A cognitive model of pathological worry

An examination of worry and self-distancing as coping strategies for anxiety-provoking experiences in individuals high in worry

OBJECTIVES

This preliminary online study investigated the short-term effects of self-distancing, worry, and distraction on anxiety and worry-related appraisals among individuals high in worry.

DESIGN AND METHODS

N = 104 community members high in trait worry were randomly assigned to think about a personally identified worry-provoking situation using self-distancing (SC), worry (WC), or distraction (DC). Participants rated their anxiety (Visual Analogue Scale for Anxiety) and appraisals of the situation (Perceived Probability, Coping, and Cost Questions) at post-task and one-day follow-up.

RESULTS

Mixed factorial ANOVAs revealed an increase in anxiety within the WC (d = .475) and no difference in anxiety within the SC (d = .010) from pre- to post-task. There was no difference in anxiety within the DC (p = .177). Participants within the SC reported a decrease in the perceived cost associated with their identified situation from pre- to post-task (d = .424), which was maintained at one-day follow-up (d = .034). Participants reported an increase in perceived ability to cope from post-task to one-day follow-up (d = .236), and from pre-task to one-day follow-up (d = .338), regardless of condition.

CONCLUSIONS

Self-distancing may prevent increases in anxiety and catastrophizing while reflecting on a feared situation.

Emotion and anxiety interact to bias spatial attention

Emotional expressions are an evolutionarily conserved means of social communication essential for social interactions. It is important to understand how anxious individuals perceive their social environments, including emotional expressions, especially with the rising prevalence of anxiety during the COVID-19 pandemic. Anxiety is often associated with an attentional bias for threat-related stimuli, such as angry faces. Yet the mechanisms by which anxiety enhances or impairs two key components of spatial attention-attentional capture and attentional disengagement-to emotional expressions are still unclear. Moreover, positive valence is often ignored in studies of threat-related attention and anxiety, despite the high occurrence of happy faces during everyday social interaction. Here, we investigated the relationship between anxiety, emotional valence, and spatial attention in 574 participants across two preregistered studies (data collected in 2021 and 2022; Experiment 1: n = 154, 54.5% male, Mage = 43.5 years; Experiment 2: n = 420, 58% male, Mage = 36.46 years). We found that happy faces capture attention more quickly than angry faces during the visual search experiment and found delayed disengagement from both angry and happy faces over neutral faces during the spatial cueing experiment. We also show that anxiety has a distinct impact on both attentional capture and disengagement of emotional faces. Together, our findings highlight the role of positively valenced stimuli in attracting and holding attention and suggest that anxiety is a critical factor in modulating spatial attention to emotional stimuli. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Working memory and inhibitory control deficits in children with ADHD: an experimental evaluation of competing model predictions

Introduction

Children with ADHD demonstrate difficulties on many different neuropsychological tests. However, it remains unclear whether this pattern reflects a large number of distinct deficits or a small number of deficit(s) that broadly impact test performance. The current study is among the first experiments to systematically manipulate demands on both working memory and inhibition, with implications for competing conceptual models of ADHD pathogenesis.

Method

A clinically evaluated, carefully phenotyped sample of 110 children with ADHD, anxiety disorders, or co-occurring ADHD+anxiety (Mage=10.35, 44 girls; 69% White Not Hispanic/Latino) completed a counterbalanced, double dissociation experiment, with two tasks each per inhibition (low vs. high) x working memory (low vs. high) condition.

Results

Bayesian and frequentist models converged in indicating that both manipulations successfully increased demands on their target executive function (BF10>5.33x108, p<.001). Importantly, occupying children's limited capacity working memory system produced slower response times and reduced accuracy on inhibition tasks (BF10>317.42, p<.001, d=0.67-1.53). It also appeared to differentially reduce inhibition (and non-inhibition) accuracy for children with ADHD relative to children with anxiety (BF10=2.03, p=.02, d=0.50). In contrast, there was strong evidence against models that view working memory deficits as secondary outcomes of underlying inhibition deficits in ADHD (BF01=18.52, p=.85).

Discussion

This pattern indicates that working memory broadly affects children's ability to inhibit prepotent tendencies and maintain fast/accurate performance, and may explain the errors that children with ADHD make on inhibition tests. These findings are broadly consistent with models describing working memory as a causal mechanism that gives rise to secondary impairments. In contrast, these findings provide evidence against models that view disinhibition as a cause of working memory difficulties or view working memory as a non-causal correlate or epiphenomenon in ADHD.

What Are You Worried About? Content and Extent of Worry in Autistic Adults

Autistic adults commonly experience anxiety and worry, although knowledge on how worry presents and the content, extent, and experiences among autistic adults is limited. A convergent parallel mixed-methods approach was used to explore the presentation and experiences of worry in autistic and non-autistic adults. Quantitative surveys were used to compare the content and extent of worry in autistic adults to non-autistic adults, with semi-structured interviews also conducted with autistic adults to gain a deeper understanding of the experiences, impacts and content of worry in autistic adults. Findings indicated that autistic adults demonstrated clinically significant levels of worry which were substantially higher than non-autistic adults. Autistic adults described worry as a cycle of negative thoughts impacting their daily life. Findings indicate that autistic adults may worry more than non-autistic adults, impacting on participation in activities of daily living, sleep, and mental health.

Does Anxiety Systematically Bias Estimates of Executive Functioning Deficits in Pediatric Attention-Deficit/Hyperactivity Disorder?

Growing evidence suggests that childhood ADHD is associated with larger impairments in working memory relative to inhibition. However, most studies have not considered the role of co-occurring anxiety on these estimates - a potentially significant confound given prior evidence that anxiety may increase working memory difficulties but decrease inhibition difficulties for these children. The current study extends prior work to examine the extent to which co-occurring anxiety may be systematically affecting recent estimates of the magnitude of working memory/inhibitory control deficits in ADHD. The carefully-phenotyped sample included 197 children with ADHD and 142 children without ADHD between the ages of 8 and 13 years (N = 339; Mage = 10.31, SD = 1.39; 144 female participants). Results demonstrated that ADHD diagnosis predicted small impairments in inhibitory control (d = 0.31) and large impairments in working memory (d = 0.99). However, child trait anxiety assessed dimensionally across multiple informants (child, parent, teacher) did not uniquely predict either executive function, nor did it moderate estimates of ADHD-related working memory/inhibition deficits. When evaluating anxiety categorically and controlling for ADHD, anxiety diagnosis predicted slightly better working memory (d = 0.19) but not inhibitory control for clinically evaluated children generally. Findings from the current study indicate that trait anxiety, measured dimensionally or categorically, does not differentially affect estimates of executive dysfunction in pediatric ADHD. Further, results suggest that trait anxiety is generally not associated with executive dysfunction above and beyond the impact of co-occurring ADHD. Future research is needed to further assess the role of anxiety in ADHD behavioral symptomatology, neurocognitive functioning, and mechanisms underlying these relations.

Probability, cost, and interpretation biases' relationships with depressive and anxious symptom severity: differential mediation by worry and repetitive negative thinking

People high in depressive or anxious symptom severity show repetitive negative thinking, including worry and rumination. They also show various cognitive phenomena, including probability, cost, and interpretation biases. Since there is conceptual overlap between these cognitive biases and repetitive negative thinking - all involve thinking about potential threats and misfortunes - we wondered whether repetitive negative thinking could account for (mediate) these cognitive biases' associations with depressive and anxious symptom severity. In three studies, conducted in two languages and cultures, cost bias and (in two studies) interpretation bias only predicted symptom severity via worry and repetitive negative thinking; this suggests these biases are actually associated with repetitive negative thinking, rather than with symptoms. In contrast, probability bias showed direct relationships with depressive (all studies) and anxious (two studies) symptom severity, suggesting its relationships with symptoms are partly independent of repetitive negative thinking. These results show the value of studying relationships among the various cognitive features of psychopathology. Furthermore, new interventions which target cognitive biases in depression or anxiety must show that they can improve upon cognitive behavioural therapy, which is already widely available, targets both repetitive negative thinking and probability bias, and is highly effective.

Which client with generalized anxiety disorder benefits from a mindfulness ecological momentary intervention versus a self-monitoring app? Developing a multivariable machine learning predictive model

Precision medicine methods (machine learning; ML) can identify which clients with generalized anxiety disorder (GAD) benefit from mindfulness ecological momentary intervention (MEMI) vs. self-monitoring app (SM). We used randomized controlled trial data of MEMI vs. SM for GAD (N = 110) and tested three ML models to predict one-month follow-up reliable improvement in GAD severity, perseverative cognitions (PC), trait mindfulness (TM), and executive function (EF). Eleven baseline predictors were tested regarding differential reliable change from MEMI vs. SM (age, sex, race, EF errors, inhibitory dyscontrol, set-shifting deficits, verbal fluency, working memory, GAD severity, TM, PC). The final top five prescriptive predictor models of all outcomes performed well (AUC = .752 .886). The following variables predicted better outcome from MEMI vs. SM: Higher GAD severity predicted more GAD improvement but less EF improvement. Elevated PC, inhibitory dyscontrol, and verbal dysfluency predicted better improvement in most outcomes. Greater set-shifting and TM predicted stronger improvements in GAD symptoms and TM. Older age predicted more alleviation of GAD and PC symptoms. Women exhibited more enhancements in trait mindfulness and EF than men. White individuals benefitted more than non-White. PC, TM, EF, and sociodemographic data might help predictive models optimize intervention selection for GAD.

Attention networks in multilingual adults who do and who do not stutter

This study investigated whether multilinguals who stutter differ from multilinguals who do not stutter in terms of attention networks. Towards that end, it measured (a) performance differences in attention networks between multilinguals who stutter and those who do not stutter and (b) the correlation between stuttering characteristics and attention networks. Twenty-four multilingual Dutch-English speaking adults (20-46y), half of whom were diagnosed with stuttering, completed the Attentional Network Task (ANT) that evaluates the attention networks of alerting, orienting, and executive control. A language and social background questionnaire and a lexical decision task (LexTALE) assessed the participants' language proficiency. The Stuttering Severity Instrument 4th Ed. and the Brief Version of the Unhelpful Thoughts and Beliefs About Stuttering Scale were used to evaluate stuttering characteristics. The two groups did not differ in the ANT in terms of reaction time and error rate scores. Furthermore, no differences were observed in the three attention networks between the groups. Lastly, no correlation was found between stuttering characteristics and attention networks. The results suggest that the attention abilities of multilinguals who stutter do not differ from multilinguals who do not stutter.

The relationship between worry and academic performance: examining the moderating role of attention control

BACKGROUND

Worry is frequently associated with reduced cognitive performance, through consumption of attention control resources. Assessing attention control during acute worry may better reflect cognitive performance in real-world scenarios. This study examined whether attention control (assessed at rest and under acute worry) moderates the relationship between worry and academic performance.

METHODS

Worry (Penn State Worry Questionnaire) and academic performance (examination grades) were assessed in 87 undergraduates, with attention control (antisaccade performance) measured at baseline and following worry induction.

RESULTS

When assessed at rest, attention control did not moderate the relationship between trait worry and academic performance. However, under acute worry, attention control significantly moderated the relationship between worry and academic performance (p = .05, f2 = 0.14), such that at low levels of attention control under worry, higher trait worry was significantly associated with lower academic performance. At high levels of attention control under worry, however, the relationship between trait worry and academic performance was not significant.

CONCLUSIONS

Findings suggest that worry may shape performance according to attention control levels, with attention control's moderating role being more pronounced under conditions of acute worry. These results provide preliminary evidence that attention control assessed under worry may better predict real-world performance, compared to assessment at rest.

Exploration versus exploitation decisions in the human brain: A systematic review of functional neuroimaging and neuropsychological studies

Thoughts and actions are often driven by a decision to either explore new avenues with unknown outcomes, or to exploit known options with predictable outcomes. Yet, the neural mechanisms underlying this exploration-exploitation trade-off in humans remain poorly understood. This is attributable to variability in the operationalization of exploration and exploitation as psychological constructs, as well as the heterogeneity of experimental protocols and paradigms used to study these choice behaviours. To address this gap, here we present a comprehensive review of the literature to investigate the neural basis of explore-exploit decision-making in humans. We first conducted a systematic review of functional magnetic resonance imaging (fMRI) studies of exploration-versus exploitation-based decision-making in healthy adult humans during foraging, reinforcement learning, and information search. Eleven fMRI studies met inclusion criterion for this review. Adopting a network neuroscience framework, synthesis of the findings across these studies revealed that exploration-based choice was associated with the engagement of attentional, control, and salience networks. In contrast, exploitation-based choice was associated with engagement of default network brain regions. We interpret these results in the context of a network architecture that supports the flexible switching between externally and internally directed cognitive processes, necessary for adaptive, goal-directed behaviour. To further investigate potential neural mechanisms underlying the exploration-exploitation trade-off we next surveyed studies involving neurodevelopmental, neuropsychological, and neuropsychiatric disorders, as well as lifespan development, and neurodegenerative diseases. We observed striking differences in patterns of explore-exploit decision-making across these populations, again suggesting that these two decision-making modes are supported by independent neural circuits. Taken together, our review highlights the need for precision-mapping of the neural circuitry and behavioural correlates associated with exploration and exploitation in humans. Characterizing exploration versus exploitation decision-making biases may offer a novel, trans-diagnostic approach to assessment, surveillance, and intervention for cognitive decline and dysfunction in normal development and clinical populations.

The effect of uncertainty on attentional bias in subclinical worriers: Evidence from reaction time and eye-tracking

BACKGROUND AND OBJECTIVES

High-worry individuals have been assumed to show attentional bias towards threat, particularly under high uncertainty. This study experimentally investigated the effect of uncertainty on attentional bias in subclinical worriers.

METHODS

A visual dot-probe task combined with eye-tracking was used to assess participants' attentional bias towards blurred and unfiltered stimuli. Fifty high-worry and 47 low-worry participants were randomly assigned to either the high- or low-uncertainty threat condition. Aversive noise bursts were delivered either unpredictably (the high-uncertainty threat condition) or predictably (the low-uncertainty threat condition) during the visual dot-probe task.

RESULTS

In the low-uncertainty threat condition, high-worry participants exhibited enhanced attentional engagement towards blurred pictures compared to low-worry participants. They also had shorter initial fixation latencies on blurred pictures than on unfiltered pictures. In the high-uncertainty threat condition, high-worry participants demonstrated more difficulty in disengaging from threatening pictures compared to low-worry participants.

LIMITATION

First, this study used a nonclinical sample. Second, the power was limited with regard to the analysis of eye-movement data. Third, anxiety and worry induced by noise bursts were measured using subjective rating scales only. Fourth, some picture characteristics, such as luminosity and complexity, were not controlled. Finally, uncertainty related to delivery of noise bursts and pictures were both manipulated dichotomously.

CONCLUSION

This study highlights the importance of uncertainty in the maintenance of attentional bias towards threat-related pictures in high-worry individuals.

Mind wandering in anxiety disorders: A status report

Many investigations have targeted the subject of worry in anxiety disorders. Worry can be regarded as a subtype of mind wandering (MW), which is undeliberate, perseverative, negatively-valenced, and mainly future-oriented. Nevertheless, until now only a few studies have explored the role of overall MW in the origin and course of anxiety disorders. To foster progress in this field, we briefly describe and discuss relevant studies addressing MW in subjects with anxiety disorders or symptoms or disorders associated with anxiety symptoms. Provisional synthesis suggests that: a) the overall amount of MW is positively correlated with anxiety symptoms; b) MW characteristics reflecting worry and rumination appear to be relevant in anxiety; c) comorbid depressive and ADHD symptoms may contribute to excessive MW in anxiety; d) MW-related therapeutic interventions may be useful as complementary treatments in anxiety disorders. However, more studies related to MW in anxiety disorders or symptoms are necessary to corroborate and extend these initial findings. Such investigations should ideally combine experience sampling with self-rating assessments of both MW and worry/rumination.

The interactive effects of different facets of threat uncertainty and cognitive load in shaping fear and anxiety responses

A large body of research indicates that exaggerated response to uncertainty of a future threat is at the core of anxiety and related disorders, underscoring the need for a better understanding of the underlying mechanisms. Although behavioral and neuroimaging studies have suggested a close relationship between uncertainty responses and cognitive control, little is known about what elements of uncertainty are more or less vulnerable to cognitive modulation in shaping aversive responses. Leveraging a novel paradigm, an n-back working memory task embedded within a modified threat-of-shock paradigm, we examined how the influences of different facets of uncertainty (i.e., occurrence and timing) on psychophysiological responses were modulated by cognitive load. Psychophysiological responses were assessed using the acoustic startle reflex. Replicating prior work, the effects of cognitive load and temporal unpredictability of threat on startle responses were evident. The effect of occurrence unpredictability appears to depend on other factors. Under low cognitive load, startle response was potentiated when both the occurrence and the timing of threat were predictable. Under high cognitive load, startle response was significantly reduced, especially when a threat context involves uncertainty in both temporal and probability domains. These observations provide a framework for refining the model of fear and anxiety and for understanding the etiology of psychological disorders characterized by maladaptive uncertainty responses.

Cognitive processing biases associated with fear of childbirth

Fear of childbirth (FOC) is a phobic-like response concerning the prospect of giving birth. FOC can have negative implications for women during pregnancy and can impact their birthing experience. Cognitive processing biases (e.g., difficulty disengaging from threatening information, interpreting ambiguous information as threatening, and preferentially recalling threatening content) have previously been found to maintain general anxiety and low mood. To date, there has been no research assessing these attention, interpretation, and memory biases and their relationship with FOC in pregnant women. Accordingly, in this cross-sectional study, participants who were at least 12 weeks pregnant (n = 116), recruited through a local hospital trust, completed tasks assessing attention (emotional Stroop task), interpretation (scrambled sentences test), and explicit memory (recognition task) biases with materials including FOC-related content. They also completed three separate measures of FOC and measures of low mood, general anxiety, worry, and rumination. We found that a negative interpretation bias (but not attention or explicit memory biases) was associated with higher levels of FOC. These findings indicate that women presenting with higher FOC are more likely to demonstrate negative interpretation biases for ambiguous information relating to childbirth, which may inform research developing interventions to support women presenting with FOC.

Pain catastrophizing and worry about health in generalized anxiety disorder

Because the diagnostic criteria of generalized anxiety disorder (GAD) are not tied to specific worry domains (worry is 'generalized'), research on the content of worry in GAD is lacking. To our knowledge, no study has addressed vulnerability for specific worry topics in GAD. The goal of the current study, a secondary analysis of data from a clinical trial, is to explore the relationship between pain catastrophizing and worry about health in a sample of 60 adults with primary GAD. All data for this study were collected at pretest, prior to randomization to experimental condition in the larger trial. The hypotheses were that (1) pain catastrophizing would be positively related to the severity of GAD, (2) the relationship between pain catastrophizing and the severity of GAD would not be explained by intolerance of uncertainty and psychological rigidity, and (3) pain catastrophizing would be greater in participants reporting worry about health compared to those not reporting worry about health. All hypotheses were confirmed, suggesting that pain catastrophizing may be a threat-specific vulnerability for health-related worry in GAD. The implications of the current findings include a better understanding of the ideographic content of worry, which could help focus treatment interventions for individuals with GAD.

Exploring the Relationship Between Intolerance of Uncertainty and Trust in Physicians from Spousal and Parent-Child Perspectives

Objective

The present study aimed to probe the intergenerational transmission of intolerance of uncertainty (IU) and trust in physicians. Besides, through the actor-partner interdependence model (APIM), the predictive effect of parents' IU on their own and their spouses' trust in physicians was examined. A mediation model was further constructed to probe the mechanisms by which parents' IU affects children's trust in physicians.

Methods

The Intolerance of Uncertainty Scale-12 (IUS-12) and the Wake Forest Physician Trust Scale (WFPTS) were employed to conduct the questionnaire survey among 384 families (each family with a father, mother, and one child).

Results

IU and trust in physicians were found to be intergenerationally transmitted. The results of the APIM analyses showed that fathers' total IUS-12 scores negatively predicted their own (β = -0.419, p < 0.01) and mothers' (β = -0.235, p < 0.01) total WFPTS scores. Mothers' total IUS-12 scores negatively predicted their own (β = -0.353, p < 0.01) and fathers' (β = -0.138, p = 0.017) total WFPTS scores. The results of mediation analyses indicated that parents' total WFPTS scores and children's total IUS-12 scores mediated the effect of parents' total IUS-12 scores on children's total WFPTS scores.

Conclusion

The public's IU is a crucial influencing factor of their trust in physicians. Besides, the IU between couples and between parents and children could be mutually affected. On the one hand, husbands' IU could affect their own and their wives' trust in physicians, and vice versa. On the other hand, parents' IU and trust in physicians could affect their children's IU and trust in physicians, respectively.

Psychological Outcomes and Mechanisms of Mindfulness-Based Training for Generalised Anxiety Disorder: A Systematic Review and Meta-Analysis

This systematic review aimed to identify 1) the effect of mindfulness training on pre-post measures of anxiety and attention among adults experiencing high levels of generalised anxiety; and 2) the impact of predictors, mediators and moderators on post-intervention changes in anxiety or attention. Trait mindfulness and distress measures were included as secondary outcomes. A systematic search was conducted in November 2021 in electronic databases using relevant search terms. Eight articles comprising four independent studies were included (N = 334). All studies included participants diagnosed with generalised anxiety disorder (GAD) who participated in an 8-week manualised program. The meta-analysis indicated that mindfulness training had a large effect on anxiety symptoms (g = -1.92, 95%CI[-3.44, -0.40]) when compared to inactive (i.e., care as usual, waitlist) or non-specified (i.e., condition not defined) controls. However, a significant effect was not found when compared to active controls. Effects for depression, worry and trait mindfulness did not reach statistical significance, despite small-large effect sizes favouring mindfulness compared to inactive/non-specified controls. Our narrative review found evidence that changes in aspects of trait mindfulness mediate anxiety reduction following mindfulness training. However, a small number of studies were available for inclusion in the review, with high risk of bias and low certainty of evidence present. Overall, the findings support the use of mindfulness training programs for GAD and indicate mechanisms that may differ from those involved in other cognitive therapy approaches. Further RCTs with evidence-based controls are needed to clarify techniques most beneficial for generalised anxiety to support individually tailored treatment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-023-04695-x.

‘It just doesn't feel right’ and other reasons why some people fear and avoid positive emotions

The need to further our understanding of positive affect dysregulation in depression has been widely acknowledged. Two related relevant concepts in this realm, are Avoidance Of Positivity (AOP; referring to avoidance behaviour towards positivity) and Fear Of Positivity (FOP; referring to anxious or unpleasant feelings related to positivity). However, traditionally manifestations of AOP and FOP are considered in isolation, and self-report scales used to measure both concepts show considerable content overlap. Therefore, the first study aim was to examine how AOP and FOP relate to one another, depressive symptomatology and anhedonia, through new clearly delineated scales. For exploratory purposes, general and state-specific versions were developed. The second aim was to uncover beliefs that underlie the tendency towards AOP/FOP. An adult community sample (n = 197) completed online measures of AOP, FOP, depressive symptoms and anhedonia, and answered open-ended questions about reasons for AOP and FOP. Cross-sectionally, preliminary evidence was found for AOP and FOP being positively associated with one another, depressive symptomatology and anhedonia. Even after controlling for depressive symptomatology, anhedonia remained positively associated with AOP and FOP. So, AOP and FOP may be viable candidate mechanisms maintaining anhedonia that are worth further investigation and may be appropriate to target during treatment. Answers to the open-ended questions (n = 77) reflected various beliefs underlying AOP/FOP, which were broader than simply anticipating negative consequences of feeling positive and also touched on themes of unworthiness and social inappropriateness of feeling positive. Some theoretical and clinical implications of different beliefs underlying AOP/FOP are discussed.

Neurocognitive predictors of adherence to an online pain self-management program adjunct to long-term opioid therapy

INTRODUCTION

While pain self-management programs can significantly improve patient outcomes, poor adherence is common and the need for research on predictors of adherence has been noted. A potential, but commonly overlooked, predictor is cognitive function. Our aim, then, was to examine the relative influence of various cognitive functional domains on engagement with an online pain self-management program.

METHOD

A secondary analysis of a randomized controlled trial testing the impact of E-health (a 4-month subscription to the online Goalistics Chronic Pain Management Program) plus treatment as usual, relative to treatment as usual alone, on pain and opioid dose outcomes in adults receiving long-term opioid therapy of morphine equivalence dose ≥20 mg; 165 E-health participants who completed an on-line neurocognitive battery were included in this sub-analysis. A variety of demographic, clinical, and symptom rating scales were also examined. We hypothesized that better processing speed and executive functions at baseline would predict engagement with the 4-month E-health subscription.

RESULTS

Ten functional cognitive domains were identified using exploratory factor analysis and the resultant factor scores applied for hypothesis testing. The strongest predictors of E-health engagement were selective attention, and response inhibition and speed domains. An explainable machine learning algorithm improved classification accuracy, sensitivity, and specificity.

CONCLUSIONS

The results suggest that cognition, especially selective attention, inhibitory control, and processing speed, is predictive of online chronic pain self-management program engagement. Future research to replicate and extend these findings seems warranted.

CLINICALTRIALS.GOV REGISTRATION NUMBER

NCT03309188.

To Leave is to Die a Little: Assessing the Symptom Structure of Separation Anxiety Disorder in Left-Behind Emerging Adults

The literature on separation anxiety disorder (SAD) presented two contentious issues relating to its assessment. First, studies are scarce in assessing the symptom structure of DSM-5 SAD among the adult population. Second, the accuracy in assessing the severity of SAD through measuring the intensity of disturbance and the frequency of occurrence of symptoms is yet to be studied. To address these limitations, the present study aimed to: (1) examine the latent factor structure of the newly developed separation anxiety disorder symptom severity inventory (SADSSI); (2) evaluate the necessity of using frequency or intensity formats through comparison of differences in the latent level; and (3) investigate SAD latent class analysis. Utilizing 425 left-behind emerging adults (LBA), the findings showed that a general factor with two dimensions (i.e., response formats) measuring frequency and intensity symptom severity separately has excellent fit and good reliability. Finally, the latent class analysis yielded a three-class solution best fitting to the data. Overall, the data provided evidence for the psychometric soundness of SADSSI as an assessment tool for separation anxiety symptoms among LBA.

Differential replay of reward and punishment paths predicts approach and avoidance

Neural replay is implicated in planning, where states relevant to a task goal are rapidly reactivated in sequence. It remains unclear whether, during planning, replay relates to an actual prospective choice. Here, using magnetoencephalography (MEG), we studied replay in human participants while they planned to either approach or avoid an uncertain environment containing paths leading to reward or punishment. We find evidence for forward sequential replay during planning, with rapid state-to-state transitions from 20 to 90 ms. Replay of rewarding paths was boosted, relative to aversive paths, before a decision to avoid and attenuated before a decision to approach. A trial-by-trial bias toward replaying prospective punishing paths predicted irrational decisions to approach riskier environments, an effect more pronounced in participants with higher trait anxiety. The findings indicate a coupling of replay with planned behavior, where replay prioritizes an online representation of a worst-case scenario for approaching or avoiding.

Psychometric Properties of the Serbian Smartphone Application-Based Addiction Scale (SABAS) and Validation of the English Version Among Non-native English Speakers

The present study evaluated the psychometric properties of the Serbian Smartphone Application-Based Addiction Scale (SABAS) and the original English version of the same scale administered to a Serbian-speaking sample. In Study 1, 599 participants completed Serbian SABAS, with 189 having both test and retest data. Results suggested good internal consistency (α = .81) and test–retest reliability (ICC = .795, p < .001, 95% CI [.731, .844], rtest-retest = .803) of the scale. Convergent validity of the SABAS was evaluated through correlations with the Smartphone Addiction Scale–Short Version (SAS-SV), as well as with anxiety, depression, worry, duration, and purpose of smartphone use. Divergent validity of the SABAS was evaluated through comparing the correlations with entertainment and productive smartphone use. The modified CFA model showed an acceptable fit (χ2(8) = 25.53, p = .001, CFI = .961, TLI = .926, RMSEA = .096, SRMR = .042), confirming the unidimensionality of the SABAS. In the second study, the English SABAS, completed by 335 non-native speakers from Serbia, also showed a good fit of the single-factor model (χ2(9) = 12.56, p = .184, CFI = .990, TLI = .984, RMSEA = .036, SRMR = 0.026), and good psychometric features. Based on the study’s findings, the Serbian version of SABAS is a reliable and valid measure for screening the risk of smartphone addiction. Moreover, the English version can be used among non-native Serbian English speakers.

Impaired disengagement from worry: Dissociating the impacts of valence and internally-directed attention

Worry is a repetitive, negative thought process that is widely experienced as difficult to control. Despite the adverse effects of uncontrollable worry on academic and other role functioning, the mechanisms by which worry becomes uncontrollable remain poorly understood. Previous experimental work has historically emphasized valence (negative versus positive or neutral). However, contemporary cognitive neuroscience also distinguishes between internally-directed attention (e.g., to thoughts) and externally-directed attention (e.g., to perceptual stimuli). To date, no studies have experimentally examined potential dissociable contributions of valence versus attentional direction to impaired disengagement from worry. In a 2 (negative or neutral valence) x 2 (internal or external attention) between-subjects, experimental and prospective design (https://osf.io/vdyfn/), participants (N = 200) completed alternating blocks of a randomly-assigned attention manipulation and validated sustained attention task. Participants also rated trait worry and distress during the experimental session (T1) and a naturalistic stressor (the week before finals; T2). There was a main effect, such that internally-directed attention impaired sustained attention (increased commission errors). Worry (internal x negative) also impaired sustained attention (faster and less accurate responding) in planned group contrasts. Trait worry did not moderate these effects. Sustained attention at T1 did not predict distress or worry during the T2 stressor. These findings augment the literature on the attentional consequences of worry and replicate and extend previous findings of altered speed-accuracy tradeoffs following experimentally-induced worry. We also find evidence for impaired disengagement from internally-directed (versus externally-directed) attention, which may help to explain impaired disengagement from related forms of perseverative thought (e.g., rumination).

Specific Pandemic-Related Worries Predict Higher Attention-Related Errors and Negative Affect Independent of Trait Anxiety in UK-Based Students

Background

The COVID-19 pandemic has resulted in many individuals experiencing increased symptoms of anxiety. We predict that this increase may be underpinned by pandemic-related worry (PRW), characterised by repetitive negative thinking about pandemic-specific outcomes; and that this relationship is mediated through reduced attentional capacity required to regulate negative affect.

Methods

We developed a novel scale to measure the contents of PRW in an initial sample of 255 participants, and explored its relationship with cognitive functioning and negative affect in a sample of 382 UK-based university students, whilst controlling for recalled pre-pandemic trait anxiety.

Results

A five-factor model of PRW was identified, with factors reflecting worry about decline in quality of life (QoL) and probability of infection correlating with attention and memory-related errors. Importantly, attention-related errors partially mediated the positive relationship between PRW and negative affect, even when controlling for pre-pandemic trait anxiety.

Conclusion

PRW's relationship with negative affect was partially mediated through attentional function, consistent with models of anxiety and attentional control. In UK-based students PRW may be predominantly focused on the decline in QoL; therefore, interventions targeting worry about the decline in QoL caused by COVID-19 are especially important in this population in the wake of the pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10608-022-10336-7.

Dimensions of inattention: Cognitive, behavioral, and affective consequences

Inattention to one's on-going task leads to well-documented cognitive, behavioral, and physiological consequences. At the same time, the reliable association between mind-wandering and negative mood has suggested that there are affective consequences to task inattention as well. We examined this potential relationship between inattention and mood in the following study. Six hundred and fifty-five participants completed self-report questionnaires related to inattentive thinking (i.e., attentional lapses, daydreaming, mindfulness, rumination, reflection, worry, postevent processing, inattentiveness, and counterfactual thinking), a questionnaire about depressive symptoms, and a questionnaire about anxiety symptoms. First, an exploratory factor analysis was conducted to identify potential underlying constructs of types of inattentive thinking. Using ordinary least squares extraction and Oblimin rotation, a three-factor model demonstrated suitable fit, broadly representing mind-wandering/inattentive consequences, repetitive negative thinking, and reflective/introspective thinking. Second, after eliminating measures that did not strongly load on any factor, structural equation modeling was conducted and found that the relationship between mind-wandering and depression was partially explained by repetitive negative thinking, whereas the relationship between mind-wandering and anxiety was fully explained by repetitive negative thinking. The present findings suggest that understanding how inattentive thoughts are interrelated not only influences mood and affect but also reveals important considerations of intentionality, executive functioning, and qualitative styles of these thoughts.

A network approach to climate change anxiety and its key related features

Research has pointed to startling worldwide rates of people reporting considerable anxiety vis-à-vis climate change. Yet, uncertainties remain regarding how climate anxiety's cognitive-emotional features and daily life functional impairments interact with one another and with climate change experience, pro-environmental behaviors, and general worry. In this study, we apply network analyses to examine the associations among these variables in an international community sample (n = 874). We computed two network models, a graphical Gaussian model to explore network structure, potential communities, and influential nodes, and a directed acyclic graph to examine the probabilistic dependencies among the variables. Both network models pointed to the cognitive-emotional features of climate anxiety as a potential hub bridging general worry, the experience of climate change, pro-environmental behaviors, and the functional impairments associated with climate anxiety. Our findings offer data-driven clues for the field's larger quest to establish the foundations of climate anxiety.

Attenuated interoceptive processing in individuals with major depressive disorder and high repetitive negative thinking

Repetitive negative thinking (RNT) is a transdiagnostic symptom associated with poor outcomes in major depressive disorder (MDD). MDD is characterized by altered interoception, which has also been associated with poor outcomes. The present study investigated whether RNT is directly associated with altered interoceptive processing. Interoceptive awareness toward the heart and stomach was probed on the Visceral Interoceptive Attention (VIA) task with fMRI in MDD individuals who were propensity-matched on the severity of depression and anxiety symptoms and relevant demographics but different in RNT intensity (High RNT [H-RNT, n = 48] & Low RNT [L-RNT, n = 49]), and in matched healthy volunteers (HC, n = 27). Both H-RNT and L-RNT MDD individuals revealed reduced stomach interoceptive processing compared to HC in the left medial frontal region and insular cortex (H-RNT: β = -1.04, L-RNT: β = -0.97), perirhinal cortex (H-RNT: β = -0.99, L-RNT: β = -1.03), and caudate nucleus (H-RNT: β = -1.06, L-RNT: β = -0.89). However, H-RNT was associated with decreased right medial temporal lobe activity including the hippocampus and amygdala during stomach interoceptive trials (β = -0.61) compared to L-RNT. Insular interoceptive processing was similar in H-RNT and L-RNT participants (β = -0.07, p = 0.92). MDD individuals with high RNT exhibited altered gastric interoceptive responses in brain areas that are important for associating the information with specific contexts and emotions. Attenuated interoceptive processing may contribute to RNT generation, non-adaptive information processing, action selection, and thus poor treatment outcome.

Elevated Anxious and Depressed Mood Relates to Future Executive Dysfunction in Older Adults: A Longitudinal Network Analysis of Psychopathology and Cognitive Functioning

Vulnerability models posit that executive-functioning (EF) problems centrally affect future common (vs. rare) psychopathology symptoms. Conversely, scar theory postulates that depression/anxiety (vs. other psychopathology) symptoms centrally influence reduced EF. However, most studies so far have been cross-sectional. We used cross-lagged panel network analysis to determine temporal and component-to-component relations on this topic. Community older adults participated across four time points. Cognitive tests and the caregiver-rated Neuropsychiatric Inventory assessed nine psychopathology and eight cognitive-functioning nodes. Nodes with the highest bridge expected influence cross-sectionally were agitation and episodic memory. Episodic memory had the strongest inverse relation with age. Agitation had the strongest negative association with global cognition. EF nodes tended to be centrally affected by prior depressed and anxious moods rather than influential on any future nodes. Heightened anxious and depressed mood (vs. other nodes) centrally predicted future decreased EF-related (vs. non-EF-related) nodes in older adults, supporting scar (vs. vulnerability) theory.

Development and psychometric evaluation of a scrambled sentences test specifically for worry in individuals with generalised anxiety disorder

The tendency to draw negative conclusions from ambiguous information (interpretation bias) is prevalent across emotional disorders and plays a key role in the development and maintenance of pathological worry and anxious mood. Assessing interpretation bias using valid and reliable measures is central to empirical research. A commonly used measure of interpretation bias is the scrambled sentences test (SST), originally relating to depression. Given the association between interpretation bias and worry, we aimed to develop and psychometrically evaluate a new version of the SST with items pertaining to common worry domains for use in worry and anxiety research. In Studies 1-3 (analogue samples, combined N = 288), the new worry SST showed excellent construct validity (moderate-to-strong associations with worry and anxiety-related measures), and reliability (split-half and test-retest reliability). We confirmed construct validity in Study 4 (N = 215 individuals with generalised anxiety disorder). Furthermore, we demonstrated version specificity in analogue and clinical samples: the worry SST was associated with trait worry but not trait rumination, while the original depression SST largely showed the opposite pattern. Overall, the new worry SST is a psychometrically robust measure that may be especially useful for research into cognitive processes underpinning worry and anxiety.

Associations between child mental health, carer worry and help-seeking

Carers may not always express child mental health concerns to health professionals. Therefore, identifying factors delaying help-seeking is important. The aim of this study was to examine the relationship between carer affect and help-seeking. In a secondary analysis of data collected from school-aged children (N = 1,857, mean age = 9.85 years, 51% female), we used logistic regression to examine the associations between carer worry, help-seeking and child mental health. Regarding worry, higher levels of emotional problems (OR = 1.42, 95% CI = 1.33-1.52), conduct problems (OR = 1.24, 95% CI = 1.12, 1.36), peer problems (OR = 1.17, 95% CI = 1.05-1.27) or functional impairment (OR = 1.37, 95% CI = 1.2-.56) were associated with higher levels of carer worry. Regarding help-seeking, higher levels of functional impairment were associated with higher levels of help-seeking (OR = 1.51, 95% CI = 1.09-2.11). After controlling for mental health problems, carers who reported being worried about their child's mental health were less likely than other carers to seek help (OR = 0.13, 95% CI = 0.05-0.35). Knowledge of these factors may inform early interventions. Alongside implications for future research and practice, limitations of the study are discussed.

A systematic review of the literature on interpretation bias and its physiological correlates

An important, yet under-explored area of interpretation bias research concerns the examination of potential physiological correlates and sequalae of this bias. Developing a better understanding of the physiological processes that underpin interpretation biases will extend current theoretical frameworks underlying interpretation bias, as well as optimising the efficacy of cognitive bias modification for interpretation (CBM-I) interventions aimed at improving symptoms of emotional disorders. To this end, systematic searches were conducted across the Web of Science, PsycInfo and Pubmed databases to identify physiological markers of interpretation bias. In addition, grey literature database searches were conducted to compliment peer-reviewed research and to counter publication bias. From a combined initial total of 898 records, 15 studies were included in qualitative synthesis (1 of which obtained from the grey literature). Eligible studies were assessed using a quality assessment tool adapted from the Quality Checklist for Healthcare Intervention Studies. The searches revealed seven psychophysiological markers of interpretation bias, namely event-related potentials, heart rate and heart rate variability, respiratory sinus arrythmia, skin conductance response, pupillometry, and electromyography. The respective theoretical and practical implications of the research are discussed, followed by recommendations for future research.

A Preliminary Examination of the Interaction between Maternal Generalized Anxiety Disorder and Offspring Negative Affect in Relation to Maternal Worry about Offspring and Perceptions of Psychological Control

Both maternal symptoms and adolescent offspring characteristics are associated with maladaptive parenting among families at risk for anxiety. One disorder that may be particularly associated with maladaptive parenting behaviors is generalized anxiety disorder (GAD). Previous work suggests that offspring negative affect (NA) is associated with different levels of maladaptive parenting behaviors among mothers with GAD. No work to date, however, has examined the association between offspring reported NA, maternal GAD, and maternal worry about offspring or maternal perceptions of psychological control (PC) among mothers of adolescents. Sixty-five mothers who were elevated in anxious arousal and their adolescent offspring between the ages of 12 and 16 years old (n = 65, 55% male, M_age = 13.89) reported on parenting (mother report), NA (offspring report), and GAD symptoms (assessed via structured clinical interview), and maternal anxiety sensitivity (AS) symptoms. Study results indicated that maternal GAD status interacted with offspring NA in relation to maternal reported use of PC and worry about offspring. Specifically, offspring NA was positively related to PC for mothers without GAD, but not for mothers with GAD. Further, for mothers with GAD, offspring NA was negatively related to worry about offspring, but this relation did not persist for mothers without GAD. Maternal AS was related to overall higher levels of worry about offspring and PC. Mothers with GAD report using higher levels of maladaptive parenting when offspring report lower levels of NA, and lower levels when offspring report high NA. This pattern was specific to maternal GAD (c.f. anxiety sensitivity).

Avoidance of mild threat observed in generalized anxiety disorder (GAD) using eye tracking

Attentional biases towards threat are assumed to be a causal factor in the development of anxiety disorders, including generalized anxiety disorder (GAD). However, findings have been inconsistent, and studies often examine single time-point bias during threat exposure, instead of across time. Attention to threat may shift throughout exposure (e.g., from initial engagement to avoidance), and research suggests that threat intensity and state anxiety influence attentional biases. No studies to our knowledge have examined biases across time and with varying threat intensity and state anxiety. Participants with GAD (n=38) and non-anxious controls (n=25) viewed emotional (high threat, mild threat, and positive) and neutral image pairs under calm and anxious mood states while their eye movements were tracked. Participants showed an initial orientation to emotional images, and, under the anxious mood induction, demonstrated a bias towards threatening images at first fixation and over time. Results suggest it may be normative to attend to threat cues over other stimuli while in an anxious state. Individuals with GAD uniquely showed a bias away from mild (but not high) threat images over time relative to controls. Implications for theories of attentional biases to threat and clinical implications for GAD and anxiety disorders broadly are discussed.

Changing Metacognitive Appraisal Bias in High-Worriers Through Reappraisal Training

Background and Objectives

Worry-related negative metacognitive beliefs about worrying maintain and predict pathological worry. For the current proof-of-principle study, we developed a computerized cognitive bias modification based—reappraisal training (RT), to modify the appraisal of negative metacognitive beliefs in a high-worrying sample. A functional and dysfunctional RT were pitted against each other to investigate whether appraisals of one’s thinking and coping changed following training. Moreover, training effects on the number of negative thoughts and interpretations of the worry content were examined.

Methods

Participants (N = 81) were trained to adopt a functional (disconfirmation of negative metacognitive beliefs) or dysfunctional (confirmation of negative metacognitive beliefs) appraisal style using a series of vignettes that had to be completed in line with the intended training direction. Changes in negative thoughts from pre- to post-RT were assessed with a behavioral state worry task, and transfer to interpretations with an open-ended stem sentence task.

Results

Findings support the use of the RT to alter a metacognitive appraisal bias, as participants receiving the functional RT reported fewer negative appraisals of one’s thinking and coping than participants in the dysfunctional RT group. Number of negative thoughts and interpretations were not directly affected by training.

Limitations

This study employed an analog sample and future research should replicate findings in a clinical sample for which negative metacognitions are more relevant.

Conclusions

These findings highlight the potential of metacognitive RT for future translational studies with (clinical) samples characterized by repetitive negative thinking and/or negative metacognitive beliefs.

Toward Linguistic Recognition of Generalized Anxiety Disorder

Background

Generalized anxiety disorder (GAD) refers to extreme, uncontrollable, and persistent worry and anxiety. The disorder is known to affect the social functioning and well-being of millions of people, but despite its prevalence and burden to society, it has proven difficult to identify unique behavioral markers. Interestingly, the worrying behavior observed in GAD is argued to stem from a verbal linguistic process. Therefore, the aim of the present study was to investigate if GAD can be predicted from the language people use to put their anxious worries into words. Given the importance of avoidance sensitivity (a higher likelihood to respond anxiously to novel or unexpected triggers) in GAD, this study also explored if prediction accuracy increases when individual differences in behavioral avoidance and approach sensitivity are taken into account.

Method

An expressive writing exercise was used to explore whether GAD can be predicted from linguistic characteristics of written narratives. Specifically, 144 undergraduate student participants were asked to recall an anxious experience during their university life, and describe this experience in written form. Clinically validated behavioral measures for GAD and self-reported sensitivity in behavioral avoidance/inhibition (BIS) and behavioral approach (BAS), were collected. A set of classification experiments was performed to evaluate GAD predictability based on linguistic features, BIS/BAS scores, and a concatenation of the two.

Results

The classification results show that GAD can, indeed, be successfully predicted from anxiety-focused written narratives. Prediction accuracy increased when differences in BIS and BAS were included, which suggests that, under those conditions, negatively valenced emotion words and words relating to social processes could be sufficient for recognition of GAD.

Conclusions

Undergraduate students with a high GAD score can be identified based on their written recollection of an anxious experience during university life. This insight is an important first step toward development of text-based digital health applications and technologies aimed at remote screening for GAD. Future work should investigate the extent to which these results uniquely apply to university campus populations or generalize to other demographics.

Job burnout among Israeli healthcare workers during the first months of COVID-19 pandemic: The role of emotion regulation strategies and psychological distress

The current worldwide COVID-19 pandemic has elicited widespread concerns and stress. Arguably, healthcare workers are especially vulnerable to experience burnout during these times due to the nature of their work. Indeed, high prevalence of burnout was found among healthcare workers during the outbreak. However, the individual differences predicting burnout among healthcare workers during the pandemic have been understudied. The aim of the current study was, therefore, to identify risk and protective factors contributing to the severity of burnout among healthcare workers, above and beyond levels of current psychological distress. The survey was distributed online during the period April 13–28, 2020, approximately two months after the first COVID-19 case was identified in Israel. Ninety-eight healthcare workers completed an online survey administered cross-sectionally via the Qualtrics platform that included questionnaires assessing habitual emotion regulation strategies (i.e., trait worry, reappraisal, and suppression), psychological distress, COVID-19 related concerns, and burnout. A hierarchical linear regression analysis revealed that only trait worry and psychological distress were significant predictors of job burnout among healthcare workers. These findings highlight the role of maladaptive emotion regulation tendencies, specifically trait worry, in job burnout among healthcare workers. These findings have implications for both the assessment and treatment of healthcare workers. We discuss potential mechanisms and implications for practice.

A Pilot Randomized Controlled Trial of Goal Management Training in Canadian Military Members, Veterans, and Public Safety Personnel Experiencing Post-Traumatic Stress Symptoms

Post-traumatic stress disorder (PTSD) is a severe psychiatric illness that disproportionately affects military personnel, veterans, and public safety personnel (PSP). Evidence demonstrates that PTSD is significantly associated with difficulties with emotion regulation (ER) and difficulties with cognitive functioning, including difficulties with attention, working memory, and executive functioning. A wide body of evidence suggests a dynamic interplay among cognitive dysfunction, difficulties with ER, and symptoms of PTSD, where numerous studies have identified overlapping patterns of alterations in activation among neuroanatomical regions and neural circuitry. Little work has examined interventions that may target these symptoms collectively. The primary objective of this pilot randomized controlled trial (RCT) with a parallel experimental design was to assess the effectiveness of goal management training (GMT), a cognitive remediation intervention, in reducing difficulties with cognitive functioning, and to determine its effects on PTSD symptoms and symptoms associated with PTSD, including difficulties with ER, dissociation, and functioning among military personnel, veterans, and PSP. Forty-two military personnel, veterans, and PSP between the ages of 18 and 70 with symptoms of PTSD were recruited across Ontario, Canada between October 2017 and August 2019. Participants were randomized to either the waitlist (WL) (n = 18) or the GMT (n = 22) condition. Participants in both conditions received self-report measures and a comprehensive neuropsychological assessment at baseline, post-intervention, and 3-month follow-up. Following their completion of the 3-month follow-up, participants in the WL condition were given the opportunity to participate in GMT. Assessors and participants were blind to intervention allocation during the initial assessment. A series of 2 (time) × 2 (group) ANOVAs were conducted to assess the differences between the WL and GMT conditions from pre- to post-intervention for the self-report and neuropsychological measures. The results demonstrated significant improvements in measures of executive functioning (e.g., verbal fluency, planning, impulsivity, cognitive shifting, and discrimination of targets) and trending improvements in short-term declarative memory for participants in the GMT condition. Participants in the GMT condition also demonstrated significant improvements from pre- to post-testing in measures of subjective cognition, functioning, PTSD symptom severity, difficulties with ER, dissociative symptom severity, and depression and anxiety symptoms. No adverse effects were reported as a result of participating in GMT. The results of this pilot RCT show promise that GMT may be a useful intervention to improve symptoms of cognitive dysfunction, symptoms of PTSD, and symptoms associated with PTSD within military personnel, veterans, and PSP. Future work is needed to address the small sample size and the durability of these findings.

Attentional networks in co-occurring generalized anxiety disorder and major depression disorder: Towards a staging approach to the executive control deficits

INTRODUCTION

Major Depression Disorder (MDD) and Generalized Anxiety Disorder (GAD) often co-occur, but the neurocognitive mechanisms of this co-occurrence remain unknown. Prominent views have pointed to attentional processes as potent mechanisms at play in MDD and GAD, respectively. Yet uncertainty remains regarding the very nature of attentional impairments in patients with co-occurring MDD and GAD.

METHODS

Inspired by contemporary models of attentional networks, we compared the three main attentional networks, namely the orienting, alerting, and executive networks of the Attention Network Task's model, in four groups of patients with, respectively, co-occurring DSM-5 MDD and GAD (n = 30), DSM-5 MDD only (n = 30), DSM-5 GAD only (n = 30), or free from any DSM-5 diagnosis (n = 30). To capture the multivariate nature of our data, we examined between-group differences in the attentional networks through a multivariate analysis of variance.

RESULTS

Patients with co-occurring MDD and GAD exhibited more severe impairments in the executive control network than those with only one of the disorders. Although patients with MDD or GAD solely did not differ in terms of attentional impairments, both groups showed significantly more impairments in the executive control network than those free from any DSM-5 diagnosis (all Bonferonni-corrected post-hoc ps < 0.05).

CONCLUSIONS

Our findings align with a longstanding staging approach to comorbidity whereby, via synergistic effects, co-occurring disorders produce more damages than the sum of each disorder. Here, for the first time, we extended this approach to the executive network of attention in the context of the co-occurrence between MDD and GAD.

Health anxiety is associated with fearful imagery of contracting COVID-19: An experimental study

BACKGROUND

Aversive mental images of contracting or having a severe disease are assumed to contribute to the development and maintenance of health anxiety (HA) via the elicitation of fear, arousal and defensive mobilization. The current COVID-19 pandemic is known to trigger fears of contracting COVID-19.

METHODS

In this study, we used an experimental approach to investigate whether COVID-19-related mental images lead to a fearful response and whether this is associated with levels of HA. 139 participants vividly imagined neutral, standard fear and COVID-19 related narrative scenes.

RESULTS

Standard fear and COVID-19 scripts prompted higher anxiety, arousal, displeasure and avoidance tendencies as compared to neutral scripts. HA was associated with higher anxiety, arousal, displeasure, imagery vividness and stronger avoidance tendencies during imagery of COVID-19 scenes. No associations were found for anxiety sensitivity, trait anxiety as well as depressive and anxiety symptoms. Moreover, there was no association of HA with emotional responses during imagery of standard fear scenes.

LIMITATIONS

Fear responses were assessed via verbal reports. Future studies should also assess behavioral and physiological correlates of fear.

CONCLUSIONS

The present results indicate that individuals with high levels of HA are prone to fearful mental imagery of contracting COVID-19 which might be crucial factor contributing to the exacerbation and chronicity of excessive HA in times of a pandemic.

Visuospatial working memory capacity moderates the relationship between anxiety and OCD related checking behaviors

BACKGROUND

Compulsive checking behavior is the most prevalent compulsive behavior in patients with obsessive-compulsive disorder (OCD). While some studies have shown that anxiety and executive function influence compulsive checking behavior, the relationship between these constructs is inconclusive. Hence, we sought to explore the interplay between executive function, anxiety and compulsive checking behavior.

MATERIALS AND METHODS

47 healthy participants (HC) and 51 patients with OCD participated in the study. Symptoms and emotional states were assessed using the Yale-Brown Obsessive Compulsive Scale, the Obsessive-Compulsive Inventory-Revised, the Beck Anxiety Inventory, and the Beck Depression Inventory. Participants also completed three tests of neuropsychological functioning: the Stop Signal Task, the Spatial working memory Task, and the Wisconsin card sorting test. We analyzed the relationships between anxiety, executive function, and compulsive checking symptoms.

RESULTS

Patients with OCD showed significantly greater anxiety (p < 0.001) and impairments in visuospatial working memory function (p = 0.030) compared to HC participants, while inhibition and set-shifting were not significantly different between the two groups. Visuospatial working memory was negatively related to compulsive checking behavior (p = 0.016). Visuospatial working memory also played a moderating role in the positive relationship between anxiety and compulsive checking behavior (β = -0.281, p = 0.022).

CONCLUSION

Anxiety symptoms play an important role in explaining compulsive checking behavior in patients with OCD who have relatively weak visuospatial working memory ability. These findings provide a foundation for further research regarding the roles of emotion and cognitive inflexibility in compulsive checking behavior in patients with OCD.

Executive Functioning Constructs in Anxiety, Obsessive-Compulsive, Post-Traumatic Stress, and Related Disorders

PURPOSE OF REVIEW

We synthesize theories proposing complex relations between cognitive functioning and anxiety-related concepts. We evaluate vulnerability theories suggesting that deficits in various cognitive functioning domains predict future anxiety-associated concepts. We examine scar theories asserting the opposite direction of effects (i.e., anxiety predicting cognitive dysfunction). Furthermore, we examine more novel frameworks on this topic.

RECENT FINDINGS

Reliable evidence exists for the scar and vulnerability theories. This includes mounting data on diverse anxiety symptoms predicting cognitive dysfunction (and conversely) unfolding at between- and within-person levels (dynamic mutualism theory). It also includes data on the stronger effects or central influence of anxiety (versus non-anxiety) symptoms on executive functioning (EF; i.e., higher-order cognitive control governing myriad thinking and action repertoires) versus non-EF domains and vice versa (network theory). In addition, it reviews emerging evidence that enhanced cognitive control can correlate with higher anxiety among children (overgeneralized control theory). The generally inverse relations between anxiety symptoms and cognitive dysfunction are bidirectional and complex within and between persons. Plausible mediators and moderators merit more attention, including immune, metabolism, and neural markers and the social determinants of health.

Adult Aging Moderates the Relationship Between Trait Cognitive Anxiety and Subjective Everyday Cognitive Difficulties

The present aim was to determine, across the adult lifespan, the extent to which different dimensions of trait anxiety might affect subjective cognitive difficulties in everyday life. Following Attentional Control Theory (ACT; Eysenck et al., 2007), we predicted that trait anxiety would have a greater effect on attention and verbal abilities than on visual abilities. We also expected trait cognitive anxiety to exhibit more robust relationships with cognition than trait somatic anxiety. Importantly, we predicted that effects of anxiety would be greater in older adults, in line with the Strength and Vulnerability Integration model (SAVI; Charles, 2010). The sample comprised 286 United Kingdom-based adults aged 18–93 years. Participants completed self-report measures of trait cognitive and somatic anxiety (the State-Trait Inventory for Cognitive and Somatic Anxiety; STICSA, Ree et al., 2008) and everyday cognitive difficulties (the Multiple Abilities Self-Report Questionnaire; MASQ, Seidenberg et al., 1994). Moderated regression models were constructed, including trait cognitive or somatic anxiety as a predictor of cognitive difficulties, and age as the moderator variable. Covariates included depression, stress (the Depression Anxiety Stress Scales—short form; DASS-21, Lovibond and Lovibond, 1995), gender, current mental health treatment status, and physical health status. When cognitive anxiety was the predictor variable, somatic anxiety was also included as a covariate, and vice-versa. Trait cognitive anxiety and age interacted to predict all MASQ subscales other than visual-perceptual ability. Difficulties with attention, verbal memory, and language abilities were significantly greater at higher levels of anxiety for all age groups, with the effect greatest in older adults. Difficulties with visual-spatial memory were significantly greater at higher levels of anxiety in middle-aged and older adults only. Higher trait somatic anxiety predicted difficulties with verbal memory and language ability independently of age, and interacted with age to predict language difficulties. Interestingly, age also significantly predicted less subjective difficulty with attention, independently of anxiety level. The results show that trait cognitive and somatic anxiety are both related to subjective, everyday cognitive difficulties. However, effects of trait cognitive anxiety are more robust across cognitive domains and tend to increase, or first appear, over the course of the adult lifespan.

Psychometric Properties and Prospective Predictive Utility of the Contrast Avoidance Questionnaires

Abstract. Recent theoretical research posits that a key factor in the development and maintenance of pathological worry is the avoidance of sudden emotional shifts. Recently two self-report instruments were developed to index this phenomenon (Contrast Avoidance Questionnaire – Worry [CAQ-W] and Contrast Avoidance Questionnaire – General Emotion [CAQ-GE]). This work employed a multi-study design to provide an independent evaluation of the latent structure of these measures; additionally, the validity and longitudinal predictive ability of the measures was examined. Findings of the factor analytic work support a two-factor solution for each of the questionnaires. These were defined as the following subscales: CAQ-W: Emotional Contrast; Negative Affect, and for the CAQ-GE: Avoidance; Discomfort. Test-retest reliability of the measure was strong and the identified subscales demonstrated differential predictive ability regarding future worry and depression. Results indicate that subscales related to the experience of negative affect rather than avoidance, display predictive utility of future symptoms. These findings are somewhat discrepant with extant literature on ecological momentary assessment (EMA) assessment of contrast avoidance indicating the need for refinement in the self-report measurement of this construct.

Lessons unlearned: A conceptual review and meta-analysis of the relationship between the Attention Control Scale and Objective Attention Control

Attention control is central to many models of emotion. Among the most common measures of attention, control is the Attention Control Scale (ACS), which has exerted considerable influence in terms of the volume and breadth of research findings, with its use in cognitive-experimental research continuing to increase in recent years. However, there are growing concerns about whether the ACS genuinely indexes attention control. The present paper considers the context and development of the ACS, reviews and meta-analyses the available evidence regarding its association with objective measures of attention control. Meta-analytic results from nine studies (total n = 1274) indicated that the full-scale ACS was not significantly associated with behavioural measures of attentional control (r = .067, p = .093, N = 1274, 95% CI: -.011, .145). Findings indicated likely missing studies with lower correlations suggesting the true association may be smaller. Limited evidence of shared variance between subjective and objective measures of attention control contrasts with considerable evidence that the scale is closely correlated with dispositional traits (e.g. anxiety, agreeableness) that could plausibly influence responding. Thus, on the balance of current findings, we conclude that there is little compelling evidence that responding on the ACS reflects genuine attention control abilities.

What's Worrying Our Students? Increasing Worry Levels over Two Decades and a New Measure of Student Worry Frequency and Domains

Background

The frequency and severity of mental health problems in student populations have been a growing cause for concern worldwide, and studies have identified measures of a number of mental health symptoms that have been steadily increasing in frequency and intensity over the past 20-25 years.

Methods

In two studies we investigate the levels and domains of pathological worrying in university student participants. Study 1 is a retrospective study of Penn State Worry Questionnaire (PSWQ) data collected between 2001 and 2019. Study 2 describes the development of the Student Worry Questionnaire, a short and easily delivered measure of student worrying that identifies both frequency of worry as well as the student-relevant domains across which worrying occurs.

Results

Study 1 revealed a steady increase in student worry scores of around 20% between 2001 and 2019, with a significant positive correlation between year of data collection and mean PSWQ score. The domain scores in Study 2 indicated that academic work was a significantly higher worry than any of the other domains, and worries about intimate relationships and 'what people think of me' were also worries that scored higher than either financial or health worries.

Conclusions

The present studies indicate that pathological worrying can be added to the list of anxiety- and stress-related symptoms that have been shown to be on the increase in student populations in recent decades, and we discuss whether these increases represent a greater willingness to report symptoms or a genuine increase in experienced symptoms over time.