive worries across life domains.
  • Treatment steps illustrated include psychoeducation, an individualized model, self-monitoring, sorting worries, problem-solving for solvable issues, and in-sensu worry exposure for selected exaggerated worries about unsolvable problems.

Limitations

  • The paper states that its summary simplifies research on pathological worry and GAD; it also cautions that moderate or severe depressive episodes should be excluded or remitted before this approach, because self-selection of worries and exposure may overwhelm acutely depressed patients.
  • Evident from the text: the proposed taxonomy and worksheet are not empirically validated in this paper; support comes from clinical experience and a single case, with no diagnostic accuracy, reliability, or controlled outcome data reported here.
  • The article notes that the effectiveness of worry exposure alone was shown in a separate controlled study (Hoyer et al., 2009), but this paper itself does not test the heuristic.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1159/000201938

Cites

37 of 37 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

9 of 42 cited sources checked · 6 supported · 0 flagged · accuracy not yet measured

  • Findingcitation

    The time spent on these worries is 10 times higher in the cited study.

    “Der Zeitaufwand für diese Sorgen ist in der genannten Studie um den Faktor 10 höher.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Hoyer et al. [2001] source

      The General Phenomenological Features of Worry section reports daily worry durations of 381 minutes for GAD patients, 74 for social phobics, and 103 for controls (page not available in our copy). It supports a higher time spent worrying in the GAD group, but does not establish the claimed tenfold difference; the comparator implied by the citing sentence is not identified here. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Premisecitation

    Worry itself, as a predominantly verbal-abstract activity, has an emotion-avoidant function.

    “Insbesondere Borkovec [Borkovec et al., 1998;Sibrava und Borkovec, 2006] hat in seinen Arbeiten darauf hingewiesen, dass den Sorgen selbst, als vorwiegend verbal-abstrakter Aktivität, eine (emotions-)vermeidende Funktion zukommt.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Borkovec et al., 1998 source
    • cites Sibrava und Borkovec, 2006

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Findingcitation

    A treatment concept that uses worry exposure alone to target pathological worries is equally effective, as shown in a recent controlled study.

    “Dass eine Behandlungskonzeption, die mittels Sorgenexposition allein auf die pathologischen Sorgen abzielt, ebenso effektiv ist, konnten wir kürzlich in einer kontrollierten Studie zeigen [Hoyer et al., 2009].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Hoyer et al., 2009 source
  • Premisecitation

    In the second, more important process, worries are used consciously or automatically to reduce physically experienced stress associated with intense emotions.

    “Im zweiten, wichtigeren Prozess werden Sorgen bewusst oder automatisch eingesetzt, um den mit intensiven Emotionen verbundenen, körperlich erlebten Stress zu reduzieren [Borkovec et al., 1998;Mennin et al., 2002].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Borkovec et al., 1998 source

      “Worry Suppresses Somatic Anxiety” (p. 5) reports that worry suppresses cardiovascular responses to threatening images, supporting the claim that it reduces physically experienced anxiety. The cited passages do not establish that worry is used consciously or automatically for this purpose, or characterize it as a second, more important process. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites Mennin et al., 2002 source
  • Premisecitation

    The themes of worries are the same as in healthy people.

    “Die Themen der Sorgen sind die gleichen wie bei Gesunden [Becker et al., 2003].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Becker et al., 2003 source
  • May combine two claims. 23
  • Classified as probably not a substantial claim. 27

  • May combine two claims.

    Premisecitation

    Worries of GAD patients are experienced as significantly less controllable and more emotionally impairing and are accompanied by stronger physical symptoms than those of healthy people or patients with social phobia.

    “Sorgen von Patienten mit Generalisierter Angststörung werden als deutlich weniger kontrollierbar und emotional stärker beeinträchtigend erlebt und sind von stärkeren körperlichen Symptomen begleitet als diejenigen von Gesunden oder von Patienten mit einer anderen Angststörung (Soziale Phobie, Hoyer et al. [2001]).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Hoyer et al. [2001] source

  • May combine two claims.

    Premisecitation

    Worries in patient groups are more frequent and intense but not categorically distinguishable by theme or quality.

    “Sorgen sind bei Patientengruppen zwar häufiger und intensiver, aber weder thematisch [Becker et al., 2003] noch qualitativ kategorial unterscheidbar.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Becker et al., 2003 source

  • May combine two claims.

    Premisecitation

    Two variants of avoidance play a role: a superstitious variant and a process to reduce stress.

    “Zwei Varianten der Vermeidung spielen eine Rolle [Borkovec et al., 1998]:”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Borkovec et al., 1998 source

  • May combine two claims.

    Premisecitation

    In the superstitious variant, patients believe that thinking about a feared event beforehand lowers its probability of occurrence, feel better prepared, and gain a sense of safety and control.

    “Eine «abergläubische» Variante, bei der Patienten meinen, die Auftretenswahrscheinlichkeit eines befürchteten Ereignisses zu senken, wenn sie sich vorher darüber «Gedanken» gemacht haben.Sie fühlen sich dadurch besser vorbereitet.Dies vermittelt ein Gefühl von Sicherheit und Kontrolle.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Borkovec et al., 1998 source

      In “Worry as an Attempt to Avoid Negative Events or to Prepare for the Worst” (pp. 7–8), the paper reports that people believe worrying prepares them for the worst and can make a feared event seem less likely to occur. It describes this as a superstitious association, but does not say that it gives them a feeling of safety and control. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    In the case example, important solvable problems could be worked on with systematic problem solving, which strengthened the experience of control.

    “Wichtige lösbare Probleme (Zeitmanagement bei der Arbeit; Organisation der Enkelkindbetreuung) konnten mittels systematischem Problemlösen bearbeitet werden, was das Kontrollerleben stärkte.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In the case example, after applying the ordering scheme for worries, the patient experienced a clear reduction in frequency of worry episodes within a short time.

    “Durch die nachfolgende Anwendung des Ordnungsschemas für die Sorgen erlebte die Patientin binnen kurzer Zeit eine deutliche Reduktion der Häufigkeit und Frequenz von Sorgenepisoden.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingreasoning

    Working through the taxonomy of worries alone is accompanied by great relief for many patients.

    “Allein das Bearbeiten der Taxonomie der Sorgen geht für viele Patienten mit großer Entlastung einher.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the case example, after confrontation in sensu with two relevant worry areas and targeted abandonment of avoidance behavior, the clinically relevant worry symptomatology remitted within a few weeks and general physical arousal and tension were clearly reduced.

    “Infolge der Konfrontation in sensu mit zwei der als relevant identifizierten Sorgenbereiche und der gezielten Aufgabe des Vermeidungsverhaltens (Rückversicherung, Ablenkung sowie Kontrollstrategien) waren die klinisch relevante Sorgensymptomatik bei der Patientin binnen weniger Wochen remittiert sowie das Ausmaß der allgemeinen körperlichen Erregung und Anspannung deutlich reduziert.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The additional 6-month duration criterion is intended to ensure that everyday worries and problems do not lead to a GAD diagnosis.

    “Das zusätzliche, relativ strenge Zeitkriterium von 6 Monaten soll sicherstellen, dass nicht schon Alltagssorgen und -probleme zur Vergabe der Diagnose einer Generalisierten Angststörung führen.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites DSM-IV-Textrevision; deutsch: Saß et al., 2003

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    GAD patients tend to more accurate perception of phasic arousal and to catastrophizing overinterpretations.

    “zugleich neigen sie zu einer genaueren Wahrnehmung des phasischen Arousals und zu katastrophisierenden Überinterpretationen [Andor et al., 2008].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Andor et al., 2008 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Worries may also have a positive function, although this is controversial in the literature.

    “Sorgen haben möglicherweise auch eine positive Funktion (s.u.), wenngleich dies in der Literatur umstritten ist [vgl.Davey, 2006].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Davey, 2006

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    Because worries are not accompanied by increased sympathetic activity but limit the emergence of strong emotional and physical symptoms, they can act as a short-term negative reinforcer.

    “Da Sorgen nicht mit erhöhter sympathischer Aktivität einhergehen, sondern das Aufkommen starker emotionaler und körperlicher Symp-tome begrenzen, können sie als kurzfristiger negativer Verstärker (Wegfall unangenehmer Spannung) wirksam werden.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Work with central worries is often made more difficult by patients repeatedly bringing up new worries whose function is essentially to avoid dealing with the most feared topics.

    “Die Arbeit mit den zentralen Sorgen wird nicht selten erschwert, indem die Patienten immer wieder neue Sorgen vorbringen, deren Funktion im Wesentlichen ist, die Beschäftigung mit den am meisten gefürchteten Themen zu vermeiden.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Interpretationreasoning

    In clinical work, it has proven useful to distinguish between important (central and recurring) and less important worries, to separate worries about solvable from those about unsolvable problems, and to evaluate worries arising from massive acute threats differently from exaggerated worries about improbable events.

    “Dabei hat es sich in der klinischen Arbeit bewährt, zwischen wichtigen (zentralen und wiederkehrenden) und weniger wichtigen Sorgen und Sorgenbereichen zu unterscheiden, Sorgen über lösbare von solchen über unlösbare Probleme zu trennen und Sorgen, die angesichts massiver akuter Bedrohungen entstehen, anders zu werten als überzogene Sorgen über unwahrscheinliche (wenn auch gravierende) Ereignisse.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Worries can be uncontrollable and serve emotion regulation (and avoidance) without counting as typical pathological worries when acute and severe stressors are present.

    “Sorgen können nach unserer klinischen Beobachtung unkontrollierbar sein und auch der Funktion der Emotionsregulation (und -vermeidung) dienen, ohne dass sie zu den typischen pathologischen Sorgen zu zählen sind: Dies ist der Fall, wenn akute und schwerwiegende Belastungen vorliegen”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Through the taxonomic system and corresponding psychoeducation, patients learn to create order in their initially chaotic-seeming system of worries.

    “Durch das taxonomische System und die entsprechende Psychoedukation lernen die Patienten, in ihrem zunächst als chaotisch empfundenen System der Sorgen Ordnung herzustellen.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    The attempted control of one's own thoughts is an unattainable goal and indirectly leads to persistent preoccupation with them.

    “Die angestrebte Kontrolle der eigenen Gedanken ist ein nicht zu realisierendes Ziel und führt indirekt zu einer anhaltenden Beschäftigung mit ihnen.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Worries about solvable problems can be functional and thus of little relevance for treatment.

    “wenn Sorgen etwa zum Abschluss einer Reiserücktrittsversicherung führen, die intensivere Vorbereitung auf eine Prüfung motivieren oder der Prüfung der Bremsen eines Autos vorausgehen, um nur einige Beispiele zu nennen, so kann dies funktional, und damit für die Behandlung wenig relevant, sein.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    The approach is readily compatible with the manual for worry exposure by Becker and Margraf.

    “Dieser Ansatz ist ohne Weiteres kompatibel mit dem Manual zur Sorgenexposition von Becker und Margraf [2007].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Becker und Margraf [2007]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    In an acute situation, exposure in sensu could be overwhelming if this procedure has not already been established in therapy.

    “Bei einer solchen akuten Situation könnte eine Exposition in sensu eine Überforderung darstellen, sofern dieses Vorgehen nicht bereits in der Therapie etabliert wurde.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Both self-selection of suitable worries and worry exposure itself are likely to be overwhelming in acute depressive symptomatology.

    “Sowohl die Selbstselektion geeigneter Sorgen als auch die Sorgenexposition selbst dürften bei akuter depressiver Symptomatik eine Überforderung darstellen [Becker und Hoyer, 2005;Becker und Margraf, 2007].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Becker und Hoyer, 2005

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Becker und Margraf, 2007

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationcitation

    It is sensible to distinguish harmless (or appropriate) from clinically relevant worries.

    “und schon allein aus diesem Grund ist es sinnvoll, «harmlose» (oder angemessene) von klinisch relevanten Sorgen zu unterscheiden.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    In Wells' model, all worries are initially not pathological.

    “In seinem Modell sind alle Sorgen per se zunächst nicht pathologisch.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Wells [1997, 1999]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    A simple disorder model is essential for cognitive behavioral therapy of GAD.

    “Ein solches, einfaches Störungsmodell ist für die kognitive Verhaltenstherapie der Generalisierten Angststörung unerlässlich [Helbig und Hoyer, 2007].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Helbig und Hoyer, 2007

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationreasoning

    The method is likely particularly efficient when both therapist and patient are clear about which worries are dysfunctional and pathological and which are not.

    “Die Methode dürfte dann besonders effizient sein, wenn sowohl Therapeut als auch Patient sich darüber im Klaren sind, welche Sorgen dysfunktional und pathologisch sind, und welche nicht.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    All these worries can be present in a single person in addition to the central worries of GAD patients.

    “Alle diese Sorgen können bei einer einzelnen Person zusätzlich zu den für Patienten mit Generalisierter Angststörung zentralen Sorgen gegeben sein.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    The heuristic presented also helps therapists select the right worries for worry exposure.

    “Gleichzeitig hilft die hier vorgestellte Heuristik aber auch Therapeuten, die richtigen Sorgen für die Sorgenexposition auszuwählen.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Not only overt behavior but also cognitive behavior itself is controlled by cognitions, in the latter case metacognitions.

    “Nicht nur offenes Verhalten, sondern auch kognitives Verhalten selbst werde durch Kognitionen, in letzterem Fall Meta-Kognitionen, gesteuert.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Wells [1997, 1999]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Premisecitation

    Deriving such a model is a prerequisite for motivating patients to undergo worry exposure.

    “Die Ableitung eines solchen Modells ist die Voraussetzung dafür, Patienten zur Sorgenexposition zu motivieren [Becker und Margraf, 2007;Hoyer und Becker, 2005].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Becker und Margraf, 2007

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Hoyer und Becker, 2005

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Patients often subjectively experience that they are at a loss because of worries and that they worry about everything possible.

    “Subjektiv erleben Patienten es oft so, dass sie vor Sorgen nicht mehr ein noch aus wissen, und es kommt ihnen so vor, als machten sie sich über «alles Mögliche» Sorgen.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    GAD is defined among other things by worries not being restricted to single areas.

    “Die Generalisierte Angststörung ist unter anderem dadurch definiert, dass die Sorgen nicht nur auf einzelne Bereiche beschränkt sind.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Worries are also an attempt to prevent future catastrophes or to generate what-if questions to reduce uncertainty.

    “Grundsätzlich sind Sorgen auch ein Versuch, zukünftige Katastrophen zu verhindern [Davey et al., 1996;Davey, 2006] oder Was-wäre-wenn?-Fragen zu generieren, um Unsicherheit zu reduzieren [Dugas et al., 1997].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Davey et al., 1996 source
    • cites Davey, 2006

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Dugas et al., 1997 source

  • May combine two claims.

    Interpretationreasoning

    Negative metacognitions are particularly important for maintaining the disorder because they promote worries about worries (meta-worries) and initiate dysfunctional and counterproductive counter-regulation attempts.

    “Negative Meta-Kognitionen seien für die Störungsaufrechterhaltung aber von besonderer Bedeutung, weil sie «Sorgen über Sorgen» (meta-worries) fördern und weil sie dysfunktionale und kontraproduktive Gegenregulationsversuche initiieren.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    According to our clinical experience, patients quickly succeed in distinguishing important from less important worries in connection with targeted psychoeducation.

    “Unserer klinischen Erfahrung nach gelingt dies Patienten in Verbindung mit der gezielt eingesetzten Psychoedukation schnell.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Sorting out worries alone can already lead to significant relief at the beginning of therapy because it becomes clear that worries are not as branched and endless as they subjectively seemed at first.

    “Allein dieses «Aussortieren» von Sorgen kann bereits am Anfang der Therapie zu einer bedeutsamen Entlastung führen, weil deutlich wird, dass die Sorgen nicht so verzweigt und endlos sind, wie es subjektiv anfangs gewirkt hat.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Worry exposure is a suitable way to check negative metacognitions for their reality content.

    “Sorgenexposition sei ein geeigneter Weg, insbesondere die negativen Meta-Kognitionen auf ihren Realitätsgehalt hin zu überprüfen.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Less important worries, often occurring in worry chains, have an emotion-regulating and avoidant function that must be considered in psychoeducation.

    “Auch wenn den «weniger wichtigen», oft in sogenannten Sorgenketten auftretenden Sorgen auf diese Weise therapeutisch relativ leicht begegnet werden kann, so haben sie andererseits eine emotionsregulierende und -vermeidende Funkti-on, die es im Rahmen der Psychoedukation (bzw.des Modells der Aufrechterhaltung) zu berücksichtigen gilt.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Control attempts such as thought suppression, distraction, avoidance, and worry chains share that they can reduce worry frequency at most short-term but maintain the problem long-term.

    “Kontrollversuchen wie Gedankenunterdrückung, Ablenkung, Vermeidung und Sorgenketten ist gemeinsam, dass sie allenfalls kurzfristig die Häufigkeit von Sorgen mindern können, längerfristig aber das Problem aufrechterhalten.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    When patients then try to counter-regulate, worries tend to become stronger, and this in turn seems to confirm existing negative metacognitions.

    “Wenn die Patienten dann versuchen gegenzuregulieren, werden die Sorgen eher stärker, und dies wiederum scheint bestehende negative Meta-Kognitionen (z.B. «Ich werde meiner Sorgen nicht mehr Herr») zu bestätigen.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    For patients, worries often have an emotion-avoidant function; this leads to a strong expansion of frequency and intensity of worries especially when many emotions are involved, i.e., in times of crisis and stress.

    “Für Patienten haben die Sorgen häufig eine emotionsvermeidende Funktion; dies führt aber dazu, dass sich gerade dann, wenn viele Emotionen im Spiel sind, also in Krisen-und Belastungszeiten, die Häufigkeit und Intensität der Sorgen stark ausweitet.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Interpretationcitation

    Negative metacognitions about worries are a relatively complex construct, so their exploration in therapy is not easy and requires special training.

    “Da es sich bei diesen sogenannten negativen Meta-Kognitionen über die Sorgen um ein relativ komplexes Konstrukt handelt, ist ihre Exploration in der Therapie nicht einfach und bedarf des speziellen Trainings (praktische Hinweise hierzu bei Wells [1997]).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Wells [1997]

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationown data

    According to our clinical observation, negative metacognitions can be well identified especially in the context of cognitive preparation for worry exposure.

    “Unserer klinischen Beobachtung nach lassen sich negative Meta-Kognitionen insbesondere im Kontext der kognitiven Vorbereitung zur Sorgenexposition gut identifizieren.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Worry chains can be rather catastrophizing chains (within one topic area) or thematic jumps.

    “Dies können eher «katastrophisierende Ketten» (innerhalb eines Themenbereiches) oder thematische Sprünge sein.”
    Quote in the paperNot a substantial claim
43 of 43

Cites

Flagged first, then by citations

Research works printed but not linked: 7

  1. [2]2. Bär T, Zubrägel D, Linden M: Kognitive Verhaltens- therapie bei generalisierten Angststörungen -das Manual der Berliner KVT-GAD-Studie. Verhal- tensther Verhaltensmed 2007;28:447-462.
  2. [6]6. Becker ES, Goodwin R, Hölting C, Hoyer J, Margraf J: Worry and worry content in young women. J Nerv Ment Dis 2003;191:688-691.
  3. [7]7. Böhm K, Förstner U, Külz A, Voderholzer U: Versor- gungsrealität der Zwangsstörungen: Werden Ex- positionsverfahren eingesetzt? Verhaltenstherapie 2008;18:18-24.
  4. [14]14. Davey GCL, Wells A (eds): Worry and Its Psycho- logical Disorders. Chichester, Wiley, 2006.
  5. [21]21. Helbig S, Hoyer J: Hilft wenig viel? Effekte einer Minimalintervention in der Wartezeit auf eine am- bulante Psychotherapie. Verhaltenstherapie 2007;17: 109-115.
  6. [27]27. Hoyer J, Beesdo K, Becker ES, Wittchen HU: Epi- demiologie und nosologischer Status der Genera- lisierten Angststörung. Z Klin Psychol Psychother 2003;32:267-275.
  7. [38]38. Stöber J: Besorgnis: Ein Vergleich dreier Inventare zur Erfassung allgemeiner Sorgen. Z Diff Diagn Psychol 1995;16:50-63.

Cited by

Sorted by citations

Related

Authors
Hoyer, J., & Heidrich, S.
Affiliations
Technische Universität Dresden (DE)
Corresponding author
Hoyer, Jürgen
ORCID
Hoyer, Jürgen
Venue
Verhaltenstherapie
Publisher
S. Karger AG
Published
2009
Volume
19
Issue
1
Pages
33-39
ISSN
  • 1016-6262 (ISSN-L)
  • 1423-0402
DOI
10.1159/000201938
OpenAlex
W2058398545
Cited by
6
References
35
Citations by year
2026: 1 · 2025: 1 · 2023: 1 · 2014: 2
FWCI
0.42
Type
journal article
Language
en
Open access
Licence
Locations
  • Verhaltenstherapie (publishedVersion)
  • Qucosa (Saxon State and University Library Dresden) (submittedVersion, other-oa)
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
pathological worry, generalized anxiety disorder, treatment planning, perceived control, psychoeducation, cognitive behavioral therapy

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.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

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