Metacognitions, worry and sleep in everyday life: Studying bidirectional pathways using Ecological Momentary Assessment in GAD patients

• We studied bidirectional pathways of worry and associated phenomena.
• The variables were investigated in everyday life of GAD patients.
• Negative metacognitions lead to heightened levels of worry – but not vice versa.
• We present evidence for a bidirectional worry–sleep quality relationship.
• The cognitive processes under study may be promising targets for treatment.

BackgroundThe metacognitive model of generalized anxiety disorder proposes that negative metacognitive beliefs are crucial in the maintenance of excessive worry. Furthermore, according to the cognitive model of insomnia, worry leads to problems falling or staying asleep and poor sleep quality. In order to test the assumed causal relationships, the present study examined the time-dependent course of negative metacognition and worry as well as worry and sleep quality, using Ecological Momentary Assessment (EMA).MethodNegative metacognitions, worry and sleep were assessed by self-report questionnaires as well as EMA in 56 GAD patients who carried a portable device for 1 week and logged sleep quality, negative metacognition and worry processes four times a day.ResultsMetacognitions, worry and sleep were significantly correlated. Structural equation modeling using multilevel analyses showed a unidirectional relationship of negative metacognitions leading to prolonged worry processes and a bidirectional relationship of worry and sleep quality.ConclusionsThese findings support the theoretically derived assumptions on the relationship between negative metacognitions, worry and sleep. Implications for further research as well as clinical implications are discussed.