A cognitive model of pathological worry
Open accessAbstract
We present an evidence-based model of pathological worry in which worry arises from an interaction between involuntary (bottom-up) processes, such as habitual biases in attention and interpretation favouring threat content, and voluntary (top-down) processes, such as attentional control. At a pre-conscious level, these processes influence the competition between mental representations when some correspond to the intended focus of attention and others to threat distracters. Processing biases influence the probability of threat representations initially intruding into awareness as negative thoughts. Worry in predominantly verbal form then develops, influenced by conscious processes such as attempts to resolve the perceived threat and the redirection of attentional control resources to worry content, as well as the continuing influence of habitual processing biases. After describing this model, we present evidence for each component process and for their causal role in pathological worry, together with implications for new directions in the treatment of pathological worry.
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The association between increases in negative thought intrusions and subsequent increases in subjective anxiety is consistent with cognitive models of pathological worry in anxiety.
“Nevertheless we found some evidence (across the sample) that increases in negative thought intrusions were associated with subsequent increases in subjective anxiety, consistent with cognitive models of pathological worry in anxiety (Hirsch & Mathews, 2012).”
From Testing the differential effects of acceptance and attention-based psychological interventions on intrusive thoughts and worry (2017) · cites this paper as Hirsch & Mathews, 2012
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Peril, prudence and planning as risk, avoidance and worry
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Owens, M., Derakshan, N., & Richards, A. (2015) · Emotion · doi:10.1037/emo0000052 · Cited by 26 · see citing works
Automaticity of Attentional Bias to Threat in High and Low Worriers
Goodwin, H., Eagleson, C., Mathews, A., Yiend, J., & Hirsch, C. (2016) · Cognitive Therapy and Research · doi:10.1007/s10608-016-9818-5 · Cited by 18 · see citing works
Self-citationContrast avoidance model of worry and generalized anxiety disorder: A theoretical perspective
Rashtbari, A., & Saed, O. (2020) · Cogent Psychology · doi:10.1080/23311908.2020.1800262 · Cited by 22 · see citing works
Carr, I., & Szabó, M. (2014) · The Journal of Early Adolescence · doi:10.1177/0272431614529366 · Cited by 25 · see citing works
Yan, Y., Lin, R., Tang, X., He, F., Cai, W., & Su, Y. (2013) · Journal of Health Psychology · doi:10.1177/1359105313479628 · Cited by 26 · see citing works
- Authors
- Hirsch, C. R., & Mathews, A.
- Affiliations
- The University of Western Australia (AU)
- King's College London (GB)
- Corresponding author
- Hirsch, Colette R.
- ORCID
- Hirsch, Colette R.
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2012-10
- Volume
- 50
- Issue
- 10
- Pages
- 636-646
- ISSN
- 0005-7967 (ISSN-L)
- PMC
- PMC3444754
- OpenAlex
- W2026506811
- Cited by
- 400
- References
- 114
- Citations by year
- 2026: 37 · 2025: 44 · 2024: 31 · 2023: 34 · 2022: 30 · 2021: 50 · 2020: 34 · 2019: 33 · 2018: 22 · 2017: 24 · 2016: 24 · 2015: 15 · 2014: 11 · 2013: 10
- FWCI
- 15.31
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Behaviour Research and Therapy (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Wellcome Trust (WT083204)
- National Institute for Health Research (NIHR)
- Mental Health Biomedical Research Centre at South London
- Maudsley NHS Foundation Trust
- King's College London
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Life Sciences › Neuroscience › Cognitive Neuroscience › Mind wandering and attention
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Keywords
- pathological worry, worry, cognitive models, attentional bias, threat processing, attentional control, top-down control, bottom-up processing, threat representation, intrusive thoughts, cognitive bias modification
- MeSH terms
- Anxiety Disorders, Attention, Cognition Disorders, Emotions, Humans, Models, Psychological, Evidence-Based Medicine, Executive Function
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