Abstract
Background: The long-term dynamic interaction between symptoms of generalized anxiety disorder (GAD) and their theorized mechanistic processes derived from three treatment models of GAD-the emotion dysregulation model, the model underlying metacognitive therapy (MCT), and the intolerance of uncertainty model-was investigated. Methods: Four data waves 2 months apart were delivered by a representative population sample of 4361 participants during the COVID-19 pandemic in Norway. Networks were estimated using the newly developed panel graphical vector autoregression (panel-GVAR) methods. Results: In the temporal network, and consistent with processes stipulated in the metacognitive model, the experience that worry is uncontrollable predicted the GAD symptom fear of awful events, which in turn predicted a range of other GAD symptoms, that is, anxiety, restlessness, and irritability. Fear of awful events had high outstrength, that is, predicted other variables to a large degree. Inconsistent with the metacognitive model, the coping strategy thought suppression negatively predicted restlessness. Consistent with the emotion dysregulation model, emotion dysregulation predicted avoidance. No relationships proposed by the intolerance of uncertainty model of GAD were identified in the temporal network. The contemporaneous network was dense with nodes clustering according to the constructs they belonged to. Conclusions: The findings indicate the importance of the theory-derived variables, the experience and belief that worry is uncontrollable and emotion dysregulation, as potential targets for intervention to alleviate GAD symptoms. The findings also indicate that uncontrollability of worry and fear of awful events should be considered central symptoms of GAD in a within-individual diagnostics supplementary to current diagnostic manuals, such as the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5).