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Perseverative thinking (PT) is a process that consists of difficulty disengaging from negative thinking; two common forms are worry and rumination. Existing measures of PT require individuals to report on their own thought processes, a method that may be subject to bias or errors. An unobtrusive, behavioral measure of PT would circumvent these biases, improving our ability to detect PT. One promising behavioral method is computational linguistic analysis, which has recently been used to investigate personality and mental health constructs (e.g., Guntuku et al., 2017; Park et al., 2015). Evidence from the co-rumination and expressed worry literatures (e.g., Parkinson & Simons, 2012; Spendelow et al., 2017), combined with the fact that PT is verbal-linguistic in nature (Ehring & Watkins, 2008), hints that PT may be particularly well-suited for detection in natural language. In this project, we will examine linguistic correlates of PT build and test a language-based model of PT.

Worry, a stream of negative thoughts about the future, is maintained by poor attentional control, and the tendency to attend to negative information (attention bias) and interpret ambiguity negatively (interpretation bias). Memories that integrate negative interpretations (interpretation-memory) may also contribute to worry, but this remains unexplored. We aimed to investigate how these cognitive processes are associated with worry and anxiety cross-sectionally (Phase 1), and then explore which cognitive processes from Phase 1 would predict worry and anxiety during times of high stress, namely prior to examinations (Phase 2), and after the initial onset of the COVID-19 pandemic (Phase 3). Worry, anxiety, and cognitive processes were assessed in an undergraduate sample (N = 64). We found that whilst greater benign interpretation bias and benign interpretation-memory bias were associated with lower levels of concurrent worry and anxiety, only interpretation bias explained unique variance in worry and anxiety. No cognitive predictor significantly explained unique variance in prospective worry and anxiety prior to examinations. In relation to anxiety and worry during the stress of the COVID-19 pandemic, both benign attention bias and benign interpretation-memory bias predicted decreased worry; only benign attention bias predicted decreased anxiety. Findings suggest that cognitive processes can predict changes in worry and anxiety during future stressful contexts.

People suffering from chronic worries pay excessive attention to emotional information. In this study we examined whether a reduced ability to inhibit attention from fearful faces (i.e. inhibition of return; IOR) can be attributed to the low vagus nerve activity observed in high worriers. Our pre-registered hypothesis was that transcutaneous auricular vagus nerve stimulation (tVNS) would enhance IOR to fearful faces. Ninety-four students who scored above a pre-determined cut-off on the Penn State Worry Questionnaire were randomly allocated to receive either tVNS (n = 45) or sham stimulation of the earlobe (n = 49). Meanwhile, to assess IOR, they performed an emotional exogenous cueing task wherein neutral and fearful faces predicted the target location at chance level. Resting levels of HRV were also collected before stimulation onset. Results showed that levels of trait worry were associated with reduced IOR, but resting levels of HRV were not. Critically, tVNS did not affect performance on the exogenous cueing task when compared to sham stimulation. These findings did not confirm the hypothesized causal role of vagus nerve activity in maintaining disrupted IOR for emotional information. They also provide evidence that high levels of worry are associated with generally reduced IOR. This points to a clear need to understand the neurobiological basis of inhibitory problems in worriers.

Safety perspectives of generalized anxiety disorder (GAD) propose that safety perception is critical to regulating anxiety. Reduced safety processing may contribute to persistent worry and anxiety that extend to recognizably safe contexts. We explored whether individuals higher in worry and intolerance of uncertainty (IU), central characteristics of GAD, display poorer recognition and use of safety cues, and whether safety perception is related to anxiety. One hundred and eighty-two adults were presented with unfolding potentially threatening scenarios, half of which contained safety information. Participants rated how safe and anxiety-provoking each scenario was as they received new information, as well as overall. Using multilevel modeling, results showed that individuals higher in worry and IU recognize safety information and use it to appraise the safety of a situation. A moderate correlation between safety and anxiety ratings, and inconsistent correspondence between ratings of safety and anxiety, suggest this relationship is complicated by additional factors. Individuals higher in worry and IU may have difficulty accepting their safety appraisals in order to inhibit their anxiety. The implications of the findings and future avenues of research are discussed.

Trait worry is a hallmark feature of anxiety and depression, interfering with attentional control and impairing cognitive performance. Previous research has shown the adaptive dual n-back training is effective in improving attentional control and reducing emotional vulnerability, but not for everyone. The current randomised controlled trial explored the role of baseline emotional vulnerability and perceived cognitive impact in training-related cognitive and emotional improvements in 60 high worriers randomly assigned to 10 sessions of the adaptive dual n-back training or non-adaptive 1-back training. Pre-training, post-training and one-month follow-up measures of cognitive performance were assessed using an emotional Flanker task, a cued task-switching task, and the MaRs-IB task. Self-report questionnaires assessed worry, anxiety, depression, somatisation, and self-efficacy, as well as participants' perceived cognitive impact of the training. Participants with higher levels of baseline emotional vulnerability presented the largest improvements in non-verbal reasoning and emotional vulnerability one month after the training, as well as the greatest perceived cognitive impact. Perceived cognitive impact was predicted by working memory improvement on the adaptive n-back training at high baseline levels of anxiety. These results suggest that the adaptive n-back training presents the greatest emotional and cognitive benefits for individuals experiencing severe levels of emotional vulnerability.

Worry is the principle characteristic of generalised anxiety disorder, and has been linked to deficient attentional control, a main function of working memory (WM). Adaptive WM training and mindfulness meditation practice (MMP) have both shown potential to increase attentional control. The present study hence investigates the individual and combined effects of MMP and a dual adaptive n-back task on a non-clinical, randomised sample of high worriers. 60 participants were tested before and after seven days of training. Assessment included self-report questionnaires, as well as performance tasks measuring attentional control and working memory capacity. Combined training resulted in continued reduction in worry in the week after training, highlighting the potential of utilising n-back training as an adjunct to established clinical treatment. Engagement with WM training correlated with immediate improvements in attentional control and resilience, with worry decreasing over time. Implications of these findings and suggestions for future research are discussed.

Previous research has documented the inhibitory effects of worry on cardiovascular reactivity to subsequently presented fear-relevant stimuli. Although theoretical assertions point to the verbal-linguistic (as opposed to imagery-based) nature of worry as the cause of these inhibitory effects, extant research investigating the effects of worrisome thinking on subsequent anxiety-eliciting tasks has not isolated the verbal-linguistic nature of worry as the active ingredient in its suppressive effects on arousal. Furthermore, prior research has not examined the potential effects of worry on maintenance of panic symptoms. In this study, participants high in anxiety sensitivity were asked to engage in verbal worry, imaginal worry, or relaxation prior to each of three repeated presentations of an interoceptive exposure task. Relaxation was associated with lower initial subjective fear that remained low across repeated exposures, and related stable sympathetic arousal (and decreased heart rate) over time. Imagery-based worry was associated with moderate initial subjective fear that was sustained across repeated exposures, and sympathetic arousal (and heart rate) that was likewise stable over time. However, verbal worry was associated with high initial subjective fear that was sustained over time, but sympathetic arousal (and heart rate) that decreased across repeated exposures. Thus, verbal worry was uniquely associated with a lack of synchronous response systems and maintenance of anxious meaning over time. Theoretical and clinical implications are discussed.

Insight in obsessive-compulsive disorder (OCD) is assumed to fluctuate over time. However, temporal variations of insight and its correlates in OCD have never been empirically studied. We used ecological momentary assessment (EMA) to analyze the temporal variation of insight into the unreasonableness of the threat-related core belief (1), into the senselessness of compulsions to prevent this belief from occurring (2), and into the belief, itself, as being due to OCD (3). Furthermore, we analyzed whether worry, self-punishment and mindfulness are associated with these aspects of insight. A total of 50 OCD patients underwent EMA 10 times a day over 6 consecutive days. Data were analyzed using multilevel modelling. Results revealed that multiple time-points within individuals accounted for up to 51.4% of insight variance, indicating a substantial fluctuation of insight over time. Root mean square successive difference (rMSSD) scores indicated significantly higher fluctuation patterns in the doubt/checking dimension as compared to taboo thoughts throughout all aspects of insight. As hypothesized, self-punishment and mindfulness significantly predicted insight into the unreasonableness of the threat-related belief and the senselessness of compulsions to prevent this belief from occurring. Mindfulness demonstrated the greatest predictive value and remained significant after controlling for OC symptoms. Contrary to expectation, worry, as it was measured in our study, was not associated with insight. Besides providing evidence for insight fluctuation, our results indicate that mindfulness-based strategies might be beneficial for increasing insight in OCD.

As a field, we lack information about specific mechanisms that are responsible for changes that occur over the course of treatments for anxiety disorders (Kazdin, 2007). Identifying these mechanisms would help streamline evidence-based approaches, increase treatment response rates, and aid in the dissemination and implementation of evidence-based approaches in diverse contexts. The current study examined reductions in experiential avoidance (EA; Hayes, Wilson, Gifford, Follette, & Strosahl, 1996), attempts to control or eliminate distressing internal experiences, regardless of behavioral consequences, as a potential mechanism of change in participants with a principal diagnosis of Generalized Anxiety Disorder (GAD) receiving either Acceptance-based Behavior Therapy (ABBT) or Applied Relaxation (AR). Participants’ EA scores across treatment on the Acceptance and Action Questionnaire (AAQ) were used to calculate slopes, which were used as predictors in a series of linear regressions. Greater change in EA across treatment significantly predicted change in worry (PSWQ) and quality of life (QOLI) across both treatments. These results contribute to the body of literature on common mechanisms of change across traditional CBTs and mindfulness and acceptance-based approaches.

Introduction Many individuals believe that worry helps solve real-life problems. Some researchers also purport that nonpathological worry can aid problem solving. However, this is in contrast to evidence that worry impairs cognitive functioning. Objective This was the first study to empirically test the effects of a laboratory-based worry induction on problem-solving abilities. Procedure Both high (n = 96) and low (n = 89) trait worriers described a current problem in their lives. They were then randomly assigned to contemplate their problem in a worrisome (n = 60) or objective (n = 63) manner or to engage in a diaphragmatic breathing task (n = 62). All participants subsequently generated solutions and then selected their most effective solution. Next, they rated their confidence in the solution's effectiveness, their likelihood to implement the solution, and their current anxiety/worry. Experimenters uninformed of condition also rated solution effectiveness. Results The worry induction led to lower reported confidence in solutions for high trait worry participants, and lower experimenter-rated effectiveness of solutions for all participants, relative to objective thinking. Further, state worry predicted less reported intention to implement solutions, while controlling for trait worry. Finally, worrying about the problem led to more elevated worry and anxiety after solving the problem compared to the other two conditions. Conclusions Overall, the worry induction impaired problem solving on multiple levels, and this was true for both high and low trait worriers.

The present study tested a novel, person-specific method for identifying discrete mood profiles from time-series data, and examined the degree to which these profiles could be predicted by lagged mood and anxiety variables and time-based variables, including trends (linear, quadratic, cubic), cycles (12-hr, 24-hr, and 7-day), day of the week, and time of day. We analyzed ambulatory data from 45 individuals with mood and anxiety disorders prior to therapy. Data were collected four-times-daily for at least 30 days. Latent profile analysis was applied person-by-person to discretize each individual's continuous multivariate time series of rumination, worry, fear, anger, irritability, anhedonia, hopelessness, depressed mood, and avoidance. That is, each time point was classified according to its unique blend of emotional states, and latent classes representing discrete mood profiles were identified for each participant. We found that the modal number of latent classes per person was three (mean = 3.04, median = 3), with a range of two to four classes. After splitting each individual's time series into random halves for training and testing, we used elastic net regularization to identify the temporal and lagged predictors of each mood profile's presence or absence in the training set. Prediction accuracy was evaluated in the testing set. Across 127 models, the average area under the curve was 0.77, with sensitivity of 0.81 and specificity of 0.75. Brier scores indicated an average prediction accuracy of 83%.

Mental imagery plays a prominent role across psychopathology. However, its quality and role in generalized anxiety disorder (GAD) have not been examined as extensively as in other disorders. The goal of the present study was to obtain a better understanding of general imagery processes and individual differences in people with GAD. Adults with GAD (N = 31) were compared to a Healthy Control (HC) group (N = 32) across mental imagery domains as per Pearson, Deeprose, Wallace-Hadrill, Heyes, and Holmes (2013)'s framework: cognitive, general use/experience, and clinical. No differences were found between the GAD and HC groups on cognitive aspects of imagery. Both groups were also similar in their ability to imagine experiences across sensory modalities. No differences were found between groups in their spontaneous use of imagery in everyday situations, or in vividness of sensory-perceptual imagery. For clinical aspects of imagery, between-group differences emerged in the experience of prospective imagery; those with GAD reported greater “pre-experiencing” (“intrusive, prospective, personally-relevant imagery”; Deeprose & Holmes, 2010), rated imagined future negative scenarios as more vivid, more likely, and more personally relevant, and evaluated the experience of these images as more intense than did HCs. Taken together, findings suggest that the presence of intrusive mental imagery distinguishes individuals with GAD from those without psychopathology. Findings could help improve interventions utilizing imagery techniques.

While research based on the emotion dysregulation model indicates a positive relationship between intense emotions and generalized anxiety disorder (GAD) symptoms, emotion-focused intervention involves the use of techniques to enhance emotional experiences, based on the notion that GAD patients are engaging in avoidance strategies. To reveal the conditions under which intense emotions lead to reduced GAD symptoms, we designed a longitudinal study to monitor changes in GAD symptoms among students (N ¼ 129) over 3 months. Our focus was on possible moderators of the effect of emotional intensity. Results indicated that when fear of emotions and negative appraisals about problem solving were low, negative emotional intensity reduced later GAD symptoms. Moreover, under the condition of high responsibility to continue thinking, emotional intensity tended to reduce later GAD symptoms. Results suggest that reduced fear of emotions and reduced negative appraisals about problem solving may enhance the use of emotional processing techniques (e.g., emotional exposure). The interaction between responsibility to continue thinking and emotional intensity requires further examination., This study was supported by a JSPS Grant-in-Aid for Scientific Research (C) to the first author (No: 26380929) and a JSPS Grant-in-Aid for JSPS Fellows to the second author (No: 13J40120).

Trauma-related rumination and worry predict chronic PTSD. This study examined whether habitual rumination and worry measured prior to trauma exposure make persons more vulnerable to the onset of PTSD, presumably because habitual ruminators and worriers will be more prone to cognitively appraise trauma exposure in a negative way. A sample of 2981 adults aged 18–65, consisting of healthy controls and persons with past or current depressive and/or anxiety disorders were assessed at baseline and at follow-up four years later (n = 2402). At follow-up, 359 participants reported exposure to a traumatic event during the last four years of whom 52 (14.4%) had developed PTSD. Pre-trauma self-reported depression severity and trait rumination – but not trait worry-predicted onset of PTSD during follow-up, controlling for demographic and clinical history variables, as well as psychiatric diagnoses at baseline. The relation of trait rumination with onset of PTSD was partly mediated by the cognitive appraisal of the traumatic event and not by the affective reaction to trauma exposure. Repetitive negative thinking in the form of rumination may be a risk factor for onset of PTSD amenable to prevention and intervention.

Repetitive negative thinking (RNT) is a common symptom across depression and anxiety disorders and preliminary evidence suggests that decreases in rumination and worry are related to improvement in depression and anxiety symptoms. However, despite its prevalence, relatively little is known about transdiagnostic RNT and its temporal associations with symptom improvement during treatment. The current study was designed to examine the influence of RNT on subsequent depression and anxiety symptoms during treatment. Participants (n = 131; 52% female; 93% White; M = 34.76 years) were patients presenting for treatment in a brief, cognitive behavior therapy based, partial hospitalization program. Participants completed multiple assessments of depression (Center for the Epidemiological Studies of Depression-10 scale), anxiety (the 7-item Generalized Anxiety Disorder Scale), and repetitive negative thinking (Perseverative Thinking Questionnaire) over the course of treatment. Results indicated statistically significant between and within person effects of RNT on depression and anxiety, even after controlling for the effect of time, previous symptom levels, referral source, and treatment length. RNT explained 22% of the unexplained variability in depression scores and 15% of the unexplained variability in anxiety scores beyond that explained by the control variables. RNT may be an important transdiagnostic treatment target for anxiety and depression.

Comorbidity among affective disorders is high. Rumination has been found to mediate cross-sectional and prospective relations between anxiety and depressive symptoms in adolescents and adults. We examined whether rumination and Worry, both forms of repetitive negative thinking, also explain the associations between affective disorders. This was studied using a prospective cohort study. In a mixed sample of 2981 adults (persons with a prior history of or a current affective disorder and healthy individuals) we assessed DSM-IV affective disorders (CIDI), rumination (LEIDS-R) and worry (PSWQ). All measures were repeated 2 years and 4 years later. Using structural equation models, we found that baseline rumination and worry partly mediated the association of baseline fear disorders (social anxiety disorder, panic disorder, agoraphobia) with distress disorders (dysthymia, major depressive disorder, generalized anxiety disorder). Moreover, baseline fear disorders predicted changes in distress disorders and changes in worry and rumination mediated these associations. The association between baseline distress disorders and changes in fear disorders was mediated by changes in rumination but not by changes in worry. From these results it can be concluded that repetitive negative thinking is an important transdiagnostic factor. Rumination and worry are partly responsible for the cross-sectional and prospective co-occurrence of affective disorders and may be suitable targets for treatment. (C) 2014 Elsevier Ltd. All rights reserved.

We explored whether transdiagnostic internet-delivered cognitive behavioural therapy (iCBT) for mixed anxiety and depression effectively reduces repetitive negative thinking (RNT), and whether reductions in RNT and positive metacognitive beliefs mediate symptom improvement during iCBT. Participants with generalized anxiety disorder (GAD), major depressive disorder (MDD), or mixed GAD/MDD diagnoses were randomly allocated to a 6-lesson clinician-guided iCBT anxiety and depression program (n = 46) or wait-list control (WLC, n = 53). Depression (PHQ-9), generalized anxiety (GAD-7), RNT (Repetitive Thinking Questionnaire) and positive beliefs about RNT (Positive Beliefs about Rumination Scale) were assessed at pre-, mid-, and post-treatment or matched time points for WLC. Tests of serial indirect effects explored the potential meditating role of RNT and positive belief reductions on the impact of iCBT on depression and anxiety symptoms post-treatment. Results showed that both RNT frequency and positive beliefs about the value of RNT reduced significantly following iCBT compared to WLC, with gains maintained at 3-month follow-up. Reductions between pre- and mid-treatment in positive beliefs and RNT mediated improvements in depression symptoms post-iCBT, and reductions in positive beliefs mediated improvements in GAD symptoms. These findings indicate that iCBT is an effective treatment for RNT and positive metacognitive beliefs. Future dismantling studies are needed to assess the most effective treatment components.

Recently there has been increased interest in emotional and physical tolerance risk factors for mood and anxiety disorders. Three tolerance risk factors that have been shown to be related are anxiety sensitivity (AS), distress tolerance (DT), and discomfort intolerance (DI). Although previous research has demonstrated these constructs are malleable, no research has investigated the effects of an AS intervention on DT or DI. Further, no studies have investigated whether changes in DT or DI play a role in mood and anxiety symptom amelioration due to an AS intervention. Participants (N = 104), who were selected for elevated levels of AS, completed a single-session computer-assisted AS intervention or a control intervention and follow-up assessments at 1-week and 1-month post intervention. Results revealed that the intervention reduced AS and increased DT, but did not affect DI at the 1-week follow-up. Mediation analyses revealed that changes in AS and DT both mediated changes in symptoms (depression, anxiety, worry) due to the intervention at 1-month follow-up, however, when AS and DT were considered in the same model only the effect via AS remained significant. These results have important implications for the nature of the relationships between AS, DT, and DI as well as the specific mechanistic pathways through which an AS intervention ameliorates symptoms.

Despite research supporting the effectiveness of evidence-based interventions in the treatment of eating disorders, those interventions are under-utilised in routine clinical practice, possibly due to clinicians' concerns about delivering the relevant techniques. This study examined what elements of therapy clinicians worry about when delivering cognitive-behavioural therapy (CBT) for the eating disorders, and what clinician variables are associated with such concerns. The participants were 113 clinicians who used individual CBT with eating disorder patients. They completed a novel measure of concerns about delivering elements of CBT, as well as demographic characteristics and a standardised measure of intolerance of uncertainty. Clinicians worried most about body image work and ending treatment, but least about delivering psychoeducation. Their concerns fell into four distinct factors. Older, more experienced clinicians worried less about delivering the CBT techniques, but those with greater levels of prospective and inhibitory anxiety worried more about specific factors in the CBT techniques. Clinicians' capacity to tolerate uncertainty might impair their delivery of evidence-based CBT, and merits consideration as a target in training and supervision of CBT clinicians.

Insomnia is a common health problem that affects about 10% of the population. The purpose of this investigation was to examine the association between cognitive processes and the persistence and remission from insomnia in the general population.In a longitudinal design, 2333 participants completed a survey on night time and daytime symptoms, and cognitive processes. Follow-up surveys were sent out six months and 18 months after the first assessment. Participants were categorised as having persistent insomnia, being in remission from insomnia or being a normal sleeper.Cognitive processes distinguished between people with persistent insomnia and normal sleepers. Specifically, worry, dysfunctional beliefs, somatic arousal, selective attention and monitoring, and safety behaviours increased the likelihood of reporting persistent insomnia rather than normal sleep. For people with insomnia, more worry about sleep at baseline predicted persistent insomnia but not remission later on. Lower selective attention and monitoring, and use of safety behaviours over time increased the likelihood of remission from insomnia. In general, these results remained, when psychiatric symptoms and medical complaints were added to the models.The findings support that certain cognitive processes may be associated with persistence and remission of insomnia. Clinical implications are discussed.

Fibromyalgia (FM) is a prevalent chronic pain disorder associated with large suffering and substantial societal costs. Pain-related avoidance behaviour and hypervigilance to bodily symptoms are common in FM and contribute in maintaining and exacerbating the disorder. Exposure therapy targeting avoidance behaviours and hypervigilance has shown promise in the treatment of FM. The present study investigated mediators of treatment outcome in exposure therapy for FM. We used data from a randomised trial, where 140 participants were allocated to 10-week internet-delivered exposure therapy or to a waiting-list control condition. The main outcome variable (FM symptoms) and the hypothesized mediators (FM-related avoidance behaviour, mindful non-reactivity and FM-related worry) were measured weekly throughout treatment. Mediation analyses were conducted using linear mixed effects models with bootstrap replication and time-lagged analysis. Results indicated that all three process variables were significant mediators of FM severity. However, in the time-lagged analyses, only FM-related avoidance behaviour displayed a unidirectional relationship over time with FM symptoms, suggesting a causal effect. Thus, results illustrate that changes in avoidance behaviour mediate the outcome of exposure on FM symptoms, which implies that avoidance behaviour is an important treatment target in exposure therapy.

Transdiagnostic interventions present pragmatic benefits in treatment dissemination and training of mental health professionals when faced with emotional disorders such as anxiety and depression. Excessive worry is a common feature across emotional disorders and represents an ideal candidate target for transdiagnostic intervention. The current pilot trial examined the efficacy of a behavioural activation treatment for worry (BAW) in a community population. 49 individuals experiencing excessive worry were randomised to waitlist or BAW receiving an 8 week group based intervention. Results demonstrated that BAW was successful in reducing excessive worry, depressive symptoms, cognitive avoidance, Intolerance of Uncertainty and improving problem solving orientation. Twice as many individuals showed clinically significant reductions in excessive worry after treatment compared to the waitlist control. Despite limitations to sample size and power, this study presents promising support for BAW as a practical transdiagnostic treatment for worry.

To compare a mindfulness-based intervention with cognitive behavioral therapy (CBT) for the group treatment of anxiety disorders.One hundred five veterans (83% male, mean age=46 years, 30% minority) with one or more DSM-IV anxiety disorders began group treatment following randomization to adapted mindfulness-based stress reduction (MBSR) or CBT.Both groups showed large and equivalent improvements on principal disorder severity thru 3-month follow up (ps.001, d=-4.08 for adapted MBSR; d=-3.52 for CBT). CBT outperformed adapted MBSR on anxious arousal outcomes at follow up (p.01, d=.49) whereas adapted MBSR reduced worry at a greater rate than CBT (p.05, d=.64) and resulted in greater reduction of comorbid emotional disorders (p.05, d=.49). The adapted MBSR group evidenced greater mood disorders and worry at Pre, however. Groups showed equivalent treatment credibility, therapist adherence and competency, and reliable improvement.CBT and adapted MBSR were both effective at reducing principal diagnosis severity and somewhat effective at reducing self-reported anxiety symptoms within a complex sample. CBT was more effective at reducing anxious arousal, whereas adapted MBSR may be more effective at reducing worry and comorbid disorders.

Worry is a verbal and abstract thought activity with only little mental imagery involved. It has been shown that this processing bias leads to hampered emotional processing of worry topics so that worry is maintained in the long run. However, there is some evidence that mental imagery during worrying has the opposite effect: It leads to stronger emotional reactions than verbal thoughts and thereby fosters emotional processing of worry topics. In the present study, we examined whether training mental imagery reduces pathological worry. We compared the effect of a novel training in mental imagery (TMI; n = 37) on various worry-related outcomes to a control training in verbal thinking (TVT; n = 38) and a waiting-list control group (n = 36) in a sample of pathologically high worriers. Both trainings showed significant within-group decline regarding e.g. pathological worry activity, worry-related impairment and anxiety assessed both one and five weeks after the training. Cohen's d on different outcome measures ranged from .39 to 1.17. However, unexpectedly, there were no significant differences between groups on any worry- or affect-related outcome measures. In, sum our training in general mental imagery skills turned out to be a promising intervention for the reduction of pathological worry. However, we found a training in verbal thinking to also have unexpected beneficial effects. The theoretical and clinical implications of these findings and methodological limitations of our study are discussed.

Depression often is characterized by inflexible autonomic and metacognitive processes that interfere with effective self-regulation. However, few studies have integrated these factors to improve the prediction of which individuals are at greatest risk for depression. Among 134 undergraduates, we evaluated whether parasympathetic inflexibility (a lack of reduction in respiratory sinus arrhythmia) in response to a sadness induction involving loss would prospectively predict symptoms of depression across four waves of follow-up over twelve weeks. Furthermore, we evaluated whether metacognitive components of perseverative cognition (PC) and decentering (identified by a principal component analysis) would moderate this relationship in opposite directions. Multilevel modeling demonstrated that the relationship between parasympathetic inflexibility and prospective symptoms of depression was exacerbated by PC, but attenuated by decentering. Furthermore, individuals with parasympathetic inflexibility, PC, and low decentering were at greatest risk for symptoms of depression across follow-up. These results support the utility of integrating autonomic and metacognitive risk factors to identify individuals at risk for depression.

Background Worry is a key component of anxiety and may be an effective target for therapeutic intervention. We compared two psychological processes (attention and acceptance) on the frequency of intrusive worrying thoughts in an experimental worry task. Method 77 participants were randomised across three groups and completed either a 10 min attention or acceptance-based psychological exercise, or progressive muscle relaxation control. We subsequently measured anxiety, and the content and frequency of intrusive thoughts before and after a ‘worry induction task’. Results Groups did not differ in baseline worry, anxiety or thought intrusions. Both attention and acceptance-based groups experienced fewer negative thought intrusions (post-worry) compared to the relaxation control group. The acceptance exercise had the largest effect, preventing ‘worry induction’. Increases in negative intrusive thoughts predicted subjective anxiety. Discussion We provide evidence that acceptance and attention psychological exercises may reduce anxiety by reducing the negative thought intrusions that characterise worry., Graphical abstract Image 1, Highlights • We used an experimental worry task to see how psychological interventions can target worry. • We compared 10-min attention and acceptance-based exercises to progressive muscle relaxation. • Both acceptance and attention were better than relaxation, and acceptance had the largest effect. • Increases in negative intrusive thoughts predicted subjective anxiety across all groups. • Acceptance and attention psychological exercises may help anxiety by reducing worry.

We know little about why some people get better after psychological treatments for pain disability, whereas other people do not. In order to understand differences in treatment response, we need to explore processes of change during treatment. It has been suggested that people with pain complaints who change early in treatment have better outcomes. Therefore, we aimed to investigate whether changes in psychological variables at different time points are related to outcome, and whether early or late changes are better predictors of outcome. We used the fear avoidance model as a theoretical framework. We followed 64 patients weekly over 6-7 weeks and then determined outcome. Our findings indicate that people who decrease in catastrophizing and function early in treatment as well as in depressive symptoms, worry, fear avoidance beliefs and function late in treatment have better outcomes. Early decreases in function, and late decreases in depressive symptoms and worry uniquely predict improvements in disability. While early and late changes covaried concurrently, there were no significant sequential relationships between early and late changes. Changes in the proposed process variables in the fear avoidance model, early as well as late in treatment, thus add valuable information to the explanation of outcome.

Putatively adaptive emotion regulation strategies (e.g., acceptance, problem solving, reappraisal) show weaker associations with psychopathology than putatively maladaptive strategies (e.g., avoidance, self-criticism, hiding expression, suppression of experience, worry, rumination). This is puzzling, given the central role that adaptive strategies play in a wide range of psychotherapeutic approaches. We explored this asymmetry by examining the effects of context (i.e., emotion intensity, type of emotion, social vs. academic circumstances) on the implementation of adaptive and maladaptive strategies. We asked 111 participants to describe 8 emotion-eliciting situations and identify which strategies they used in order to regulate their affect. We found support for a contextual model of emotion regulation, in which adaptive strategies were implemented with more cross-situational variability than maladaptive strategies. In addition, the variability in implementation of two adaptive strategies (acceptance, problem solving) predicted lower levels of psychopathology, suggesting that flexible implementation of such strategies in line with contextual demands is associated with better mental health. We discuss these findings by underscoring the importance of adopting a functional approach to the delineation of contextual factors that influence the implementation of emotion regulation strategies.

Background: Intolerance of uncertainly (IU), cognitive avoidance (CA) and positive beliefs about worry (PB) independently predict worry frequency in older adolescents and adults, and when targeted together in treatment produce significant reductions in both worry and anxiety in this age range. The present study addresses a gap in the literature by testing whether a cognitive model of excessive worry and anxiety incorporating these process variables is applicable to children and adolescents. Method: Primary and secondary school students (n=515; aged 7-19 years) completed modified self-report measures of worry frequency, anxiety, IU, CA and PB and a path analysis undertaken to test whether IU was a higher order variable for CA and PB and whether the relationship between IU/CA/PB and anxiety was mediated by worry frequency. Results: Significant (bivariate) correlations were observed between the measures of IU, PB, CA, worry and anxiety across the age range. However separate path models had to be fitted for children (aged 7-12 years) and adolescents (aged 13-19) with PB being dropped from the child model. CA was related to anxiety only through worry in children while IU showed direct paths to worry and anxiety in both children and adolescents. Conclusions: Cognitive models of persistent worry in adults and older adolescents may, with some modification, have applicability to children. Further testing and refinement of these cognitive models of worry may lead to improvements in existing treatments for anxious youth. (Less)

Cognitive therapy (CT) assumes that personality disorders (PDs) are characterized by interpretational biases that maintain the disorder. Changing interpretations is therefore a major aim of CT of PDs. This study tested whether Borderline PD (BPD), Avoidant and Dependent PD (AV/DEPD), and Obsessive-Compulsive PD (OCPD) are characterized by specific interpretations. Among the 122 participants there were 55 PD patients (17 BPD, 30 AV/DEPD, 29 OCPD diagnoses), 26 axis-1 patients, and 41 nonpatients. Participants put themselves into 10 scripts of negative events and noted feelings, thoughts and behaviors that came to mind. Next, they chose between hypothesized BPD-specific, AV/DEPD-specific, and OCPD-specific interpretations of each event (forced choice). Lastly, participants rated belief in each interpretation. Regression analyses revealed that forced choices and belief ratings supported the CT-model of BPD and AV/DEP: interpretations were specific. The alleged OCPD-beliefs were however not specifically related to OCPD, with relatively high popularity in axis-1 patients and nonpatients. The open responses were classified by judges blind for diagnoses, with the following results. BPD was characterized by low levels of solution-focused and healthy-flexible/accepting responses, and higher levels of criticizing others and malevolent interpretations of others. AV/DEPD was characterized by lower levels of solution-focused responses, and higher levels of self-criticism, negative emotions, guilt and fear of judgment, as well as lower levels of other-criticism. OCPD only showed trends for lower healthy responses, and higher compulsiveness and worry. It is concluded that the assumptions of CT are supported for BPD and AV/DEPD, but not-at least not on the explicit interpretational level-for OCPD. CT of OCPD might need a slightly different approach. (PsycINFO Database Record (c) 2011 APA, all rights reserved) (journal abstract)

Worry-prone individuals have less residual working memory capacity during worry compared to low-worriers (Hayes, Hirsch, & Mathews, 2008). People typically worry in verbal form, and the present study investigated whether verbal worry depletes working memory capacity more than worry in imagery-based form. High and low-worriers performed a working memory task, random interval generation, whilst thinking about a worry in verbal or imagery form. High (but not low) worriers had less available working memory capacity when worrying in verbal compared to imagery-based form. The findings could not be accounted for by general attentional control, amount of negatively-valenced thought, or appraisals participants made about worry topics. The findings indicate that the verbal nature of worry is implicated in the depletion of working memory resources during worry among high-worriers, and point to the potential value of imagery-based techniques in cognitive-behavioural treatments for problematic worry.

Novel theoretical frameworks place the symptom profile of generalised anxiety disorder (GAD) within the context of dysfunctional emotional processes. It is suggested that fear and intolerance of emotions exacerbate subjective distress and motivate the use of maladaptive coping strategies, such as worry. To date, studies evaluating these models have suffered two key limitations. Firstly, few studies have involved treatment-seeking samples, and secondly, none have evaluated the unique variance attributable to emotion appraisal variables above and beyond previously established predictors of worry and GAD. The present study begins to address these limitations by assessing the contribution of fear and perceived uncontrollability of emotions in predicting worry and clinical GAD status after controlling for variance attributable to depressive symptoms, meta-cognitive beliefs, intolerance of uncertainty, and perceptions of external threat. Supporting current models, results showed that perceived control over emotional reactions was a unique predictor of GAD diagnostic status and both clinical and non-clinical worry.

This study examined an experiential avoidance conceptualization of depressive rumination in 3 ways: 1) associations among questionnaire measures of rumination, experiential avoidance, and fear of emotions; 2) performance on a dichotic listening task that highlights preferences for non-depressive material; and 3) psychophysiological reactivity in an avoidance paradigm modeled after the one used by Borkovec, Lyonfields, Wiser, and Deihl (1993) in their examination of worry. One hundred and thirty-eight undergraduates completed questionnaire measures and participated in a clinical interview to diagnose current and past episodes of depression. Of those, 100 were randomly assigned to a rumination or relaxation induction condition and participated in a dichotic listening task, rumination/relaxation induction, and depression induction. Questionnaire measures confirmed a relationship between rumination status and avoidance; however, no significant effects were found in the dichotic listening task. Psychophysiological measures indicated no difference in physiological response to a depression induction among high ruminators (HR). However, low ruminators (LR) in the relaxation condition exhibited a larger IBI response than LR in the rumination condition. Overall, these results provide partial support for an avoidance conceptualization of depressive rumination. Implications of these findings are discussed.

Generalised anxiety disorder (GAD) is characterised by persistent and uncontrollable worry. According to the cognitive avoidance theory of GAD, worry may function as an affective dampening strategy motivated by intolerance of negative emotional states. By facilitating avoidance of more distressing cognitions and associated affect, worry is said to preclude modification of the fear representation in memory, maintaining threat associations and perpetuating further anxiety and worry. The present study evaluated these assumptions in a treatment-seeking GAD sample. Sixty-one participants were randomly allocated to conditions in which they were instructed to worry, imaginally process or relax in response to an anxiety trigger. Results supported the detrimental impact of worry, showing maintained threat expectancies and decreased control perceptions compared to other modes of processing. However, skin conductance level increased as a function of worry and there was no suggestion that worry suppressed affective responding. These findings highlight the need for clarification of the mechanisms involved in the maintenance of threat associations and worry in GAD.

It is not clear if treatments for depression targeting repetitive negative thinking (RNT: rumination, worry and content-independent perseverative thinking) have a specific effect on RNT resulting in better outcomes than treatments that do not specifically target rumination. We conducted a systematic search of PsycINFO, PubMed, Embase and the Cochrane library for randomized trials in adolescents, adults and older adults comparing CBT treatments for (previous) depression with control groups or with other treatments and reporting outcomes on RNT. Inclusion criteria were met by 36 studies with a total of 3307 participants. At post-test we found a medium-sized effect of any treatment compared to control groups on RNT (g = 0.48; 95% CI: 0.37–0.59). Rumination-focused CBT: g = 0.76, Mindfulness-based Cognitive Therapy: g = 0.42, p effect sizes than other types of treatment (i.e., anti-depressant medication, light therapy, engagement counseling, life review, expressive writing, yoga) (g = 0.14) compared to control groups. Effects on RNT at post-test were strongly associated with the effects on depression severity and this association was only significant in RNT-focused CBT. Our results suggest that in particular RNT-focused CBT may have a more pronounced effect on RNT than other types of interventions. Further mediation and mechanistic studies to test the predictive value of reductions in RNT following RNT-focused CBT for subsequent depression outcomes are called for.

Metacognitive Therapy (MCT) and Applied Relaxation (AR) were compared in a pilot treatment trial of generalized anxiety disorder (GAD). Twenty outpatients meeting criteria for DSM-IV-TR GAD were assessed before treatment, after treatment and at 6 m and 12 m follow-up. The patients were randomized and treated individually for 8-12 weekly sessions. There was no drop-out from MCT and 10% at 6 m follow-up from AR. At post-treatment and at both follow-up points MCT was superior to AR. Standardized recovery rates for MCT at post-treatment were 80% on measures of worry and trait-anxiety compared with 10% following AR. At 6 m follow-up recovery rates for MCT were 70% on both measures compared with 10% and 20% for AR. At 12 m follow-up recovery rates for MCT were 80% (worry) and 60% (trait-anxiety) compared with 10% and 20% following AR. The recovery rates for MCT are similar to those obtained in an earlier uncontrolled trial (Wells & King, 2006). The effect sizes and standardized recovery rates for MCT suggest that it is a highly effective treatment.

In this experiment we investigated the effect of different instructions on the modification of attentional biases, and subsequently on worry persistence. Participants without excessive worry completed a modified dot-probe task, designed to train attention either to threat or neutral words. Half of each group was given explicit instructions regarding the relationship between word valence and target location, and half were given the more usual minimal instructions. Impact on worry persistence was assessed by categorizing the valence of thought intrusions before and after a period of instructed worry. Response latencies to test items on the dot-probe task showed that attention had been successfully manipulated in the expected direction, and explicit instructions led to more effective attention modification. Moreover, participants in the attend-threat group who received explicit instructions reported significantly more negative thought intrusions following instructed worry, as rated by an assessor, whereas participants in the attend-neutral group did not. These findings suggest that an attentional bias towards threatening information plays a role in worry persistence, and that explicit instructions may be helpful in modifying this bias.

Based on the theory that generalized anxiety disorder (GAD) is maintained through a reactive and fused relationship with one’s internal experiences and a tendency towards experiential avoidance and behavioral restriction, an acceptance based behavioral therapy (ABBT) was developed to specifically target these elements. Since ABBT has been shown to be an efficacious treatment in previous studies, the current study focuses on proposed mechanisms of change over the course of therapy. Specifically, the current study focuses on session-by-session changes in two proposed mechanisms of change: acceptance of internal experiences and engagement in meaningful activities. Overall, clients receiving ABBT reported an increase in the amount of time spent accepting internal experiences and engaging in valued activities. Change in both acceptance and engagement in meaningful activities was related to responder status at post-treatment and change in these two proposed mechanisms predicted outcome above and beyond change in worry. In addition, change in acceptance was related to reported quality of life at post-treatment.