A cognitive model of pathological worry

“We use the term attentional control in this paper to refer to processes underlying the ability to intentionally ignore distracting information (e.g. external noises when trying to work), or shift attention from one topic to another (Miyake et al., 2000).”

“Furthermore, it may be that some reported beliefs about worry are post-hoc attempts at explaining or understanding the experience of worry, rather than being causes of worry (see Nisbett & Wilson, 1977; for a discussion of how post-hoc rationalizations can arise).”

“The latter effect has been revealed in studies in which tasks requiring attentional control capacity for their performance are particularly susceptible to interference from worry (Eysenck et al., 2007; Hayes et al., 2008; Leigh & Hirsch, 2011).”

“Pathological worry has much in common with what has been described as rumination, more often studied in the context of depression (Nolen-Hoeksema, 1991).”

“Faster responding to targets replacing threatening cues, indicating selective attention toward threat, occurs in individuals with pathological worry (Bradley, Mogg, White, Groom, & DeBono, 1999; MacLeod, Mathews, & Tata, 1986; Mogg, Mathews, & Eysenck, 1992).”

“Two well-known theories in this respect are the ‘Attentional Control Theory’ (Eysenck and Derakshan, 2011) and the ‘Cognitive Model’ of pathological worry (Hirsch and Mathews, 2012).”

“Cognitive and neurological models of anxiety implicate attentional bias to threat in the development, maintenance, and remediation of anxiety pathology (6-8).”

“Hirsch and Mathews (2012) reviewed evidence that trait worriers have an increased tendency to engage with threatening information than non-worriers and also have greater difficulty disengaging from it, either due to impaired attentional control ability or a goal-driven focus on threat.”

“Hirsch and Mathews (2012) suggest that worry episodes can be triggered by negative interpretations and, once begun, subsequent interpretations direct worry to increasingly negative content.”

“Interpretation biases have been extensively studied in relation to psychopathology, where they are argued to have a role in the onset and maintenance of disorders such as anxiety and depression (e.g., Beck and Clarke, 1988; Mathews and Mackintosh, 2000; Clark, 2001; Hirsch and Mathews, 2012; Hirsch et al., 2016).”

“Excessive worry features in a number of emotional disorders [Hirsch and Mathews, 2012] and results from studies that elucidate its neural basis may help explain how and why neuroticism contributes to vulnerability for psychopathology.”

“The cognitive model (Hirsch & Mathews, 2012) and attentional control theory (Eysenck & Derakshan, 2011) postulate that compromised executive function (EF) and other cognitive constructs are negatively linked to increased excessive and uncontrollable worry, the core symptom of generalized anxiety…”

“In keeping with the model proposed by Hirsch and Mathews (2012), we found that GAD status predicted impaired “cold” inhibition and, debatably, impaired cognitive inhibition specifically, with additional variance explained by trait anxiety, although not by trait worry.”

“Cognitive models of SAD propose that individuals with higher levels of social anxiety automatically and selectively attend to socially threatening information (attention bias) and interpret emotionally ambiguous events as threatening (interpretation bias) [18,19].”

“…processes that initiate and maintain the pathological worrying that characterizes GAD (See Behar, DiMarco, Hekler, Mohlman, & Staples, 2009; Hirsch & Mathews, 2012 for KEYWORDS intolerance of uncertainty; worry; generalized anxiety disorder; process; construct ARTICLE HISTORY received 10…”

“Thus, GAD patients appeared particularly sensitive to threat, as they may have recruited additional appraisal, attention allocation and response preparation processes, possibly resulting in overestimation or over-interpretation of threat (Hirsch and Mathews, 2012).”

“Thoughts about threat may also be processed automatically and preferentially [14,15].”

“Anxious individuals are more easily distracted by task-irrelevant internal (e.g., worrying thoughts) or external (threatening) stimuli (Hirsch & Mathews, 2012; Mogg & Bradley, 1998).”

“In many mental disorders, researchers have proposed bottomup (BU) and top-down (TD) models to explain information processing (Cohen et al., 2012; Hirsch and Mathews, 2012).”

“In Hirsch and Mathews' (2012) model of pathological worry three processes combine to maintain uncontrollable worry: emotional processing biases, impaired attentional control and the tendency to represent possible negative outcomes in over-general verbal form.”

“Crown Copyright 2013 Published by Elsevier Ltd. Open access under CC BY license.”

“Promising candidates include the processing mode account of RNT (Watkins, 2008), the meta-cognitive model (Papageorgiou & Wells, 2003), and information processing models (Hirsch & Mathews, 2012; Joormann, 2010).”

“Deficient top-down processing has been shown to increase processing of threat information, and thus represents one possible contributor to states such as pathological worry (Hirsch & Mathews, 2012), including generalized anxiety disorder (GAD; MacLeod & Rutherford, 1992, 2004).”

“If such threat representations do enter into conscious awareness, Hirsch and Mathews (2012) suggest that increased attentional control can be used to disengage and shift attentional focus from worry toward goal-directed behavior.”

“These results add to a growing body of evidence that high worry is characterized by deficits in attentional control (Hayes et al., 2008), which is a central prediction of current cognitive models of pathological worry and anxiety (Eysenck et al., 2007; Hirsch & Mathews, 2012).”

“Other putative neural mechanisms of RNT involve interactions between bottom‐up emotional reactivity and top‐down inhibitory control (Disner et al., 2011; Hirsch & Mathews, 2012) that may contribute to the negative content and self‐focus of RNT.”

“The assertion that worrymight lead to difficulty concentrating is supported by several prominent theoretical models of anxiety (e.g., Eysenck, Derakshan, Santos, & Calvo, 2007; Hirsch & Mathews, 2012; Sarason, 1984).”

“…and behavioral consequences such as difficulty concentrating, affective dysregulation, muscle tension, gastrointestinal distress, and difficulty solving problems (Aldao, Mennin, Linardatos, & Fresco, 2010; Andrews et al., 2010; Borkovec, Robinson, Pruzinsky, & DePree, 1983; Hirsch & Mathews, 2012).”

“…of negative future possibilities, and a large body of research now underscores the centrality of prospective representations to threatmanagement and anxiety disorders (Borkovec & Inz, 1990; Borkovec & Ray, 1998; Finnbogad & Berntsen, 2011; Hirsch & Mathews, 2012; Szabó & Lovibond, 2002).”

“Indeed, the cognitive model (Hirsch and Mathews, 2012) asserts that pathological worry in GAD is intrinsically linked to the proclivity to attend to and difficulty disengaging from negative social material.”

“…findings are consistent with the cognitive models of GAD, which propose that GAD patients show obvious impairments in cognitive control (Hirsch and Mathews, 2012), including negative attention bias (Fonzo et al., 2015; McClure et al., 2007; Monk et al., 2008), inhibition impairments (Hallion et…”

“Moreover, theories of anxiety (Bishop, 2007; Eysenck et al., 2007; Hirsch & Mathews, 2012) and empirical data (for reviews, see Berggren & Derakshan, 2013; Eysenck & Derakshan, 2011) suggest that anxiety disorders may be associated with impaired attentional control component of WM.”

“…responses produce increases in internal regulatory efforts often characterized by worry, rumination, and other forms of cognitive effort (e.g., Berenbaum, 2010; Hirsch & Mathews, 2012; Mennin & Fresco, 2014; Newman & Llera, 2011; Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008; Tamir, 2005).”

“…process posited to maintain worry and rumination, but this process is thought to operate in interaction with other biases (see the combined-cognitive-biases hypothesis; Hirsch, Clark, & Mathews, 2006) as well as levels of attentional control and types of mentation style (Hirsch & Mathews, 2012).”

“Numerous theories have been put forward to account for the onset and persistence of chronic worry 31,32 .”

“…worrying on a measure of WMC and in this sense have direct implications for theories of anxiety and worry (e.g. Berggren & Derakshan, 2013; Eysenck et al., 2007; Hirsch & Mathews, 2012) that attempt to understand the main mechanism by which anxiety-related effects impair performance outcome(s).”

“One candidate explanation is that verbal processing, unlike imagery, simultaneously primes a wide range of semantically related potential threats, and so increases the range of possible negative thoughts that can intrude later (for a discussion of this possibility, see Hirsch & Mathews, 2012).”

“Attention Bias Another key emotional processing bias proposed in Hirsch and Mathews’ (41) model is selective attention to threatening information (attention bias), which heightens perceived threat in the environment, presumably leading to more worry.”

“…would disempower the capableness of removing distracting negative information from working memory, thus circumscribe the possibilities to encode new information that was helpful to mood improvement, and thereby exacerbating worry and anxiety (Hirsch and Mathews, 2012; Whitmer and Banich, 2007).”

“This concept of a hierarchy in cognitive deficits and biases that could produce a snowball effect is also reflected in the idea of combined cognitive biases developed by Hirsch & Mathews (2012).”

“However, given that worry is often verbal in nature (Hirsch & Mathews, 2012), future studies investigating cognitive training effects may be maximised by using the single verbal n -back task or dual n -back tasks.”

“Vulnerability models, such as the cognitive model of pathological worry, theorize that attentional control deficits predict and lead to the initiation and maintenance of excessive and uncontrollable worry [18].”

“Whereas nonanxious individuals tend to favor positive or benign interpretations of ambiguous stimuli and situations, anxious individuals favor more threatening interpretations (ie, negative interpretative bias) and tend to exaggeratedly anticipate possible negative events in the future [2,4-7].”

“…hatched boxes indicate how attentional and interpretational biases can facilitate the identification of potential worries by directly influencing how stimuli and events are evaluated or by increasing the frequency with which intrusive negative thoughts are experienced (e.g. Hirsch & Mathews, 2012).”

“This supports cognitive models of worry and anxiety positing that, in worry-prone individuals, negative emotion processing biases, impaired attentional control, and their interplay contribute to excessive worry (Berggren & Derakshan, 2013; Hirsch & Mathews, 2012).”

“Such a possibility is consistent with the idea that strong bottom-up influences lead threat representations to dominate attentional focus and exacerbate anxiety (Eysenck et al., 2007; Hirsch & Mathews, 2012).”

“Finally, in a more recent account of the etiology of GAD in adults, Hirsch and Mathews (2012) proposed that negative information-processing biases, reduced executive functions, and verbal worry are critical factors.”

“Support for working memory-focused models would include signi fi cant reductions in inhibitory control performance when working memory demands are experimentally induced (14, 45).”

“Network-centrality analyses showed that reduced attention or verbal short-term memory repetition predicted elevated anxious mood (but not other psychopathology nodes), suggesting that the cognitive model of worry (Hirsch & Mathews, 2012) could apply to late-life anxiety.”

“…(Artiges, et al., 2000; Cathomas et al., 2021; Martinelli et al., 2018; Salame et al., 1998; Strauss et al., 2011), pathological worry (Hirsch and Mathews, 2012), and atypical neurodevelopment (Addicott, et al., 2021; Elison et al., 2012; Pellicano et al., 2011; Pierce and Courchesne,…”

“However, on amoremechanistic level, proximal models of individual pathological worry have only recently been developed (Hirsch and Mathews, 2012; Davey and Meeten, in press), and will be required to understand the individual neurological and psychological mechanisms that generate a worry experience…”

“People under time pressure or who suffer from unwanted thoughts also produce more predictable sequences [66], as do individuals with impairment in areas of the brain associated with executive control [63,67,68].”

“Selective attention to threat has been postulated as a causal factor in Hirsch and Mathews’ (2012) cognitive model of pathological worry.”

“According to deficit-based cognitive models (Hirsch & Mathews, 2012), pathological worry is mainly maintained by deficits in cognitive control, especially in the context of negative emotional information.”

“Indeed, although different theoretical approaches emphasize alternative characteristics of worry (e.g., Davey, 1994; Dugas, Gagnon, Ladouceur, & Freeston, 1998; Hirsch & Mathews, 2012; Wells, 1999), they all tend to agree that normal worrying involves problem-solving or coping attempts.”

“…Knepp and Friedman, 2008; Peasley-Miklus et al., 2012), which refers to a consistent and stable cognitive style of worrying about uncertain future events (Hirsch and Mathews, 2012), and integrates the specific worry contents with the features of an enduring trait or tendency (Lin et al., 2012).”