Chronic Worry as Avoidance of Arousal

Previous research suggests that worry is primarily a verbal-linguistic activity that may serve as a method of cognitive avoidance of fearful imagery. The purpose of the present study was to examine cognitive avoidance in high worriers (N=22) and low worriers (N=24) using psychophysiological measures and a modified dichotic listening task. The task involved presenting neutral words into an unattending ear while worry or neutral scenarios were presented into the attending ear. Participants were given a surprise word recognition test of the words presented to provide evidence of cognitive avoidance beyond self-report. Contrary to the hypotheses, high worriers did not have less physiological reactivity than did low worriers. Low worriers recognized more words than did high worriers overall. High worriers remembered more words from the worry scenario than the neutral condition, as would be expected if they attempted to avoid the worry scenario. Implications for treatment of worry and the use of the dichotic listening task in researching worry are discussed.     

Thoughts,images, worry,and anxiety

Recent models suggest that worry is primarily a verbal-linguistic process that enables images to be avoided and reduces somatic activation. Five-hundred and two subjects completed a questionnaire that assessed variables related to generalized anxiety disorder (GAD) criteria and also asked subjects to indicate the percentage of thoughts and images while worrying. Subjects were divided into excessive worriers (worry excessively about two or more topics more days than not for at least the last 6 months) and ordinary worriers (those who did not meet the previous criteria). As predicted, worry was reported as being composed predominantly of thoughts rather than images, and excessive worriers reported a significantly higher percentage of thoughts compared to ordinary worriers. The number of somatic symptoms was positively correlated with the percentage of images. This relationship was stronger among excessive worriers than ordinary worriers, specifically for autonomic hyperactivity symptoms. Further, in the excessive worry group only there was a significant negative correlation between the number of autonomic hyperactivity symptoms and the percentage of thoughts.This research was partially supported by grants from les Fonds de Recherche en Santé de Québec and the Medical Research Council of Canada. The study was completed while the first author was supported by the Medical Research Council of Canada.The authors gratefully acknowledge the assistance of France Blais for recruiting subjects, administering questionnaires, and entering data.     

Thought Control Strategies in Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is characterized by excessive anxiety and worry that is difficult to control; but methods of thought control among persons with GAD have not been previously investigated. Forty-two patients with GAD and 55 non-anxious controls (NACs) completed the Thought Control Questionnaire (TCQ; A. Wells & M. I. Davies, 1994). Patients with GAD reported significantly greater use of worry and punishment strategies, and less use of distraction and social control strategies, than NACs. Further, worry and punishment strategies were positively correlated with depressive symptoms and excessive worry, while distraction and social control strategies were negatively correlated with these measures of psychopathology. Higher life satisfaction was associated with greater use of distraction and social control strategies, and lesser use of worry and punishment strategies.     

Preliminary Validation of Subjective Anchor Scales for Worry and Rumination

This research is a preliminary validation of two single-item visual analogue scales. The worry visual analogue scale (WVAS) and the rumination visual analogue scale (RVAS) are self-report measures developed to track state changes in worry and rumination. Each of these scales uses an idiographic anchor sheet, enabling each participant to quantify their personal scale of worry or rumination. We compared ratings on the WVAS and RVAS with self-report measures of trait worry and rumination as well as other constructs administered concurrently in two separate studies. In study 1 we compared results within an unselected undergraduate sample. In study 2 we compared results within a community-based sample of individuals with generalized anxiety disorder (GAD), individuals with GAD comorbid with unipolar depressive disorders, and healthy controls. Results from both studies indicate the WVAS is a reliable state-level measure of worry with acceptable discriminant and convergent validity. Results for the RVAS showed similar reliability and convergent validity but lacked as much discriminant validity. This difference is possibly due to all experimental groups having comorbid anxiety, which is associated more with worry than rumination. Regression analyses indicate the WVAS predicts trait-level anxiety measures more strongly than measures of depression and beyond the predictive ability of the RVAS. The RVAS predicts measures of depression more strongly than it does measures of anxiety but is not consistently a stronger predictor of depression than the WVAS. These findings suggest worry and rumination are distinct regulatory constructs. In study 2, participants with GAD, and GAD comorbid with unipolar depressive disorders, scored significantly higher than healthy controls in worry and rumination. The internal reliability of the measures is reported.     

Cognitive Control in Generalized Anxiety Disorder: Relation of Inhibition Impairments to Worry and Anxiety Severity

Cognitive models of generalized anxiety disorder (GAD) propose that cognitive control, broadly construed, and inhibition specifically, play a role in the maintenance of GAD symptoms. However, few studies have explicitly investigated inhibition, and in particular “cold” (non-emotional) inhibition, and its relation to worry and anxiety severity in GAD. Adults with GAD (n?=?35) and healthy controls (n?=?21) completed computerized Stroop and Go/NoGo tasks, two widely-used tests of inhibition. GAD status predicted significantly worse (slower and less accurate) performance on the Stroop but not the Go/NoGo task. Clinician-rated anxiety severity predicted slower and less accurate Stroop performance over and above the effect of GAD diagnosis but did not predict Go/NoGo performance. Trait worry did not incrementally predict performance on either task. These findings provide qualified support for theoretical models of inhibition impairments in GAD and suggest that inhibition could be a promising target for novel neurocognitive interventions.     

Automaticity of Attentional Bias to Threat in High and Low Worriers

Individuals with high levels of worry are more likely than others to attend to possible threats, although the extent of top-down attentional control processes on this bias is unknown. We compared the performance of high (n = 26) and low worriers (n = 26) on a probe discrimination task designed to assess attention to threat cues, under cognitive load or no-load conditions. The expected difference between groups was confirmed, with high worriers being more likely to attend to threat cues than low worriers. Importantly however, there were no significant effects involving condition (cognitive load vs. no-load), nor any significant association with self-perceived attentional control ability. These results suggest that pathological worriers are more likely to attend to threat than are individuals with low levels of worry, regardless of task demands on limited cognitive control resources. This finding is consistent with the dominance of habitual bottom-up influences over top-down control processes in biased attention to threat.     

Quality of life in patients with postural tachycardia syndrome

OBJECTIVES: To quantify quality of life and identify demographic and clinical correlates of functioning in a well-characterized sample of patients with postural tachycardia syndrome (POTS). PATIENTS AND METHODS: Prospective patients were those seen at the Mayo Clinic Autonomic Disorders Laboratory from September 2000 to June 2001. Neurologists made diagnoses of POTS according to established criteria. Patients completed a questionnaire packet that included measures of quality of life (36-Item Short-Form Health Survey [SF-36]) and symptom severity (Autonomic Symptom Profile). Additional clinical information was abstracted from medical records. RESULTS: Ninety-four patients (89% female; mean age, 34.2 years) were enrolled in the study. Patients with POTS reported impairment across multiple domains on the SF-36. Physical functioning, role functioning, bodily pain, general health, vitality, and social functioning were all significantly impaired compared with a healthy population (P<.01 for all) and similar to that reported by patients with other chronic, disabling conditions. Hierarchical regression analyses revealed that symptom severity (beta = -.36, P<.001) and disability status (beta = -36, P<.001) were independent predictors of SF-36 physical component scores, with the full model accounting for 54% of the variance (P<.001). None of the variables examined accounted for a significant amount of the variance in SF-36 mental component scores. CONCLUSIONS: Patients with POTS experience clear limitations across multiple domains of quality of life, including physical, social, and role functioning. Treatment should address the multiple and varied impairments experienced by these patients and may require a multidisciplinary approach. Future research must further delineate factors, both disease related and psychosocial, that predict functioning and adjustment in this population.     

Worry, Procrastination, and Perfectionism: Differentiating Amount of Worry, Pathological Worry, Anxiety, and Depression

This study investigates features that differentiate worry from somatic anxiety and depression. Theoretical models of the worry process suggest that worry is closely related to procrastination. In addition, research on worry and elevated evidence requirements proposes a relationship between worry and perfectionism. Perfectionism, however, is multidimensional in nature. Moreover, previous research has linked procrastination and perfectionism mainly to anxiety and depression. Therefore, the relationship among worry, procrastination, and dimensions of perfectionism was investigated in a sample of 180 students, controlling for anxiety and depression. Results show that worry had substantial correlations with procrastination and perfectionism, particularly with perfectionist concern over mistakes and doubts. Moreover, worry was related to parental criticism and expectations, but unrelated to excessively high personal standards. Instead, high-worriers reported to lower standards under stress. Partial correlations indicated that these correlations were specific for amount of worry, thus differentiating amount of worry, pathological worry, anxiety, and depression.     

A catastrophizing assessment of worrisome thoughts

Cognitive products of anxiety related to the automatic questioning style proposed by Kendall and Ingram (1987) were examined in the context of chronic worry using a method modeled after the cognitive therapy technique of decatastrophizing. As chronic worriers generated sequences of possible catastrophic consequences for two worry topics, they generated significantly more catastrophic steps than nonworriers. Also, worriers reported a significant increase in subjective discomfort as catastrophizing progressed while nonworriers' reports revealed no change. With few exceptions, the content of worriers' catastrophic sequences did not differ from that of nonworriers. Despite this, worriers rated the events in their sequences as significantly more likely to actually occur than nonworriers. These results are consistent with the view of Ingram and Kendall (1987) that anxiety is associated with automatic questions of the form “what if?” It is argued that the differences between the cognitive products of worriers and nonworriers observed during catastrophizing reflect worriers' more ready access to elaborate memory stores of answers to catastrophic “what if?” questions that have been acquired through frequent repetition.     

The occupational and quality of life consequences of chronic fatigue syndrome/myalgic encephalomyelitis in young people

INTRODUCTION: Chronic fatigue syndrome, termed myalgic encephalomyelitis in the United Kingdom (CFS/ME), is a debilitating condition involving severe exhaustion, cognitive difficulties, educational and vocational losses, and disruption of social activities and relationships. CFS/ME may affect volition (that is, value, interest and sense of competence). PURPOSE: To test Model of Human Occupation (MOHO) concepts by comparing young people with and without CFS/ME in terms of occupational participation, volition and health-related quality of life during infection and over time. METHOD: Three hundred and one people (12-18 years old) diagnosed with glandular fever were evaluated at the time of acute infection (baseline). Six months following diagnosis, 39 of them met the criteria for CFS/ME. A further 39 who recovered were randomly selected and matched to CFS/ME participants. Both groups were re-evaluated at 12 months and 24 months. The Occupational Self Assessment and the Child General Health Questionnaire were used to compare occupational participation. RESULTS: Those with CFS/ME reported lower levels of perceived competency, more difficulties with physical functioning and poorer general health status than those who recovered. CONCLUSION: Those with CFS/ME report lower perceived competency, and compromises in physical functioning, school performance, social activities, emotional functioning and general health. This supports the MOHO assertion that impairments affect volition and quality of life.     

Periaqueductal gray neurons project to spinally projecting GABAergic neurons in the rostral ventromedial medulla

The analgesic effects of morphine are mediated, in part, by periaqueductal gray (PAG) neurons that project to the rostral ventromedial medulla (RVM). Although much of the neural circuitry within the RVM has been described, the relationship between RVM neurons and PAG input and spinal output is not known. The objective of this study was to determine whether GABAergic output neurons from the PAG target RVM reticulospinal neurons. Immunocytochemistry and confocal microscopy revealed that PAG neurons project extensively to RVM neurons projecting to the spinal cord, and two-thirds of these reticulospinal neurons appear to be GABAergic (contain GAD67 immunoreactivity). The majority (71%) of PAG fibers that contact RVM reticulospinal GAD67-immunoreactive neurons also contained GAD67 immunoreactivity. Thus, there is an inhibitory projection from PAG to inhibitory RVM reticulospinal neurons. However, there were also PAG projections to the RVM that did not contain GAD67 immunoreactivity. Additional experiments were conducted to determine whether the heterogeneity in this projection can be explained by the electrophysiological character of the RVM target neurons. PAG projections to electrophysiologically defined and juxtacellularly filled ON, OFF, and Neutral cells in the RVM were examined. Similar to the pattern reported above, both GAD67- and non-GAD67-immunoreactive PAG neurons project to RVM ON, OFF, and Neutral cells in the RVM. These inputs include a GAD67-immunoreactive projection to a GAD67-immunoreactive ON cell and non-GAD67 projections to GAD67-immunoreactive OFF cells. This pattern is consistent with PAG neurons producing antinociception by direct excitation of RVM OFF cells and inhibition of ON cells.     

Severity of pediatric pain in relation to school-related functioning and teacher support: An epidemiological study among school-aged children and adolescents

The current cross-sectional study examined child and adolescent pain severity in relation to various domains of school functioning and, in line with self-determination theory, the potentially protective role of perceived teacher support of child/adolescent autonomy and competence. Data from a large representative sample of Flemish school children and adolescents (N = 10650; 50.8% boys; age range 10–21 years; mean age = 14.33) was collected as part of the World Health Organization (WHO) collaborative Health Behaviour in School-Aged Children (HBSC) survey. Child/adolescent pain severity was graded based on a pediatric pain classification system adapted from that of Von Korff et al. The current study thus provided insight regarding the prevalence of pain among Flemish children/adolescents and, extending the limitations of existing literature, examined the specific role of pain severity across various domains of school functioning. Findings indicated that a sizeable proportion of children reported moderate to severe pain problems (ie, about 14% of children and adolescents were classified in the highest pain grades: ie, grade III or IV). Furthermore, higher pain grades were associated with poorer outcomes across all indices of school functioning (ie, school absenteeism, school-related pressure and satisfaction, and bullying experiences), with the exception of academic performance. However, the association between pain grade and school absenteeism was less pronounced when children perceived their teachers to be highly supportive of competence and autonomy. Furthermore, teacher support of competence appeared to buffer against the harmful effects of severe pain upon instances of bullying experiences at school. Future research directions and implications for school-based interventions are discussed.     

Shared and Distinct Cognitive/Affective Mechanisms in Intrusive Cognition: An Examination of Worry and Obsessions

Generalized anxiety disorder and obsessive–compulsive disorder are defined by chronic intrusive thoughts. The aim of the present study was to evaluate the relationship between cognitive (attentional control) and motivational (negative urgency) mechanisms potentially underlying worry and obsessions. Participants (N = 526) completed an online questionnaire battery consisting of self-report measures of worry, OCD symptoms, attentional control (AC), negative urgency (NU), and trait negative affect. After controlling for trait negative affect, self-reported AC was negatively related to worry, repugnant obsessions, and ordering symptoms. Greater NU was associated with increased worry and repugnant obsessions. Further, self-reported AC and NU interacted such that greater NU was associated with greater worry at high but not low levels of AC. AC and NU were independently associated with repugnant obsessions. Perceived executive functioning impairments may confer risk for intrusive thoughts, particularly worries, whereas distress-driven impulsivity may contribute to the involuntary, ego-dystonic features of intrusions.     

Impact of perceived cognitive impairment in breast cancer survivors

PurposeCognitive impairment is commonly reported by breast cancer survivors, yet little is known regarding its impact on quality of life. The purpose of this study was to obtain a better understanding of breast cancer survivors' experiences of perceived cognitive impairment, its trajectory, and its impact on relationships, daily functioning, work and overall life satisfaction after breast cancer diagnosis and treatment.MethodsThe results are based on qualitative interviews with 22 breast cancer survivors who reported cognitive impairment and who were at least 1 year post-chemotherapy treatment. Interviews were recorded, transcribed verbatim, and analyzed using a content analysis approach.ResultsBreast cancer survivors' primarily expressed concerns in 6 major domains including: short-term memory, long-term memory, speed of processing, attention and concentration, language and executive functioning. Concerns emerged as salient after treatment ended as other problems resolved. All of the survivors found these impairments frustrating, and some also reported these changes as detrimental to their self-confidence and social relationships. Employed survivors reported working harder to perform tasks and use of compensatory strategies to complete work tasks. Validation of perceived cognitive impairment by family, friends, and healthcare providers was perceived as important to adjustment.ConclusionsPerceived cognitive deficits have broad implications for the well-being of breast cancer survivors. Study findings underscore the broad consequences of this symptom, provide direction for theory development, measurement selection, and additional intervention targets. A greater understanding of cognitive impairment in breast cancer survivors may lead to the development of effective treatment of this symptom.     

Changes in Explanatory Flexibility Among Individuals with Generalized Anxiety Disorder in an Emotion Evocation Challenge

Seventy-eight undergraduates, 39 with self-reported generalized anxiety disorder (GAD), completed measures of mood and explanatory flexibility (the capacity to assign causes to negative events with a balance of historical and contextual factors) prior to and directly after a musical priming challenge that consisted of listening to negatively-valenced emotional music and thinking about a personally relevant negative event. After the emotion evocation, participants also completed a measure of state emotion regulation. Despite comparable increases in negative affect, GAD analogues evidenced drops in explanatory flexibility whereas non-GAD Controls did not. Drops in explanatory flexibility among GAD analogues covaried significantly with lack of emotional clarity. Findings suggest that for individuals with GAD, emotionally evocative experiences may result in a constricted perspective when apprehending the causes for negative events. This perspective may serve to dampen arousal, but perhaps at the cost of failing to inform one’s actions with important emotional information.     

Post-traumatic stress disorder symptoms, pain, and perceived life control: associations with psychosocial and physical functioning

The symptoms of PTSD and pain frequently co-occur following a traumatic event; however, very little is known about how these two conditions are associated with physical and psychosocial functioning. The current study intended to first examine the differential association of co-occurring pain complaints and PTSD symptoms with disability in the domains of psychosocial and physical functioning, and second, to test whether perceived life control is a mediator of these relationships. All participants experienced a motor vehicle accident (MVA) and reported pain due to accident-related injuries (n=183). Structural equation modeling was used to develop two models hypothesizing a relationship between PTSD symptomatology, pain severity, and perceived life control. Separate models were constructed for psychosocial and physical functioning, based on the hypothesis that pain and PTSD would be differentially related to disability in these two domains. Results suggested that more severe PTSD symptoms and greater pain complaints were related to psychosocial impairment, however, only pain was significantly related to impairment in physical functioning. Perceptions of life control were shown to further explain these interrelationships.     

Adding a subjective dimension to an ICF-based disability measure for people with multiple sclerosis: development and use of a measure for perception of disabilities

Objective. The subjective dimension of disability, the perception of disability, is a dimension missing from the International Classification of Functioning, Disability and Health (ICF), and from health-related quality of life (HRQOL) instruments. However, it is a highly relevant dimension for clinical practice as perceived disability may identify care needs. We therefore developed a measure for this subjective dimension of disability in multiple sclerosis (MS) and examined the contribution of this dimension to QOL.

Method. A measure named the Multiple Sclerosis Impact Profile-Disability Perception (MSIP-DP) was developed to reflect a person's perception of disabilities reported using the original MSIP-disability (MSIP-D) items. MS patients (n = 530) completed both MSIP sections, the medical outcome study short form questionnaire (SF-36), the World Health Organisation Quality Of Life-BREF (WHOQOL-BREF) and questions concerning disease severity. The contribution of disability perception (DP) to QOL in MS was estimated using hierarchical multiple regression analyses after controlling for MS severity.

Results. Confirmative factor analysis confirmed the hypothesised disability perception domains that correspond with the related disability domains in the MSIP. DP scales yielded sufficient reliability. DP explained a unique and substantial part of the variance in QOL, particularly the perception of impairments in mental functions.

Discussion. Results indicated that the subjective dimension of functioning and health operationalised in the MSIP-DP is a relevant concept in explaining QOL in MS. In clinical practice psychological interventions addressing a patient's perception of disability, particularly of impairments in mental functioning, may contribute to QOL.     

The Metacognitive Model of GAD: Assessment of Meta-Worry and Relationship With <Emphasis Type="Italic">DSM-IV</Emphasis> Generalized Anxiety Disorder

The metacognitive model of GAD places negative metacognitive beliefs and meta-worry as central in the development and maintenance of disorder. The present study examined the psychometric properties of the Meta-worry Questionnaire (MWQ) and used it to test hypotheses derived from the metacognitive model in the context of DSM-IV GAD. The MWQ was found to possess very good internal reliability, and both frequency and belief scales were found to consist of single factors. The scales correlated meaningfully with existing measures of worry and metacognition. Consistent with hypotheses individuals meeting criteria for GAD showed significantly higher meta-worry frequency scores than individuals classified as somatic anxiety or no anxiety. Meta-worry belief distinguished the GAD group from the non-anxious group but not the somatic anxiety group. These effects remained when Type 1 worry (social and health worry) was controlled. The results provide further support for the metacognitive model. Relationship between meta-worry frequency, belief, and GAD status was explored using path analysis. The relationship between meta-worry belief and GAD classification was dependent on meta-worry frequency.     

Cross cultural differences in health related quality of life in adolescents with cystic fibrosis

Purpose : Quality of Life (QoL) is an important outcome measure in health care and pharmacological trials. The trend towards multinational clinical trials may be problematic because it is unclear as to whether, or to what extent, QoL measures are comparable across cultures. This study compared QoL between English and German adolescents with Cystic Fibrosis (CF) and their healthy peers. Method : The study comprised a cross-sectional design. The English subjects formed two groups; 58 adolescents with CF and 49 healthy controls. The German subjects consisted of 26 adolescents with CF and 75 healthy controls. Quality of life was measured using the English and German versions of the SF-36. Demographic (age and gender) and clinical data (FEV 1 % predicted and BMI) were also recorded. Results : The English and German CF groups had similar age-adjusted lung function and body mass index. Both the English CF and control groups reported a poorer quality of life than their respective German counterparts across several domains of the SF-36. These were limitations in activities due to physical health problems and emotional difficulties, social functioning, energy and vitality and pain. Conclusions : The differences in quality of life between English and German adolescents with CF appear to be either culturally determined or due to idiosyncrasies in the translations of the SF-36, rather than a consequence of their disease or its management.