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Newman MG, Przeworski A. Introduction to a special issue on the contrast avoidance model. J Anxiety Disord 2024; 102:102831. [PMID: 38219396 PMCID: PMC10923019 DOI: 10.1016/j.janxdis.2024.102831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/06/2024] [Accepted: 01/07/2024] [Indexed: 01/16/2024]
Abstract
The current paper introduces the special issue on the Contrast Avoidance Model. The Contrast Avoidance Mmodel theorizes that chronic worriers are afraid of a sharp increase in negative emotion and/or sharp reduction in positive emotion (labeled negative emotional contrasts; NECs). They thus use perseverative thought as means to create and sustain negative emotion to prevent NECs if they were to experience negative events. Further, these individuals are uncomfortable with sustained positive emotion because it leaves them vulnerable to NECs. At the same time, worry increases the probability of positive emotional contrasts (PECs), or sharp increases in positive emotion or decreases in negative emotion when things turn out better than expected or positive events are experienced. Therefore, these individuals generate negative emotion via perseverative thought as a way to avoid NECs and increase the likelihood of PECs. The current special issue provides novel research on the model.
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Przeworski A, Newman MG. The Contrast Avoidance Model: Conclusion and synthesis of new research in the special issue. J Anxiety Disord 2024; 102:102830. [PMID: 38232491 PMCID: PMC10923164 DOI: 10.1016/j.janxdis.2024.102830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/06/2024] [Accepted: 01/07/2024] [Indexed: 01/19/2024]
Abstract
In this special series, new research on the Contrast Avoidance Model (CAM) was presented, including studies on the role of CAM in the maintenance of chronic worry, the incremental validity of CAM, CAM as a mediator of the association between generalized anxiety disorder (GAD) and other variables, CAM as transdiagnostic, and interpersonal behaviors as a means to avoid negative emotional contrasts (NECs). Furthermore, the role of perseverative thought in relation to positive emotional contrasts (PECs) was explored. Studies indicated that higher worry was positively and negatively reinforced, a factor that is likely to contribute to the maintenance of GAD. Further, research demonstrated that CAM contributed unique variance to understanding GAD above and beyond other variables associated with GAD, such as intolerance of uncertainty and negative problem orientation. Additional research revealed the transdiagnostic nature of contrast avoidance, as well as the association between contrast avoidance and problem-solving deficits. In addition, both worry and rumination increased the likelihood of PECs. Further, data suggested that anxious individuals may use interpersonal strategies to avoid NECs. Finally, savoring positive emotions was found to reduce contrast avoidance, providing a novel intervention strategy to address contrast avoidance in individuals with GAD.
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Kirk PA, Holmes AJ, Robinson OJ. Anxiety Shapes Amygdala-Prefrontal Dynamics During Movie Watching. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:409-417. [PMID: 37519469 PMCID: PMC10382705 DOI: 10.1016/j.bpsgos.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 10/18/2022] Open
Abstract
Background A well-characterized amygdala-dorsomedial prefrontal circuit is thought to be crucial for threat vigilance during anxiety. However, engagement of this circuitry within relatively naturalistic paradigms remains unresolved. Methods Using an open functional magnetic resonance imaging dataset (Cambridge Centre for Ageing Neuroscience; n = 630), we sought to investigate whether anxiety correlates with dynamic connectivity between the amygdala and dorsomedial prefrontal cortex during movie watching. Results Using an intersubject representational similarity approach, we saw no effect of anxiety when comparing pairwise similarities of dynamic connectivity across the entire movie. However, preregistered analyses demonstrated a relationship between anxiety, amygdala-prefrontal dynamics, and anxiogenic features of the movie (canonical suspense ratings). Our results indicated that amygdala-prefrontal circuitry was modulated by suspense in low-anxiety individuals but was less sensitive to suspense in high-anxiety individuals. We suggest that this could also be related to slowed habituation or amplified anticipation. Moreover, a measure of threat-relevant attentional bias (accuracy/reaction time to fearful faces) demonstrated an association with connectivity and suspense. Conclusions Overall, this study demonstrated the presence of anxiety-relevant differences in connectivity during movie watching, varying with anxiogenic features of the movie. Mechanistically, exactly how and when these differences arise remains an opportunity for future research.
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Affiliation(s)
- Peter A. Kirk
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
- Experimental Psychology, University College London, London, United Kingdom
- Departments of Psychology and Psychiatry, Yale University, New Haven, Connecticut
| | - Avram J. Holmes
- Departments of Psychology and Psychiatry, Yale University, New Haven, Connecticut
- Wu Tsai Institute, Yale University, New Haven, Connecticut
| | - Oliver J. Robinson
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
- Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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Saalwirth C, Leipold B. Well‐being and sleep in stressful times of the COVID‐19 pandemic: Relations to worrying and different coping strategies. Stress Health 2021; 37:973-985. [PMID: 33913244 PMCID: PMC8237007 DOI: 10.1002/smi.3057] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/01/2021] [Accepted: 04/26/2021] [Indexed: 12/11/2022]
Abstract
The present study examined the relationships between emotional well-being (positive and negative affect), sleep-related variables (sleep quality, sleep duration, and change in sleep quality and duration compared to weeks before lockdown), and worrying about coronavirus disease (COVID-19) challenges during the beginning of the outbreak in Europe. In addition, four different coping strategies were investigated. The study was conducted in Germany with data from 665 participants (53.8% female; 18-73 years), who completed an online questionnaire in April 2020. The results revealed that COVID-19 worry was associated with impaired well-being and sleep. Meaning- and problem-focused coping were the most frequently used coping strategies, and showed positive associations with well-being and sleep. Social and avoidance coping were associated with decreased well-being and worse sleep outcomes. Three coping strategies showed moderating effects. People who worried more showed higher levels of positive affect when they used problem-focused coping compared to those who did not. Similarly, highly worried participants showed lower levels of negative affect when they reported using meaning-focused coping more often. In contrast, social coping increased the risk of high negative affect levels in worried participants. In conclusion, problem-focused and meaning-focused coping strategies seemed to be most effective in coping with COVID-19 challenges.
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Affiliation(s)
- Christina Saalwirth
- Department of PsychologyDevelopmental & Health Psychology UnitBundeswehr University MunichNeubibergGermany
| | - Bernhard Leipold
- Department of PsychologyDevelopmental & Health Psychology UnitBundeswehr University MunichNeubibergGermany
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Repetitive Negative Thinking and Eating Disorders: A Meta-Analysis of the Role of Worry and Rumination. J Clin Med 2021; 10:jcm10112448. [PMID: 34073087 PMCID: PMC8198834 DOI: 10.3390/jcm10112448] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 11/28/2022] Open
Abstract
The role of worry and rumination in eating disorders (EDs) is controversial. This meta-analysis of the literature is aimed at clarifying the relationship between repetitive negative thinking (RNT) and EDs. In accordance with the PRISMA criteria, a comprehensive search of the literature was conducted on PubMed and PsycInfo from inception to March 2021. Search terms: “eating disorder/anorexia/bulimia/binge eating disorder” AND “worry/rumination/brooding/repetitive thinking”. A manual search of reference lists was also run. Forty-three studies were included. RNT was found to be associated with anorexia, bulimia, and binge eating disorder. A moderating effect was found for “presence/absence ED diagnosis” and “subtype of ED symptom”. ED patients showed higher RNT than the general population. No differences were observed for age or between worry and rumination in the magnitude of their association with EDs.
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MacLellan A, Derakshan N. The Effects of Stoic Training and Adaptive Working Memory Training on Emotional Vulnerability in High Worriers. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-020-10183-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jendrusina AA, Stevens ES, Nahin ER, Legrand AC, Behar E. Concreteness of thoughts and images during suppression and expression of worry. Behav Res Ther 2020; 135:103754. [PMID: 33091681 DOI: 10.1016/j.brat.2020.103754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 06/21/2020] [Accepted: 10/07/2020] [Indexed: 11/26/2022]
Abstract
The avoidance theory of worry (Borkovec, Alcaine, & Behar, 2004) posits that the verbal-linguistic (versus imagery-based) nature of worry elicits abstract (versus concrete) processing, which inhibits affective responding and generates a host of negative consequences. Although suppression of worrisome thinking is maladaptive (Purdon, 1999), expression of worry using vivid imagery may increase concreteness of worrisome thinking and facilitate more adaptive emotional responding. The present study examined whether the valence, content, and expression of mentation impacts concreteness of thought. Participants (N = 62) were randomly assigned to verbalize their thoughts while engaging in either verbal-linguistic- or imagery-based mentation about both worrisome and neutral topics. Participants were also randomly assigned to engage in a 5-min period of suppressing or expressing the target stimuli before engaging in 5-min of freely expressing the targets. Verbalizations of mental content were coded for level of abstractness/concreteness. For neutral stimuli, imagery-based mentation led to greater concreteness than did verbal-linguistic mentation; however, for worrisome stimuli, imagery-based mentation did not enhance concreteness. In addition, for neutral (but not worrisome) stimuli, an initial period of suppression was associated with increased concreteness during subsequent expression. Imagery-based mentation about worrisome stimuli may not enhance concreteness; moreover, unlike suppression of neutral stimuli, suppression of worrisome stimuli may maintain, rather than ameliorate, abstractness of thought.
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Affiliation(s)
| | | | | | | | - Evelyn Behar
- City University of New York - Hunter College, USA
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Ballesio A, Bacaro V, Vacca M, Chirico A, Lucidi F, Riemann D, Baglioni C, Lombardo C. Does cognitive behaviour therapy for insomnia reduce repetitive negative thinking and sleep-related worry beliefs? A systematic review and meta-analysis. Sleep Med Rev 2020; 55:101378. [PMID: 32992228 DOI: 10.1016/j.smrv.2020.101378] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 11/19/2022]
Abstract
Repetitive negative thinking (RNT), i.e., worry, rumination, and transdiagnostic repetitive thinking, is thought to exacerbate and perpetuate insomnia in cognitive models. Moreover, RNT is a longitudinal precursor of depression and anxiety, which are often co-present alongside insomnia. Whilst accumulating evidence supports the efficacy of cognitive behavioural therapy for insomnia (CBT-I) in reducing depression and anxiety symptoms, the literature on the effects of CBT-I on RNT has never been systematically appraised. Importantly, preliminary evidence suggests that reduction of RNT following CBT-I may be associated with reduction of depression and anxiety. Therefore, we aimed to conduct a systematic review and meta-analysis on the effects of CBT-I on RNT. Seven databases were searched, and 15 randomised controlled trials were included. Results showed moderate-to-large effects of CBT-I on worry (Hedge's g range: -0.41 to g = -0.71) but small and non-reliable effects on rumination (g = -0.13). No clear evidence was found for an association between post-treatment reduction in RNT and post-treatment reduction in depression and anxiety. Although the literature is small and still developing, CBT-I seems to have a stronger impact on sleep-related versus general measures of RNT. We discuss a research agenda aimed at advancing the study of RNT in CBT-I trials.
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Affiliation(s)
- Andrea Ballesio
- Department of Psychology, Sapienza University of Rome, Italy; Department of Developmental and Social Psychology, Sapienza University of Rome, Italy.
| | - Valeria Bacaro
- Department of Human Sciences, University of Rome "G. Marconi"- Telematic, Italy
| | | | - Andrea Chirico
- Department of Developmental and Social Psychology, Sapienza University of Rome, Italy
| | - Fabio Lucidi
- Department of Developmental and Social Psychology, Sapienza University of Rome, Italy
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Chiara Baglioni
- Department of Human Sciences, University of Rome "G. Marconi"- Telematic, Italy; Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Structure and Psychometric Properties of the Penn State Worry Questionnaire for Children in Chinese Adolescents. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:1499-1510. [PMID: 32712738 DOI: 10.1007/s10802-020-00680-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The present research introduced the Penn State Worry Questionnaire for Children (PSWQ-C) to China and evaluated its structure and psychometric properties in Chinese adolescent samples. The PSWQ-C is a 14-item self-report questionnaire designed to measure the generality, excessiveness, and uncontrollability aspects of pathological worries in children and adolescents. Factor analysis results suggested that the three reverse-scored items represented one or more unknown factors rather than worry; thus, they were discarded and the remaining 11 positively worded items formed the Chinese version of the PSWQ-C (CH-PSWQ-C). The CH-PSWQ-C was found to have acceptable internal consistency reliability and favorable convergent and divergent validity by examining its correlations with measures of anxiety, depression, and some personality characteristics. To illustrate the utility of the CH-PSWQ-C in Chinese adolescent samples, we used the CH-PSWQ-C to explore the moderating effect of neuroticism on the relationship between earthquake experiences and worry; the results suggested that adolescents with high neuroticism were more vulnerable to worry after experiencing serious disasters.
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Bauer EA, Braitman AL, Judah MR, Cigularov KP. Worry as a mediator between psychosocial stressors and emotional sequelae: Moderation by contrast avoidance. J Affect Disord 2020; 266:456-464. [PMID: 32056913 DOI: 10.1016/j.jad.2020.01.092] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/30/2019] [Accepted: 01/20/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Worry is the core feature of generalized anxiety disorder (GAD), which is prevalent among emerging adults. The contrast avoidance model proposes that individuals with GAD use worry to avoid negative emotional contrasts by maintaining a state of negative affect. Research suggests worry in response to stressors increases anxiety, but more research is needed to examine depression as an outcome and the predictions of contrast avoidance in the context of multiple stressor subtypes. The current study examined whether worry may be associated with increased symptoms of anxiety and depression, regardless of stressors, due to the use of worry as an avoidance strategy, moderating these associations. METHODS 367 undergraduate college students from a medium-sized, public university completed self-report questionnaires online. RESULTS Worry significantly mediated the associations from academic stressors and social stressors to symptoms of anxiety and depression. Contrast avoidance significantly moderated associations between academic stressors and worry as well as worry and anxiety. For those high in contrast avoidance, worry was relatively high regardless of academic stressors; for those low in contrast avoidance, students with fewer academic stressors reported less worry. LIMITATIONS The present study relied on self-report. In addition, the cross-sectional design limits the ability to draw conclusions about temporal relations. CONCLUSIONS Contrast avoidance elevated worry regardless of academic stressors, and strengthened the association between worry and anxiety but not worry and depression. Individuals who experience high levels of contrast avoidance may benefit from cognitive interventions focusing on reducing beliefs about the perceived benefits of worry.
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Affiliation(s)
- Elizabeth A Bauer
- Old Dominion University, 132-E Mills Godwin Bldg, Norfolk, VA 23529, United States
| | - Abby L Braitman
- Old Dominion University, 132-E Mills Godwin Bldg, Norfolk, VA 23529, United States; Virginia Consortium Program in Clinical Psychology, United States.
| | - Matt R Judah
- Old Dominion University, 132-E Mills Godwin Bldg, Norfolk, VA 23529, United States; Virginia Consortium Program in Clinical Psychology, United States
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11
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Castagna PJ, Calamia M, Davis Iii TE. Can worry and physiological anxiety uniquely predict children and adolescents' academic achievement and intelligence? APPLIED NEUROPSYCHOLOGY-CHILD 2019; 10:53-64. [PMID: 30987449 DOI: 10.1080/21622965.2019.1596809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
When exploring the relationship anxiety has with IQ, academic achievement studies often rely on diagnostic groups or total scores for an anxiety measure. The differential effects caused by anxiety dimensions, as well as their interactions, were examined with an exploratory method. This study examined the main effect of worry and physiological anxiety as predictors of youths' academic and cognitive functioning. Two samples of youth that presented to an out-patient clinic (n = 121, M = 10.59, SD = 2.78, range = 6-16; n = 92, M = 10.07, SD = 2.76, range = 6-16) were administered well-established performance measures of academic and intellectual functioning, along with a measurement of anxiety. In an exploratory analysis, the interaction between worry and physiological anxiety was the only significant effect, robust across all academic composites and intelligence indices. Physiological anxiety had a differential relationship with academic achievement domains (and processing speed) dependent on levels of worry; low-levels of worry were predictive of improved scores at high, but not low-, levels of physiological anxiety. In contrast, high-, but not low-, levels of physiological anxiety were associated with lower scores when accompanied by elevated levels of worry when predicting intelligence indices.
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Affiliation(s)
- Peter J Castagna
- College of Agriculture, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Matthew Calamia
- College of Agriculture, Louisiana State University, Baton Rouge, Louisiana, USA
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12
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Newman MG, Jacobson NC, Zainal NH, Shin KE, Szkodny LE, Sliwinski MJ. The Effects of Worry in Daily Life: An Ecological Momentary Assessment Study Supporting the Tenets of the Contrast Avoidance Model. Clin Psychol Sci 2019; 7:794-810. [PMID: 31372313 DOI: 10.1177/2167702619827019] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The contrast avoidance model (CAM) suggests that worry increases and sustains negative emotion to prevent a negative emotional contrast (sharp upward shift in negative emotion) and increase the probability of a positive contrast (shift toward positive emotion). In Study 1, we experimentally validated momentary assessment items (N = 25). In Study 2, participants with generalized anxiety disorder (N = 31) and controls (N = 37) were prompted once per hour regarding their worry, thought valence, and arousal 10 times a day for 8 days. Higher worry duration, negative thought valence, and uncontrollable train of thoughts predicted feeling more keyed up concurrently and sustained anxious activation 1 hr later. More worry, feeling keyed up, and uncontrollable train of thoughts predicted lower likelihood of a negative emotional contrast in thought valence and higher likelihood of a positive emotional contrast in thought valence 1 hr later. Findings support the prospective ecological validity of CAM. Our findings suggest that naturalistic worry reduces the likelihood of a sharp increase in negative affect and does so by increasing and sustaining anxious activation.
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Affiliation(s)
| | - Nicholas C Jacobson
- Department of Psychology, The Pennsylvania State University.,Massachusetts General Hospital, Boston, Massachusetts
| | | | - Ki Eun Shin
- Department of Psychology, The Pennsylvania State University
| | - Lauren E Szkodny
- Department of Psychology, The Pennsylvania State University.,Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Martin J Sliwinski
- Department of Psychology, The Pennsylvania State University.,Department of Human Development and Family Studies, The Pennsylvania State University
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Intolerance of uncertainty, depression, and anxiety: Examining the indirect and moderating effects of worry. Asian J Psychiatr 2017; 29:129-133. [PMID: 29061409 DOI: 10.1016/j.ajp.2017.04.017] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 03/22/2017] [Accepted: 04/25/2017] [Indexed: 11/23/2022]
Abstract
The present study sought to examine the indirect and moderating effects of worry between intolerance of uncertainty (IU) and symptoms of depression and anxiety. The study was a cross sectional study. Data were collected from 120 psychiatric patients, aged 22 to 37 years. A battery of self-report questionnaires was administered for tapping IU, worry, depression and anxiety symptoms. Results from indirect effects analyses revealed that even though IU, worry, depression, and anxiety symptoms correlated moderately with each other, worry carried a substantial proportion of variance in predicting symptoms of depression and anxiety. However, the relative effect was more pronounced for anxiety compared to depression symptoms. The results from hierarchical analyses supported the moderator role of worry. More specifically, a high level of worry enhanced the association between IU and symptoms of depression and anxiety. Given the potential for worry as a mechanism, and/or moderator between IU and symptoms of depression and anxiety, adults with a tendency to use this negative repetitive thought process (e.g. worry) may be at higher risk to develop psychological symptoms.
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14
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Nakajima M, Takano K, Tanno Y. Adaptive functions of self-focused attention: Insight and depressive and anxiety symptoms. Psychiatry Res 2017; 249:275-280. [PMID: 28135598 DOI: 10.1016/j.psychres.2017.01.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 10/21/2016] [Accepted: 01/10/2017] [Indexed: 11/19/2022]
Abstract
Maladaptive forms of self-focus, such as rumination, are considered transdiagnostic factors that contribute to depressive and anxiety symptoms. However, no or few studies have explored the possibility that adaptive forms of self-focus can also be a common factor that is negatively associated with depressive and anxiety symptoms. To test this possibility, we first examined the psychometric properties of a scale measuring adaptive forms of self-focus (the Self-Reflection and Insight Scale) on Japanese undergraduates (n=117). We replicated the two-factor structure of the scale: (a) self-reflection, which is a tendency to focus purposefully on self for self-regulation, and (b) insight, which is a sense of clear self-understanding. Second, we tested our specific hypothesis that these two factors negatively predict a common factor of depressive and anxiety symptoms. The results of structural equation modeling showed that insight (but not self-reflection) has a significant negative association with a latent variable that explains both depressive and anxiety symptoms. Furthermore, this common-factor model explained the data better than a control model in which insight predicts depressive and anxiety symptoms individually. These results suggest that (lack of) insight plays an important role in psychological (mal)adjustment as a shared process in depressive and anxiety symptoms.
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Affiliation(s)
- Miho Nakajima
- Department of Cognitive and Behavioral Science, Graduate School of Arts and Sciences, University of Tokyo, 3-8-1 Komaba, Meguro-ku, Tokyo 153-8902, Japan.
| | - Keisuke Takano
- Center for Learning and Experimental Psychopathology, University of Leuven, Belgium, Tiensestraat 102, 3000, Leuven, Belgium
| | - Yoshihiko Tanno
- Department of Cognitive and Behavioral Science, Graduate School of Arts and Sciences, University of Tokyo, 3-8-1 Komaba, Meguro-ku, Tokyo 153-8902, Japan
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15
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The effects of adaptive working memory training and mindfulness meditation training on processing efficiency and worry in high worriers. Behav Res Ther 2017; 89:1-13. [DOI: 10.1016/j.brat.2016.11.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 11/01/2016] [Accepted: 11/06/2016] [Indexed: 01/19/2023]
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Ruscio AM, Gentes EL, Jones JD, Hallion LS, Coleman ES, Swendsen J. Rumination predicts heightened responding to stressful life events in major depressive disorder and generalized anxiety disorder. JOURNAL OF ABNORMAL PSYCHOLOGY 2016; 124:17-26. [PMID: 25688429 DOI: 10.1037/abn0000025] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although studies have documented heightened stress sensitivity in major depressive disorder (MDD) and generalized anxiety disorder (GAD), the mechanisms involved are poorly understood. One possible mechanism is the tendency to ruminate in response to stress. We used ecological momentary assessment to study ruminative thoughts after stressful events in 145 adults with MDD, GAD, comorbid MDD-GAD, or no psychopathology. Diagnosed individuals reported more event-related rumination than controls, even after adjusting for event stressfulness. Rumination was equally common in MDD and GAD and was especially severe among comorbid cases. More rumination immediately after the event predicted poorer affect, more maladaptive behavior, and more MDD and GAD symptoms at the next signal, even when pre-event levels of these variables were controlled. Rumination mediated, but did not moderate, the association of stress with affect and with symptoms. Stress-related rumination was more deleterious for diagnosed than healthy individuals, more intense for more severe clinical cases, and more persistent for cases with a greater temperamental vulnerability for emotional disorders. These results implicate rumination as a mechanism of stress sensitivity and suggest pathways through which it may maintain depression and anxiety in everyday life.
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Affiliation(s)
| | | | | | | | | | - Joel Swendsen
- National Center for Scientific Research, University of Bordeaux
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17
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Thornton EW, Tedman S, Rigby S, Bashforth H, Young C. Worries and concerns of patients with multiple sclerosis: development of an assessment scale. Mult Scler 2016; 12:196-203. [PMID: 16629423 DOI: 10.1191/135248506ms1273oa] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study examined the nature of worry in adult patients with multiple sclerosis (MS) in the UK. A measure of worry in MS was developed and the relationship between worry and standard scale measures of anxiety and depression was examined. Thirty-nine patients with MS and 40 controls completed the new worry scale (WQMS) that was psychometrically evaluated, together with the Penn State Worry Questionnaire (PSWQ), the Hospital Anxiety and Depression Scale (HAD) and a previously developed scale to assess self-efficacy in MS (SESMS). The scores for both anxiety ( t=2.34; p<0.05) and depression ( t=5.52; p<0.01) were higher in MS patients than controls, as was the new scale for worry - the WQMS. A factor analysis (explaining 65.73% of the variance) suggests that the worries of patients may be dichotomized into those concerned with the physical effects of the disease and those relating to the impact on social interaction, family relationships and daily activity in the home and/or work. Worry in patients with MS was associated with a decreased sense of being able to produce positive activities or effect positive outcomes (low self-efficacy). The questionnaire provides a framework for investigation in clinic of specific concerns and level of worry they engender.
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Affiliation(s)
- E W Thornton
- School of Psychology, University of Liverpool, UK.
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18
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Weinberg A, Meyer A, Hale-Rude E, Perlman G, Kotov R, Klein DN, Hajcak G. Error-related negativity (ERN) and sustained threat: Conceptual framework and empirical evaluation in an adolescent sample. Psychophysiology 2016; 53:372-85. [PMID: 26877129 PMCID: PMC4756390 DOI: 10.1111/psyp.12538] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 07/30/2015] [Indexed: 01/03/2023]
Abstract
The error-related negativity (ERN) currently appears as a physiological measure in relation to three Research Domain Criteria (RDoC) constructs: Cognitive Control, Sustained Threat, and Reward Learning. We propose a conceptual model in which variance in the ERN reflects individual differences in the degree to which errors are evaluated as threatening. We also discuss evidence for the placement of the ERN in the "Sustained Threat" construct, as well as evidence that the ERN may more specifically reflect sensitivity to endogenous threat. Following this, we present data from a sample of 515 adolescent females demonstrating a larger ERN in relation to self-reported checking behaviors, but only in older adolescents, suggesting that sensitivity to internal threat and the ERN-checking relationship may follow a developmental course as adolescents develop behavioral control. In contrast, depressive symptoms were linked to a smaller ERN, and this association was invariant with respect to age. Collectively, these data suggest that the magnitude of the ERN is sensitive both to specific anxiety-related processes and depression, in opposing directions that may reflect variation in internal threat sensitivity. We discuss directions for future research, as well as ways in which findings for the ERN complement and challenge aspects of the current RDoC matrix.
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Affiliation(s)
| | | | | | - Greg Perlman
- Department of Psychiatry, Stony Brook University
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University
| | | | - Greg Hajcak
- Department of Psychology, Stony Brook University
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Abstract
BACKGROUND Worry is experienced by many older adults, yet our understanding of the emotional experience of late-life worry is poor as findings regarding older adults are inferred from findings of studies conducted with young adults. In the present study, we aimed to characterize age differences in affect, self-reported arousal, and physiological arousal experienced during worry. METHODS Fifty-three young (M = 21.4, SD = 2.6 years) and 55 older community-dwelling adults (M = 69.1, SD = 8.1 years) participated in an experimental induction of worry or pleasant/neutral recall. Measures collected included: Penn State Worry Questionnaire (PSWQ), worry intensity item, Multiple Affect Adjective Checklist-Revised (MAACL-R), Self-Assessment Maniken arousal item, and heart rate. Standardized residual scores were calculated to represent change from baseline for self-report and psychophysiological measures. RESULTS Older adults had lower trait worry and worry intensity at baseline. A significant age by induction type interaction was found for the MAACL-R subscales of anxiety, depression, hostility, and positive affect. Compared with young adults, older adults experienced smaller changes in emotions in response to the worry induction than in the recall induction. For both worry and recall inductions, older adults exhibited less change in self-reported arousal and interbeat intervals from baseline compared with young adults. CONCLUSIONS Findings from the present study illuminate both similarities and differences in the experience of worry for older and young adults. This study provides preliminary evidence for the characterization of late-life worry as generating less anxiety than worry during young adulthood.
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Abstract
This review outlines the main theoretical and methodological issues relating to worry. The relationship of worry to anxiety and problem solving is discussed. Three models of worry are described: attention bias (Mathews, 1990), fear avoidance (Borkovec, Shadick, & Hopkins, 1991), and Tallis and Eysenck's (1994) stage model. Worry's proposed role in inhibiting emotional processing is discussed, and unresolved methodological and theoretical issues are considered. It is concluded that worry is elusive and difficult to study but greater understanding of worry is necessary.
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Spielberg JM, Miller GA, Warren SL, Sutton BP, Banich M, Heller W. Transdiagnostic dimensions of anxiety and depression moderate motivation-related brain networks during goal maintenance. Depress Anxiety 2014; 31:805-13. [PMID: 24753242 PMCID: PMC4418555 DOI: 10.1002/da.22271] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/07/2014] [Accepted: 03/11/2014] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Advancing research on the etiology, prevention, and treatment of psychopathology requires the field to move beyond modular conceptualizations of neural dysfunction toward understanding disturbance in key brain networks. Although some studies of anxiety and depression have begun doing so, they typically suffer from several drawbacks, including: (1) a categorical approach ignoring transdiagnostic processes, (2) failure to account for substantial anxiety and depression comorbidity, (3) examination of networks at rest, which overlooks disruption manifesting only when networks are challenged. Accordingly, the present study examined relationships between transdiagnostic dimensions of anxiety/depression and patterns of functional connectivity while goal maintenance was challenged. METHODS Participants (n = 179, unselected community members and undergraduates selected to be high/low on anxiety/depression) performed a task in which goal maintenance was challenged (color-word Stroop) while fMRI data were collected. Analyses examined moderation by anxiety/depression of condition-dependent coupling between regions of dorsolateral prefrontal cortex (dlPFC) previously associated with approach and avoidance motivation and amygdala/orbitofrontal cortex (OFC). RESULTS Anxious arousal was positively associated with amygdala↔right dlPFC coupling. Depression was positively associated with OFC↔right dlPFC coupling and negatively associated with OFC↔left dlPFC coupling. CONCLUSIONS Findings advance the field toward an integrative model of the neural instantiation of anxiety/depression by identifying specific, distinct dysfunctions associated with anxiety and depression in networks important for maintaining approach and avoidance goals. Specifically, findings shed light on potential neural mechanisms involved in attentional biases in anxiety and valuation biases in depression and underscore the importance of examining transdiagnostic dimensions of anxiety/depression while networks are challenged.
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Affiliation(s)
- Jeffrey M. Spielberg
- University of Illinois at Urbana-Champaign, Department of Psychology, Champaign, Illinois,Correspondence to: Dr. Jeffrey M. Spielberg, VA Boston Healthcare System, 150 South Huntington Avenue (182 JP), Boston, MA 02130.
| | - Gregory A. Miller
- University of Illinois at Urbana-Champaign, Department of Psychology, Champaign, Illinois,University of California, Department of Psychology, Los Angeles, California
| | - Stacie L. Warren
- University of Illinois at Urbana-Champaign, Department of Psychology, Champaign, Illinois,St. Louis VA Medical Center, St. Louis, Missouri
| | - Bradley P. Sutton
- University of Illinois at Urbana-Champaign, Department of Psychology, Champaign, Illinois
| | - Marie Banich
- University of Colorado, Department of Psychology, Boulder, Colorado
| | - Wendy Heller
- University of Illinois at Urbana-Champaign, Department of Psychology, Champaign, Illinois
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Topper M, Emmelkamp PMG, Watkins E, Ehring T. Development and assessment of brief versions of the Penn State Worry Questionnaire and the Ruminative Response Scale. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2014; 53:402-21. [DOI: 10.1111/bjc.12052] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 03/17/2014] [Indexed: 01/09/2023]
Affiliation(s)
- Maurice Topper
- Department of Clinical Psychology; University of Amsterdam; The Netherlands
- Cognitive Science Center Amsterdam; University of Amsterdam; The Netherlands
| | - Paul M. G. Emmelkamp
- Department of Clinical Psychology; University of Amsterdam; The Netherlands
- Cognitive Science Center Amsterdam; University of Amsterdam; The Netherlands
- The Center for Social and Humanities Research; King AbdulAziz University; Jeddah Saudi Arabia
| | - Ed Watkins
- School of Psychology; Mood Disorders Centre; University of Exeter; UK
| | - Thomas Ehring
- Department of Clinical Psychology and Psychotherapy; University of Münster; Germany
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Verbal worry facilitates attention to threat in high-worriers. J Behav Ther Exp Psychiatry 2014; 45:8-14. [PMID: 23906509 PMCID: PMC3857595 DOI: 10.1016/j.jbtep.2013.05.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/01/2013] [Accepted: 05/30/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Worry is predominantly a verbal-linguistic process with relatively little imagery. This study investigated whether the verbal nature of worry contributes to the maintenance of worry by enhancing attention to threat. It was hypothesised that verbal worry would lead to greater attentional bias to threat than imagery-based worry. METHODS Fifty high-worriers were randomly assigned to one of two groups, one in which they were instructed to worry in a verbal way and one in which they worried in an imagery-based way, before completing a dot probe task as a measure of attention to threat-related words. RESULTS Those who worried in verbal form demonstrated greater attentional bias to threat than did those who worried in imagery-based form. These findings could not be accounted for by group differences in personal relevance of or distress associated with worry topics, state mood following worry, levels of the relatedness of participants' worries to stimuli on the dot probe task, trait anxiety, general propensity to worry, nor adherence to the worry training. LIMITATIONS The present study only included word stimuli in the dot probe task; inclusion of images would allow for firmly rejecting the hypothesis that the attention effects observed following verbal worry were merely a result of priming verbal threat representations. Also, future studies could include a further control group that does not engage in any form of worry to ascertain that verbal worry increased attentional bias rather than imagery decreasing pre-existing attentional bias. CONCLUSIONS Possible mechanisms underlying this effect of verbal worry on attention to threat are discussed, together with clinical implications of the current findings.
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Warren SL, Crocker LD, Spielberg JM, Engels AS, Banich MT, Sutton BP, Miller GA, Heller W. Cortical organization of inhibition-related functions and modulation by psychopathology. Front Hum Neurosci 2013; 7:271. [PMID: 23781192 PMCID: PMC3680711 DOI: 10.3389/fnhum.2013.00271] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 05/25/2013] [Indexed: 11/13/2022] Open
Abstract
Individual differences in inhibition-related functions have been implicated as risk factors for a broad range of psychopathology, including anxiety and depression. Delineating neural mechanisms of distinct inhibition-related functions may clarify their role in the development and maintenance of psychopathology. The present study tested the hypothesis that activity in common and distinct brain regions would be associated with an ecologically sensitive, self-report measure of inhibition and a laboratory performance measure of prepotent response inhibition. Results indicated that sub-regions of DLPFC distinguished measures of inhibition, whereas left inferior frontal gyrus and bilateral inferior parietal cortex were associated with both types of inhibition. Additionally, co-occurring anxiety and depression modulated neural activity in select brain regions associated with response inhibition. Results imply that specific combinations of anxiety and depression dimensions are associated with failure to implement top-down attentional control as reflected in inefficient recruitment of posterior DLPFC and increased activation in regions associated with threat (MTG) and worry (BA10). Present findings elucidate possible neural mechanisms of interference that could help explain executive control deficits in psychopathology.
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Affiliation(s)
- Stacie L. Warren
- Department of Psychology, University of Illinois at Urbana-ChampaignChampaign, IL, USA
- Department of Mental Health, St. Louis VA Medical CenterSt. Louis, MO, USA
| | - Laura D. Crocker
- Department of Psychology, University of Illinois at Urbana-ChampaignChampaign, IL, USA
| | - Jeffery M. Spielberg
- Department of Psychology, University of Illinois at Urbana-ChampaignChampaign, IL, USA
- School of Public Health, University of California, BerkeleyBerkeley, CA, USA
| | - Anna S. Engels
- Department of Psychology, University of Illinois at Urbana-ChampaignChampaign, IL, USA
- Department of Psychology, Pennsylvania State UniversityUniversity Park, PA, USA
| | - Marie T. Banich
- Department of Psychology, University of Colorado at BoulderBoulder, CO, USA
| | - Bradley P. Sutton
- Department of Bioengineering, University of Illinois at Urbana-ChampaignUrbana, IL, USA
| | - Gregory A. Miller
- Department of Psychology, University of Illinois at Urbana-ChampaignChampaign, IL, USA
- Department of Psychology, University of DelawareNewark, DE, USA
- Department of Psychology, University of KonstanzKonstanz, Germany
| | - Wendy Heller
- Department of Psychology, University of Illinois at Urbana-ChampaignChampaign, IL, USA
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Judah MR, Grant DM, Mills AC, Lechner WV, Slish ML, Davidson CL, Wingate LR. The Prospective Role of Depression, Anxiety, and Worry in Stress Generation. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2013. [DOI: 10.1521/jscp.2013.32.4.381] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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26
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McGowan SK, Behar E. A Preliminary Investigation of Stimulus Control Training for Worry. Behav Modif 2012; 37:90-112. [DOI: 10.1177/0145445512455661] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
For individuals with generalized anxiety disorder, worry becomes associated with numerous aspects of life (e.g., time of day, specific stimuli, environmental cues) and is thus under poor discriminative stimulus control (SC). In addition, excessive worry is associated with anxiety, depressed mood, and sleep difficulties. This investigation sought to provide preliminary evidence for the efficacy of SC procedures in reducing anxiety-, mood-, and sleep-related symptoms. A total of 53 participants with high trait worry were randomly assigned to receive 2 weeks of either SC training (consisting of a 30-min time- and place-restricted worry period each day) or a control condition called focused worry (FW; consisting of instructions to not avoid naturally occurring worry so that worry and anxiety would not paradoxically increase). At post-training, SC was superior to FW in producing reductions on measures of worry, anxiety, negative affect, and insomnia, but not on measures of depression or positive affect. Moreover, SC was superior to FW in producing clinically significant change on measures of worry and anxiety. Results provide preliminary support for the use of SC training techniques in larger treatment packages for individuals who experience high levels of worry.
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Joos E, Vansteenwegen D, Hermans D. Worry as a predictor of fear acquisition in a nonclinical sample. Behav Modif 2012; 36:723-50. [PMID: 22679241 DOI: 10.1177/0145445512446477] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
People seem to differ in their conditionability, that is, the ease by which fear associations (neutral stimulus-unconditioned stimulus [CS-US] contingencies) are learned. Recently, the level of trait worry has been proposed as a predictor of heightened conditionability. The current research aimed to (a) further investigate this influence of individual differences in trait worry on the strength of fear acquisition, (b) explore whether this association could be explained by trait anxiety, and (c) assess possible underlying mechanisms of this relationship. In a nonclinical sample, the amount of trait worry predicted heightened conditionability in a differential fear conditioning paradigm, both in fear ratings and in performance on a secondary probe reaction time task. A significant correlation was observed for general conditioning to the CS+ and also for differential conditioning (taking into account excitatory and inhibitory responding) in Experiment 1. These associations could not be fully explained by trait anxiety. US inflation and strengthening of the CS-US contingency through rehearsal are discussed as possible underlying mechanisms.
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Dickens C, Coventry P, Khara A, Bower P, Mansell W, Bakerly ND. Perseverative negative cognitive processes are associated with depression in people with long-term conditions. Chronic Illn 2012; 8:102-11. [PMID: 22169527 DOI: 10.1177/1742395311433058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Perseverative negative cognitive processes, such as worry, suppression and avoidance of undesirable thoughts, have been linked to persistence and relapse of depression. Such processes could account for poor treatment response though they have received little research attention in people with long-term conditions (LTCs). METHOD We conducted a cross-sectional study to investigate the associations of perseverative negative cognitive processes with depression among medical outpatients with LTCs. In 190 patients, we recorded levels of depression (Hospital Anxiety and Depression Scale), worry (Penn State Worry Questionnaire), suppression (White Bear Suppression Inventory) and avoidance of undesirable thoughts (Acceptance and Action Questionnaire). Associations between these constructs were assessed using linear correlation and logistic regression. RESULTS Both depression (32%) and anxiety (40%) were common in patients recruited. After controlling for demographic and medical confounders, subjects in the top tertile of worry, suppression and avoidance of undesirable thoughts were 20 (95% CIs, 6.6-58.3), 10 (95% CIs, 3.5-25.9) and 22 (95% CIs, 6.0-80.0) times more likely to have possible depression compared to those in the lowest tertile. CONCLUSIONS Prospective research is required to investigate causal relationships between these constructs, and to assess the potential of psychological interventions that target these processes to improve outcomes in patients with LTCs.
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Affiliation(s)
- Chris Dickens
- Mental Health Research Group, Peninsula College of Medicine and Dentistry, University of Exeter, Plymouth, UK.
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29
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Peleg O, Mass-Friedman M. Worry about terror among young adults living in ongoing security uncertainty. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2012; 48:407-21. [PMID: 22551319 DOI: 10.1080/00207594.2012.656126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The aim of the current study was to investigate worry about terror as a mediating variable, with the exogenous variables being media viewing, differentiation of self, and trait anxiety, and the endogenous variables being somatic symptoms and perceptions of security-related stress. Participants were divided into two groups by age/academic level: 248 high school students and 191 university students. A pathway correlation model was used to investigate worry about terror as a mediating variable. The central finding was that worry about terror was a significant mediating variable in the relationship between the extent of media viewing following terror events and the level of perception of security-related stress. That is, young people who said they worried a lot reported a high level of stress relating to the terror events they saw covered in the media. In addition, trait anxiety was found to have an effect on stress perception only via the level of worry about terror. This means that high levels of stress are not experienced by all highly trait-anxious people, but only by those who suffer from higher levels of worry about terror.
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Affiliation(s)
- Ora Peleg
- Department of Counseling, The Academic College Emek Yezreel, near Afula, Israel.
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30
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Kertz SJ, Bigda-Peyton JS, Rosmarin DH, Björgvinsson T. The importance of worry across diagnostic presentations: prevalence, severity and associated symptoms in a partial hospital setting. J Anxiety Disord 2012; 26:126-33. [PMID: 22078242 DOI: 10.1016/j.janxdis.2011.10.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 10/07/2011] [Accepted: 10/09/2011] [Indexed: 01/19/2023]
Abstract
Although excessive worry has been linked primarily with Generalized Anxiety Disorder (GAD), recent work suggests worry is dimensional, with potential relevance to a range of psychiatric disorders. The current study examined associations between worry and psychological symptoms across several primary diagnoses and tested worry's hypothesized unique relation to GAD in an acute psychiatric setting. Participants were 568 patients with primary diagnoses of Major Depression, Bipolar Disorder-Depressed, Bipolar Disorder-Manic, and Psychosis. Participants completed a structured diagnostic interview and questionnaires at admission. Partial correlations controlling for GAD diagnosis indicated that worry correlated with higher depression and poorer overall well-being in the Depressed, Bipolar-Depressed, and Psychosis groups and decreased functioning in the Depressed, Bipolar-Manic, and Psychosis groups. Depressed and Bipolar-Depressed groups endorsed the highest level of worry. A comorbid anxiety disorder was associated with higher worry across primary diagnoses, even after controlling for GAD. Of the anxiety disorders, GAD and Panic Disorder diagnoses predicted higher worry scores. Results discussed in terms of conceptual implications for worry as a transdiagnostic concept and clinical interventions.
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Affiliation(s)
- Sarah J Kertz
- McLean Hospital/Harvard Medical School, 115 Mill St., Belmont, MA 02478, USA.
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31
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Ruscio AM, Seitchik AE, Gentes EL, Jones JD, Hallion LS. Perseverative thought: a robust predictor of response to emotional challenge in generalized anxiety disorder and major depressive disorder. Behav Res Ther 2011; 49:867-74. [PMID: 22030295 PMCID: PMC3514044 DOI: 10.1016/j.brat.2011.10.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 08/19/2011] [Accepted: 10/04/2011] [Indexed: 12/14/2022]
Abstract
Generalized anxiety disorder (GAD) and major depressive disorder (MDD) frequently co-occur, yet the reasons for their comorbidity remain poorly understood. In the present experiment, we tested whether a tendency to engage in negative, repetitive thinking constitutes a common risk process for the two disorders. A mixed sample of adults with comorbid GAD-MDD (n=50), GAD only (n=35), MDD only (n=34), or no lifetime psychopathology (n=35) was administered noncontingent failure and success feedback on consecutive performance tasks. Perseverative thought (PT), measured by negative thought intrusions during a baseline period of focused breathing, emerged as a powerful prospective predictor of responses to this experimental challenge. Participants reporting more frequent negative thought intrusions at baseline, irrespective of thought content or diagnostic status, exhibited a stronger negative response to failure that persisted even after subsequent success. Higher PT over the course of the experiment was associated with later behavioral avoidance, with negative affect and other traits closely linked to anxiety and depression, and with the presence and severity of GAD and MDD. These findings provide evidence for a broadly-defined PT trait that is shared by GAD and MDD and contributes to adverse outcomes in these disorders.
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Affiliation(s)
- Ayelet Meron Ruscio
- Department of Psychology, University of Pennsylvania, 3720 Walnut Street, Philadelphia, PA 19104, USA.
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32
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Mushtaq F, Bland AR, Schaefer A. Uncertainty and cognitive control. Front Psychol 2011; 2:249. [PMID: 22007181 PMCID: PMC3184613 DOI: 10.3389/fpsyg.2011.00249] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 09/11/2011] [Indexed: 11/13/2022] Open
Abstract
A growing trend of neuroimaging, behavioral, and computational research has investigated the topic of outcome uncertainty in decision-making. Although evidence to date indicates that humans are very effective in learning to adapt to uncertain situations, the nature of the specific cognitive processes involved in the adaptation to uncertainty are still a matter of debate. In this article, we reviewed evidence suggesting that cognitive control processes are at the heart of uncertainty in decision-making contexts. Available evidence suggests that: (1) There is a strong conceptual overlap between the constructs of uncertainty and cognitive control; (2) There is a remarkable overlap between the neural networks associated with uncertainty and the brain networks subserving cognitive control; (3) The perception and estimation of uncertainty might play a key role in monitoring processes and the evaluation of the "need for control"; (4) Potential interactions between uncertainty and cognitive control might play a significant role in several affective disorders.
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Affiliation(s)
- Faisal Mushtaq
- Institute of Psychological Sciences, University of Leeds Leeds, UK
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Kertz SJ, Woodruff-Borden J. Human and Economic Burden of GAD, Subthreshold GAD, and Worry in a Primary Care Sample. J Clin Psychol Med Settings 2011; 18:281-90. [DOI: 10.1007/s10880-011-9248-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Spielberg JM, Heller W, Silton RL, Stewart JL, Miller GA. Approach and Avoidance Profiles Distinguish Dimensions of Anxiety and Depression. COGNITIVE THERAPY AND RESEARCH 2011. [DOI: 10.1007/s10608-011-9364-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Newman MG, Llera SJ. A novel theory of experiential avoidance in generalized anxiety disorder: a review and synthesis of research supporting a contrast avoidance model of worry. Clin Psychol Rev 2011; 31:371-82. [PMID: 21334285 PMCID: PMC3073849 DOI: 10.1016/j.cpr.2011.01.008] [Citation(s) in RCA: 307] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 01/14/2011] [Accepted: 01/18/2011] [Indexed: 01/13/2023]
Abstract
An important emphasis of the literature on generalized anxiety disorder (GAD) has been to achieve a greater understanding of the function of emotion (e.g., avoidance, dysregulation) in the etiology and maintenance of this disorder. The purpose of the following paper is to propose a new way of conceptualizing emotional sequelae in GAD by detailing the Contrast Avoidance Model of Worry. In presenting this model, we review theory and data that led to our current position, which is that individuals with GAD are more sensitive to feeling emotionally vulnerable to unexpected negative events, and that worry (the key pathological feature of GAD) is employed to prolong and maintain a negative emotional state thereby avoiding an unexpected negative emotional shift, or contrast experience. We also discuss implications for treatment given the presence of a new target for emotional exposure techniques. Finally, we establish the Contrast Avoidance Model within the framework of extant theories and models of pathogenic processes of GAD.
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Affiliation(s)
- Michelle G Newman
- Department of Psychology, The Pennsylvania State University, University Park, PA 16802-3103, USA.
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Worry, emotion control, and anxiety control in older and young adults. J Anxiety Disord 2010; 24:759-66. [PMID: 20708492 DOI: 10.1016/j.janxdis.2010.05.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 05/12/2010] [Accepted: 05/16/2010] [Indexed: 11/23/2022]
Abstract
Young adults worry more than older adults; however, few studies have examined why age differences may exist in the frequency of worry. The present study aimed to identify age differences in worry frequency, and examine the relation of age and worry to control over one's emotions and control over anxiety. Older adults worried less often than young adults; however, young women worried more often than young men and older adults. Also, young women reported less control over their anxiety and less control over the external signs of their emotions compared to young men and older adults. Worriers had less perceived control over their anxiety, less control over the inner experience of emotions, and less control over the external signs of emotion.
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Peleg O. Worry about terror in Israel: differences between Jewish and Arab adolescents and young adults. INTERNATIONAL JOURNAL OF CHILDREN'S SPIRITUALITY 2010; 15:273-290. [DOI: 10.1080/1364436x.2010.520304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
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Sinclair RC, Soldat AS, Ryan CA. Development and Validation of Velten-like Image-Oriented Anxiety and Serenity Mood Inductions. BASIC AND APPLIED SOCIAL PSYCHOLOGY 2010. [DOI: 10.1207/s15324834basp1902_2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Improving prevention of depression and anxiety disorders: Repetitive negative thinking as a promising target. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.appsy.2012.03.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bruce JM, Arnett P. Clinical correlates of generalized worry in multiple sclerosis. J Clin Exp Neuropsychol 2009; 31:698-705. [DOI: 10.1080/13803390802484789] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jared M. Bruce
- a The University of Missouri–Kansas City , Kansas City, MO, USA
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Abstract
A new model of worry is presented, differing from previous work in which worry was set within a broader theory of anxiety. It is proposed that threat is initially evaluated in terms of imminence, likelihood, and cost set against perceived self-efficacy; this evaluation can produce worry as a relatively automatic response. Worry serves the functions of alarm, prompt, and preparation; in terms of processes, it leads to an unfocused attentional style, sensitivity to emotional information, and arousal (which produces self-absorption). Threat (and worry) are maintained if there are elevated evidence requirements or inappropriate problem solving. The therapeutic implications of the model are discussed briefly.
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42
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Chapman LK, Kertz SJ, Woodruff-Borden J. A structural equation model analysis of perceived control and psychological distress on worry among African American and European American young adults. J Anxiety Disord 2009; 23:69-76. [PMID: 18487036 DOI: 10.1016/j.janxdis.2008.03.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Revised: 03/04/2008] [Accepted: 03/31/2008] [Indexed: 10/22/2022]
Abstract
Perceived control has been identified as an important factor in the development and maintenance of mood disorders, and worry has been shown to have a unique relationship with psychological distress associated with mood disorders. The relationships between these variables have received little attention in the literature, and even less in terms of the role racial status may serve. The current study investigated the structural relationship between psychological distress and perceived control in predicting self-reported worry as well as potential differences in paths to worry in African American and European American young adults using a structural equation model. One hundred twenty-one European American and 100 African American undergraduate students completed the Beck Depression Inventory (BDI), the State Trait Anxiety Inventory (STAI), the Anxiety Control Questionnaire (ACQ), and the Penn State Worry Questionnaire (PSWQ). Results suggest that psychological distress and perceived control predict worry in both the African American and European American samples, however there were significant differences in terms of which construct contributed most. For African Americans, psychological distress contributed significantly more to worry than perceived control, whereas low perceived control contributed more to worry for European Americans. Implications and suggestions for future research are discussed.
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Affiliation(s)
- L Kevin Chapman
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY 40292, United States.
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43
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Oathes DJ, Ray WJ, Yamasaki AS, Borkovec TD, Castonguay LG, Newman MG, Nitschke J. Worry, generalized anxiety disorder, and emotion: evidence from the EEG gamma band. Biol Psychol 2008; 79:165-70. [PMID: 18499328 PMCID: PMC2597009 DOI: 10.1016/j.biopsycho.2008.04.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2007] [Revised: 03/12/2008] [Accepted: 04/07/2008] [Indexed: 11/29/2022]
Abstract
The present study examined EEG gamma (35-70 Hz) spectral power distributions during worry inductions in participants suffering from generalized anxiety disorder (GAD) and in control participants without a history of psychiatric illness. As hypothesized, the EEG gamma band was useful for differentiating worry from baseline and relaxation. During worry induction, GAD patients showed higher levels of gamma activity than control participants in posterior electrode sites that have been previously associated with negative emotion. Gamma fluctuations in these electrode sites were correlated with subjective emotional experience ratings lending additional support to interpretations of negative affect. Following 14 weeks of psychotherapy, the GAD group reported less negative affect with worry inductions and the corresponding gamma sites that previously differentiated the clinical from control groups changed for the GAD patients in the direction of control participants. These findings suggest converging evidence that patients suffering from GAD experience more negative emotion during worry and that the EEG gamma band is useful for monitoring fluctuations in pathological worry expected to follow successful treatment.
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Affiliation(s)
- Desmond J Oathes
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA.
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44
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Watkins ER. Constructive and unconstructive repetitive thought. Psychol Bull 2008; 134:163-206. [PMID: 18298268 PMCID: PMC2672052 DOI: 10.1037/0033-2909.134.2.163] [Citation(s) in RCA: 1234] [Impact Index Per Article: 77.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2006] [Revised: 08/30/2007] [Accepted: 08/31/2007] [Indexed: 01/26/2023]
Abstract
The author reviews research showing that repetitive thought (RT) can have constructive or unconstructive consequences. The main unconstructive consequences of RT are (a) depression, (b) anxiety, and (c) difficulties in physical health. The main constructive consequences of RT are (a) recovery from upsetting and traumatic events, (b) adaptive preparation and anticipatory planning, (c) recovery from depression, and (d) uptake of health-promoting behaviors. Several potential principles accounting for these distinct consequences of RT are identified within this review: (a) the valence of thought content, (b) the intrapersonal and situational context in which RT occurs, and (c) the level of construal (abstract vs. concrete processing) adopted during RT. Of the existing models of RT, it is proposed that an elaborated version of the control theory account provides the best theoretical framework to account for its distinct consequences.
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Affiliation(s)
- Edward R Watkins
- Mood Disorders Centre, School of Psychology, University of Exeter, Washington Singer Laboratories, UK.
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45
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Abstract
The author reviews research showing that repetitive thought (RT) can have constructive or unconstructive consequences. The main unconstructive consequences of RT are (a) depression, (b) anxiety, and (c) difficulties in physical health. The main constructive consequences of RT are (a) recovery from upsetting and traumatic events, (b) adaptive preparation and anticipatory planning, (c) recovery from depression, and (d) uptake of health-promoting behaviors. Several potential principles accounting for these distinct consequences of RT are identified within this review: (a) the valence of thought content, (b) the intrapersonal and situational context in which RT occurs, and (c) the level of construal (abstract vs. concrete processing) adopted during RT. Of the existing models of RT, it is proposed that an elaborated version of the control theory account provides the best theoretical framework to account for its distinct consequences.
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Affiliation(s)
- Edward R Watkins
- Mood Disorders Centre, School of Psychology, University of Exeter, Washington Singer Laboratories, UK.
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46
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Abstract
The author reviews research showing that repetitive thought (RT) can have constructive or unconstructive consequences. The main unconstructive consequences of RT are (a) depression, (b) anxiety, and (c) difficulties in physical health. The main constructive consequences of RT are (a) recovery from upsetting and traumatic events, (b) adaptive preparation and anticipatory planning, (c) recovery from depression, and (d) uptake of health-promoting behaviors. Several potential principles accounting for these distinct consequences of RT are identified within this review: (a) the valence of thought content, (b) the intrapersonal and situational context in which RT occurs, and (c) the level of construal (abstract vs. concrete processing) adopted during RT. Of the existing models of RT, it is proposed that an elaborated version of the control theory account provides the best theoretical framework to account for its distinct consequences.
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Affiliation(s)
- Edward R Watkins
- Mood Disorders Centre, School of Psychology, University of Exeter, Washington Singer Laboratories, UK.
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47
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McLaughlin KA, Mennin DS, Farach FJ. The contributory role of worry in emotion generation and dysregulation in generalized anxiety disorder. Behav Res Ther 2007; 45:1735-52. [PMID: 17270145 DOI: 10.1016/j.brat.2006.12.004] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2006] [Revised: 11/28/2006] [Accepted: 12/11/2006] [Indexed: 11/17/2022]
Abstract
The role of worry in generalized anxiety disorder (GAD) has been posited to serve as an avoidance of emotional experience, and emotion regulation deficits in GAD have been found in several previous studies. It remains unclear whether those with GAD experience more dysregulated emotions during periods of euthymia and positive affect or whether these deficits occur only during periods of worry. Individuals with GAD (with and without co-occurring dysphoria) and non-anxious controls were randomly assigned to receive a worry, neutral, or relaxation induction. Following the induction, all participants viewed a film clip documented to elicit sadness. Intensity of emotions and emotion regulation were examined following the induction period and film clip. The results revealed that, regardless of co-occurring dysphoria, individuals with GAD in the worry condition experienced more intense depressed affect than GAD participants in the other conditions and controls participants. In contrast, presence of worry appeared to have less impact on indices of emotion dysregulation, which were greater in participants with GAD compared to controls, but largely insensitive to contextual effects of worry or of relaxation. Following film viewing, both GAD participants with and without dysphoria displayed poorer understanding, acceptance, and management of emotions than did controls. However, acceptance and management deficits were most pronounced in individuals with both GAD and co-occurring dysphoria. Implications for the role of emotions in conceptualization and treatment of GAD are discussed.
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Tallis F, Eysenck MW, Mathews A. Worry: A critical analysis of some theoretical approaches. ACTA ACUST UNITED AC 2007. [DOI: 10.1080/08917779108248767] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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49
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Repetitive Thought and Emotional Distress: Rumination and Worry as Prospective Predictors of Depressive and Anxious Symptomatology. COGNITIVE THERAPY AND RESEARCH 2007. [DOI: 10.1007/s10608-006-9026-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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50
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McLaughlin KA, Borkovec TD, Sibrava NJ. The effects of worry and rumination on affect states and cognitive activity. Behav Ther 2007; 38:23-38. [PMID: 17292692 DOI: 10.1016/j.beth.2006.03.003] [Citation(s) in RCA: 230] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2005] [Accepted: 03/12/2006] [Indexed: 10/24/2022]
Abstract
The effects of worry and rumination on affective states and mentation type were examined in an unselected undergraduate sample in Study 1 and in a sample of individuals with high trait worry and rumination, high rumination, and low worry/rumination in Study 2. Participants engaged in worry and rumination inductions, counterbalanced in order across participants to assess main and interactive effects of these types of negative thinking. During mentation periods, the thought vs. imaginal nature and the temporal orientation of mentations were assessed 5 times. Following mentation periods, negative and positive affect, relaxation, anxiety, and depression were assessed. Both worry and rumination produced increases in negative affect and decreases in positive affect. Worry tended to generate greater anxiety, and rumination tended to generate greater depression. Interactive effects were also found indicating that worry may lessen the anxiety experienced during subsequent rumination. Moreover, worry lessened the depressing effects of rumination. Worry was associated with significantly greater thought than imagery, compared to rumination. Rumination involved a progression from mentation about the past to mentation about the future over time. Implications for understanding the generation of negative affect and comorbid anxiety and depression are discussed.
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