Systematic information processing style and perseverative worry

Are cognitive aspects of defense a core feature of anxiety and depression?

Anxiety and depression are highly prevalent behavior disorders, particularly in women. Recent preclinical work using animal models has been suboptimal in predicting the efficacy of drugs targeted at these conditions, suggesting a potential discrepancy between such models and the human disorders. Notably female animals tend to be equal to, or less responsive than, males in these tasks. A number of analyses suggest that mammalian defense patterns are complex: In addition to relatively discrete and immediate fight, flight, and freezing responses, a risk assessment pattern may occur in response to threat stimuli or situations with ambiguous elements. This pattern combines defensiveness with a number of cognition-linked behaviors such as sensory attention and orientation, approach, contact, and investigation of the potential threat. Studies measuring elements of this pattern suggest that female rats, and perhaps female mice, show higher levels than equivalent males. Higher female involvement may also occur in tasks involving learning/generalization/extinction of defensiveness to conditioned stimuli. Such findings are consonant with recent analyses of "female survival strategies" based on differential adaptiveness of cognitive components of defensiveness in females, due to the necessity of female care of offspring until they are independent. These data suggest the value of additional behavioral and functional analyses of cognitive aspects of defensive behavior; contributing to both an understanding of their underlying mechanisms, and providing more sensitive measures of drug responsivity for use with animal models.

Positive Attention Bias Trained during the Rethink Therapeutic Online Game and Related Improvements in Children and Adolescents' Mental Health

Attentional bias towards positive stimuli is considered a resilience factor for mental health and well-being. The aim of the present study was to analyze the effects of an attentional bias training for positive faces in a preventive therapeutic game for children and adolescents. The sample of 54, which consisted of children and adolescents aged between 10-16 years, played the REThink game, which included an attentional bias training level based on the visual search paradigm, where children had the task to quickly find the happy face among other angry faces. We measured mental health, and positive and negative emotions and analyzed their associations between changes in attention bias. Attentional bias indicators demonstrated acceptable reliability and results showed that increases in attentional bias towards positive faces were associated with improvements in children and adolescents' conduct problems, hyperactivity, and peer relationship problems. Overall, our results support the protective role of training attentional bias towards positive faces as part of a preventive therapeutic game for children and adolescents.

Anxiety Shapes Expectations of Therapeutic Benefit in Phase I Trials for Patients With Advanced Cancer and Spousal Caregivers

PURPOSE

Advanced cancer patients (ACP) hope to receive significant therapeutic benefit from phase I trials despite terminal disease and presumed symptom burdens. We examined associations between symptom burdens and expectations of therapeutic benefit for ACP and spousal caregivers (SC) during phase I trials.

PATIENTS AND METHODS

A prospective cohort of ACP-SC enrolled in phase I trials was assessed at baseline and one month using symptom burden measures evaluating depression, state-trait anxiety, quality of life, global health, post-traumatic coping, and marital adjustment. Interviews evaluated expectations of benefit.

RESULTS

Fifty-two phase I ACP and 52 SC (N = 104) were separately assessed and interviewed at baseline and one month. Total population demographics included the following: median age 61 years (28-78), 50% male, 100% married, 90% White, and 46% ≥ college education. At T1, ACP reported symptoms of mild state anxiety, mild trait anxiety, poor global health, and quality of life. SC reported moderate state and mild trait anxiety and good global health with little disability at baseline. State anxiety was a significant predictor of ACP expectations for phase I producing the following therapeutic benefits: stabilization (P = .01), shrinkage (P < .01), and remission (P = .04). Regression analyses also revealed negative associations between SC expectation for stabilization and SC anxiety: state (P = .01) and trait (P = .02). ACP quality of life was also negatively associated with SC expectations for stabilization (P = .02) and shrinkage (P = .01).

CONCLUSION

Anxiety, both state and trait, impacts couples' beliefs regarding the likelihood of therapeutic benefit from phase I trial participation.

The effect of worrying on intolerance of uncertainty and positive and negative beliefs about worry

BACKGROUND AND OBJECTIVES

The effect of a worry manipulation on the clinical constructs intolerance of uncertainty (IU), negative beliefs about the consequences of worry (NCOW), positive beliefs about the consequences of worry (PCOW), in addition to the emotions anxiety and sadness, was examined.

METHODS

A non-clinical sample was split into two groups, a worry group (n = 29), who were asked to generate 20 potential worries about a hypothetical scenario, and a control group (n = 28), who were asked to generate 2 potential worries about the same scenario. Subsequently, participants were asked to complete measures of IU, NCOW, PCOW, sadness and anxiety.

RESULTS

The worry group scored significantly higher than the control group on measures of IU, NCOW and PCOW but not on measures of sadness and anxiety.

LIMITATIONS

Possible limitations of the current study include the use of a student sample and the use of a hypothetical worry scenario.

CONCLUSIONS

The results suggest that engaging in worry can increase scores on measures of the beliefs and thought patterns often used to causally explain worry. The results are in line with recent research showing bidirectionality between anxiety related symptoms and their associated clinical constructs, and are consistent with an approach which sees anxiety symptoms as part of an evolved integrated threat management system that alerts the individual to threats to goals or challenges, and coordinates cognitive, behavioral, and affective reactions to enable effective responding to these threats and challenges.

The interplay of trait worry and trait anxiety in determining episodic retrieval: The role of cognitive control

Worrying is a key concept in describing the complex relationship between anxiety and cognitive control. On the one hand, cognitive control processes might underlie the specific tendency to engage in worrying (i.e., trait worry), conceptualized as a future-oriented mental problem-solving activity. On the other hand, the general tendency to experience the signs and symptoms of anxiety (i.e., trait anxiety) is suggested to impair cognitive control because worrisome thoughts interfere with task-relevant processing. Based on these opposing tendencies, we predicted that the effect of the two related constructs, trait anxiety and trait worry, might cancel out one another. In statistics, such instances have been termed suppressor situations. In four experiments, we found evidence for such a suppressor situation: When their shared variance was controlled, trait worry was positively whereas trait anxiety was negatively related to performance in a memory task requiring strategic, effortful retrieval. We also showed that these opposing effects are related to temporal context reinstatement. Our results suggest that trait worry and trait anxiety possess unique sources of variance, which differently relate to performance in memory tasks requiring cognitive control.

Correlates of Worry About Health Care Costs Among Older Adults

Although older adults in the United States incur more health care expenses than younger adults, little research has been done on their worry about health care costs. Using data from the 2013 National Health Interview Survey ( n = 7,253 for those 65+ years), we examined factors associated with older adults' health care cost worries, defined as at least a moderate level of worry, about ability to pay for normal health care and/or for health care due to a serious illness or accident. Bivariate analyses were used to compare worriers and nonworriers. Binary logistic regression analysis was used to examine the association of income, health status, health care service use, and insurance type with worry status. Older age and having Medicaid and Veterans Affairs (VA)/military health benefits were associated with lower odds of worry, while low income, chronic pain, functional limitations, psychological distress, and emergency department visits were associated with higher odds. Practice and policy implications for the findings are discussed.