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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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“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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“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).”
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“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).”
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“According to the cognitive model of pathological worry, attentional control deficits initiate and maintain excessive and uncontrollable worry (Hirsch and Mathews 2012).”
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“According to Hirsch and Mathews ’ illness worry model, high FoP may induce excessive vigilance and intrusive thoughts, potentially leading patients to fi xate on negative threats (64).”
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“Persistent worry can occupy working-memory resources and weaken goal-directed attentional control (Eysenck et al., 2007; Hirsch and Mathews, 2012; Moran, 2016).”
Transdiagnostic latent factors dissociating depression and anxiety through reinforcement learning
Huang, X., Ni, Y., Wang, Y., Peng, Y., & Li, J. (2026) · BMC Psychiatry · doi:10.1186/s12888-026-08592-y
Effects of HF-rTMS over left and right DLPFC on worry and parasympathetic cardiac control
Keppens, R., Verde, V., Razza, L. B., Smet, S. D., Boven, A. V., Allaert, J., Marie-Anne, V., Baeken, C., Duschek, S., del Paso, G. A. R., et al. (2026) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2026.113481
Kara, B. C., Türk, F., & Deniz, M. E. (2026) · Behavioral Sleep Medicine · doi:10.1080/15402002.2026.2742293
Mental health and somatic symptom reductions during Ukraine’s counteroffensive in the fall of 2023
Kurapov, A., Kahveci, S., Kudar, K., Berking, M., & Jens Blechert, A. (2026) · European Journal of Psychotraumatology · doi:10.1080/20008066.2026.2731851
“…anxiety suggests that participants may have become somewhat better able to regulate generalised vigilance and day-to-day apprehension over time, which is consistent with habituation to sustained unpredictability under chronic threat (Grupe & Nitschke, 2013; Hirsch & Mathews, 2012; Wells, 1999).”
L'approche transdiagnostique en psychopathologie
Philippot, P. (2026) · Dunod eBooks · doi:10.3917/dunod.mones.2026.01.0034
L'approche transdiagnostique en psychopathologie
Baeyens, C. (2026) · Dunod eBooks · doi:10.3917/dunod.mones.2026.01.0091
Hong, S., Jameson, T., Jopling, E. N., Rnic, K., Battaglini, A. M., Grocott, B. B., Tracy, A., Sánchez-López, Á., & LeMoult, J. (2026) · Journal of Adolescence · doi:10.1002/jad.70303
Metadata
- 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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