Worry and perceived threat of proximal and distal undesirable outcomes

Knowledge of Threat Biases Perceptual Decision Making in Anxiety: Evidence From Signal Detection Theory and Drift Diffusion Modeling

Background

Threat biases are considered key factors in the development and maintenance of anxiety. However, these biases are poorly operationalized and remain unquantified. Furthermore, it is unclear whether and how prior knowledge of threat and its uncertainty induce these biases and how they manifest in anxiety.

Method

Participants (n = 55) used prestimulus cues to decide whether the subsequently presented stimuli were threatening or neutral. The cues either provided no information about the probability (high uncertainty) or indicated high probability (low uncertainty) of encountering threatening or neutral targets. We used signal detection theory and hierarchical drift diffusion modeling to quantify bias.

Results

High-uncertainty threat cues improved discrimination of subsequent threatening and neutral stimuli more than neutral cues. However, anxiety was associated with worse discrimination of threatening versus neutral stimuli following high-uncertainty threat cues. Using hierarchical drift diffusion modeling, we found that threat cues biased decision making not only by shifting the starting point of evidence accumulation toward the threat decision but also by increasing the efficiency with which sensory evidence was accumulated for both threat-related and neutral decisions. However, higher anxiety was associated with a greater shift of starting point toward the threat decision but not with the efficiency of evidence accumulation.

Conclusions

Using computational modeling, these results highlight the biases by which knowledge regarding uncertain threat improves perceptual decision making but impairs it in case of anxiety.

The untold story of late effects: a qualitative analysis of breast cancer survivors' emotional responses to late effects

PURPOSE

Breast cancer survivors are at increased risk of adverse outcomes, called late effects, years after the completion of active treatment. Late effects can significantly impair physical functioning. The current study aimed to explore breast cancer survivors' experiences of late effects, their emotional responses to existing or potential late effects and their perceived impact.

METHODS

A total of 36 women treated for breast cancer in the last 10 years participated in semi-structured telephone interviews. Participant views were sought with respect to knowledge, experience, and perceived longer-term risk. A thematic analysis was conducted.

RESULTS

Four themes emerged from the data: (1) late effects awareness, (2) framing and coping, (3) uncertainty and (4) management. There was a range of emotional responses to late effects; however, many participants reported being unaware of their risk of late effects. Participants conceptualised late effects as any long-term effect of treatment regardless of the time of onset. Women reported living with constant uncertainty and feared cancer recurrence. Many were focused on managing long-term treatment side effects, rather than late effects.

CONCLUSION

Many women undergo treatment and remain unaware of associated late effect risks. National guidelines recommend patients be informed about late effects; however, the results of this study suggest a gap between policy and practice. Evidence-based interventions are needed to equip women with strategies to physically and emotionally manage late effects.

A Biobehavioral Framework of Worry for Nursing Application

Worry, characterized by repetitive and involuntary aversive thoughts about perceived concerns, is a central mental health complaint known to negatively impact quality of life of individuals facing perceived threats to health or well-being. Although empirical focus on worry has escalated over the past three decades, there has been less attention to current research trends and knowledge development related to this important phenomenon in nursing. This article presents a biobehavioral conceptual framework of worry for nursing application that is derived from a concept synthesis of biological, behavioral, clinical, and cognitive psychology sources.

Databases including CINAHL, EBM Review, Health & Wellness Resource Center, PsycINFO, and PubMed were systematically reviewed for the years 2000–2012. The adapted conceptual framework describes relationships among perceived threat; process, structure, and content worry attributes; and outcomes of worry. The framework may be applied in clinical environments as a resource to better understand and care for patients facing perceived threats to health and well-being. The framework contributes a foundation to build empirical knowledge for nursing practice, theory, and research that has potential to improve patient well-being and health-related quality of life outcomes.

The relationship between worry tendency and sleep quality in Chinese adolescents and young adults: the mediating role of state-trait anxiety

To investigate the relationship between worry tendency and sleep quality and the mediating effect of state-trait anxiety, 1072 adolescents and young adults from Jiangxi and Fujian Provinces in China were administered questionnaires pertaining to worry tendency, sleep quality, and state-trait anxiety. The results showed significant grade differences for worry tendency, sleep quality, and state-trait anxiety. Worry tendency was negatively associated with sleep quality, which was mediated by state anxiety and trait anxiety. There is a need for interventions that aim to reduce the level of worry tendency to ensure good sleep quality and the progression from worry tendency to anxiety and to poor sleep quality.