Delineating the Role of Negative Verbal Thinking in Promoting Worry, Perceived Threat, and Anxiety
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Worry is characterized by streams of verbal thoughts about potential negative outcomes. Individuals with high levels of worry (and particularly those with generalized anxiety disorder) find it very difficult to control worry once it has started. What is not clear is the extent to which verbal negative thinking style maintains worry. Our study aimed to disentangle the effects of verbal versus imagery based thinking, and negative versus positive worry-related content on subsequent negative intrusive thoughts. High worriers were trained to engage in imagery or verbal processing, focusing on either negative or positive outcomes of their current main worry. Both thinking style and valence of worry content influenced later negative intrusive thoughts that play a role in initiating worry episodes. In contrast, only valence influenced subjective ratings of worry outcomes (i.e., cost, concern, and ability to cope, although not probability), with positive valence leading to lower ratings, irrespective of thinking style.
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Mechanisms that exacerbate and maintain worry can be considered putative targets for therapeutic intervention in anxiety.
“Consequently, mechanisms that exacerbate and maintain worry can be considered as putative targets for therapeutic intervention in anxiety (Gaynor, 2014, Hirsch et al., 2015, Wiers et al., 2013).”
From Testing the differential effects of acceptance and attention-based psychological interventions on intrusive thoughts and worry (2017) · cites this paper as Hirsch et al., 2015
Worry is the cardinal symptom in generalized anxiety, characterised by increased frequency and uncontrollability of distracting negative thoughts about current and future threat.
“The cardinal symptom in generalized anxiety—worry—is characterised by increased frequency and uncontrollability of distracting negative thoughts about current and future threat (see Hirsch et al., 2015, Raedt et al., 2015).”
From Testing the differential effects of acceptance and attention-based psychological interventions on intrusive thoughts and worry (2017) · cites this paper as Hirsch et al., 2015
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Cites
(1970) · Cited by 24,983 · see citing works
Development and validation of the Penn State Worry Questionnaire
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990) · Behaviour Research and Therapy · doi:10.1016/0005-7967(90)90135-6 · Cited by 5,099 · see citing works
Mattick, R. P., & Clarke, J. C. (1998) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(97)10031-6 · Cited by 3,367 · see citing works
Preliminary exploration of worry: Some characteristics and processes
Borkovec, T. D., Robinson, E., Pruzinsky, T., & DePree, J. A. (1983) · Behaviour Research and Therapy · doi:10.1016/0005-7967(83)90121-3 · Cited by 1,468 · see citing works
Reliability Generalization of Scores on the Spielberger State-Trait Anxiety Inventory
Barnes, L. L. B., Harp, D., & Jung, W. S. (2002) · Educational and Psychological Measurement · doi:10.1177/0013164402062004005 · Cited by 947 · see citing works
Psychometric properties of the Penn State Worry Questionnaire in a clinical anxiety disorders sample
Brown, T. A., Antony, M. M., & Barlow, D. H. (1992) · Behaviour Research and Therapy · doi:10.1016/0005-7967(92)90093-v · Cited by 812 · see citing works
Mental Imagery and Emotion: A Special Relationship?
Holmes, E. A., & Mathews, A. (2005) · Emotion · doi:10.1037/1528-3542.5.4.489 · Cited by 612 · see citing works
Self-citationNewman, M. G., Zuellig, A. R., Kachin, K. E., Constantino, M. J., Przeworski, A., Erickson, T., & Cashman-McGrath, L. (2002) · Behavior Therapy · doi:10.1016/s0005-7894(02)80026-0 · Cited by 553 · see citing works
The Penn State Worry Questionnaire: Psychometric properties and associated characteristics.
Plaza, S. M., & Borkovec, T. D. (1994) · Cited by 523 · see citing works
Worrying: Perspectives on theory, assessment and treatment.
Davey, G. C. L., & Tallis, F. (1994) · Wiley eBooks · Cited by 451 · see citing works
The Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV).
Grisham, J. R., Brown, T. A., & Campbell, L. (2004) · Cited by 430 · see citing works
A cognitive model of pathological worry
Hirsch, C. R., & Mathews, A. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.06.007 · Cited by 400 · see citing works
Self-citationOn finished and unfinished tasks.
Zeigarnik, B. (1938) · Kegan Paul, Trench, Trubner & Company eBooks · doi:10.1037/11496-025 · Cited by 370 · see citing works
Reisberg, D., Pearson, D., & Kosslyn, S. M. (2002) · Applied Cognitive Psychology · doi:10.1002/acp.858 · Cited by 340 · see citing works
A comparison of three worry questionnaires
Davey, G. C. L. (1993) · Behaviour Research and Therapy · doi:10.1016/0005-7967(93)90042-s · Cited by 271 · see citing works
Self-images play a causal role in social phobia
Hirsch, C. R., Clark, D. M., Mathews, A., & Williams, R. (2003) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(02)00103-1 · Cited by 265 · see citing works
Self-citationNegative self-imagery in social anxiety contaminates social interactions
Hirsch, C., Meynen, T., & Clark, D. (2004) · Memory · doi:10.1080/09658210444000106 · Cited by 216 · see citing works
Self-citationRestriction of working memory capacity during worry.
Hayes, S., Hirsch, C. R., & Mathews, A. (2008) · Journal of Abnormal Psychology · doi:10.1037/a0012908 · Cited by 209 · see citing works
Self-citationLooking on the bright side: Accessing benign meanings reduces worry
Hirsch, C. R., Hayes, S., & Mathews, A. (2009) · Journal of Abnormal Psychology · doi:10.1037/a0013473 · Cited by 175 · see citing works
Self-citationBowler, J. O., Mackintosh, B., Dunn, B. D., Mathews, A., Dalgleish, T., & Hoppitt, L. (2012) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0029932 · Cited by 164 · cited 1× · see citing works
“effort that makes demands on limited cognitive control resources, and so may be more likely to fail under cognitive load or stress (Bowler et al., 2012).”
BackgroundSelf-citationWorry, problem elaboration and suppression of imagery: the role of concreteness
Stöber, J. (1998) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(98)00027-8 · Cited by 162 · see citing works
MacLeod, C., & Campbell, L. (1992) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.63.6.890 · Cited by 153 · see citing works
Differential effects of worry and imagery after exposure to a stressful stimulus: A pilot study
Butler, G., Wells, A., & Dewick, H. (1995) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465800017628 · Cited by 145 · cited 3× · see citing works
“anxiety, cognitive processes, threat Received 9/30/14; Revision accepted 2/6/15 Butler, Wells, and Dewick (1995) asked nonanxious participants either to worry about a distressing film clip they had viewed, or to think about it in the form of mental images.”
BackgroundResultWorrying. Perspectives on theory, assessment and treatment
Edelman, R. (1994) · Personality and Individual Differences · doi:10.1016/0191-8869(94)90055-8 · Cited by 140 · see citing works
Feels like the real thing: Imagery is both more realistic and emotional than verbal thought
Mathews, A., Ridgeway, V., & Holmes, E. A. (2012) · Cognition & Emotion · doi:10.1080/02699931.2012.698252 · Cited by 108 · see citing works
Self-citationAre Attentional Control Resources Reduced by Worry in Generalized Anxiety Disorder?
Stefanopoulou, E., Hirsch, C., Hayes, S., Adlam, A., & Coker, S. (2014) · Journal of Abnormal Psychology · doi:10.1037/a0036343 · Cited by 105 · see citing works
Self-citationStöber, J., Tepperwien, S., & Staak, M. (2000) · Anxiety Stress & Coping · doi:10.1080/10615800008549263 · Cited by 105 · see citing works
Worry in imagery and verbal form: Effect on residual working memory capacity
Leigh, E., & Hirsch, C. R. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2010.11.005 · Cited by 101 · see citing works
Self-citationStokes, C., & Hirsch, C. R. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.12.011 · Cited by 84 · see citing works
Self-citationFacilitating a benign attentional bias reduces negative thought intrusions.
Hayes, S., Hirsch, C. R., & Mathews, A. (2010) · Journal of Abnormal Psychology · doi:10.1037/a0018264 · Cited by 79 · see citing works
Self-citationCharacteristics of worry in Generalized Anxiety Disorder
Hirsch, C. R., Mathews, A., Lequertier, B., Perman, G., & Hayes, S. (2013) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2013.03.004 · Cited by 72 · see citing works
Self-citationEagleson, C., Hayes, S., Mathews, A., Perman, G., & Hirsch, C. R. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.12.017 · Cited by 70 · see citing works
Self-citationThe extent and nature of imagery during worry and positive thinking in generalized anxiety disorder.
Hirsch, C. R., Hayes, S., Mathews, A., Perman, G., & Borkovec, T. D. (2011) · Journal of Abnormal Psychology · doi:10.1037/a0024947 · Cited by 58 · see citing works
Self-citationSpecifying emotional information: Regulation of emotional intensity via executive processes.
Philippot, P., Baeyens, C., & Douilliez, C. (2006) · Emotion · doi:10.1037/1528-3542.6.4.560 · Cited by 54 · see citing works
Verbal worry facilitates attention to threat in high-worriers
Williams, M. O., Mathews, A., & Hirsch, C. (2014) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2013.05.006 · Cited by 53 · see citing works
Self-citationHirsch, C. R., & Clark, D. M. (2007) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2007.08.004 · Cited by 25 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 4
- Borkovec T. D. Sharpless B. (2004). Cognitive-behavioral therapy for generalized anxiety disorder: Living in the valued present. In Hayes S. Linehan M. Folette V. (Eds.), Mindfulness, acceptance, and the new behavior therapies: Expanding the cognitive-behavioral tradition (pp. 209– 242). New York, NY: Guilford.
- Hirsch C. R. Clark D. M. (2007). Underestimation of auditory performance in social phobia. Journal of Behavior Therapy and Experimental Psychiatry, 38, 447– 458. 17888396
- Hirsch C. R. Meynen T. Clark D. M. (2004). Negative imagery in social anxiety contaminates social situations. Memory, 12, 496– 509. 15487545
- Mattick R. Clark J. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 445– 470. 9670605
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Hirsch, C., Krahé, C., Whyte, J., Bridge, L., Loizou, S., Norton, S., & Mathews, A. (2020) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000455 · Cited by 56 · see citing works
Self-citationEagleson, C., Hayes, S., Mathews, A., Perman, G., & Hirsch, C. R. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.12.017 · Cited by 70 · see citing works
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Self-citationHirsch, C. R., Beale, S., Grey, N., & Liness, S. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00796 · Cited by 43 · see citing works
Self-citationMental imagery in generalized anxiety disorder: A comparison with healthy control participants
Tallon, K., Ovanessian, M. M., Koerner, N., & Dugas, M. J. (2020) · Behaviour Research and Therapy · doi:10.1016/j.brat.2020.103571 · Cited by 31 · 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
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Feng, Y.-C., Krahé, C., Meeten, F., Sumich, A. L., Mok, C. L. M., & Hirsch, C. R. (2019) · Behaviour Research and Therapy · doi:10.1016/j.brat.2019.103497 · Cited by 23 · see citing works
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McGowan, S. K., Stevens, E. S., Behar, E., Judah, M. R., Mills, A. C., & Grant, D. M. (2016) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2016.08.005 · Cited by 22 · see citing works
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Kollárik, M., van den Hout, M., Heinzel, C. V., Hofer, P. D., Lieb, R., & Wahl, K. (2020) · Journal of Experimental Psychopathology · doi:10.1177/2043808720912583 · Cited by 21 · see citing works
Mechanisms of Repetitive Thinking: Introduction to the Special Series
De Raedt, R., Hertel, P. T., & Watkins, E. R. (2015) · Clinical Psychological Science · doi:10.1177/2167702615584309 · Cited by 20 · see citing works
Ainsworth, B., Bolderston, H., & Garner, M. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.01.012 · Cited by 16 · see citing works
Does a novel training in mental imagery reduce pathological worry?
Skodzik, T., Adelt, M., Nossek, V. A., Kuck, S., & Ehring, T. (2018) · Behaviour Research and Therapy · doi:10.1016/j.brat.2018.07.005 · Cited by 12 · see citing works
Ma, O. Y. T., & Lo, B. C. Y. (2022) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2021.101721 · Cited by 15 · see citing works
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de Rooij, A. (2022) · Imagination, Cognition and Personality · doi:10.1177/02762366211070999 · Cited by 14 · see citing works
Ranney, R. M., Behar, E., & Bartoszek, G. (2018) · Behavior Therapy · doi:10.1016/j.beth.2018.08.006 · Cited by 13 · see citing works
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Andersson, E., Holmes, E. A., & Kavanagh, D. J. (2018) · mHealth · doi:10.21037/mhealth.2018.09.11 · Cited by 11 · see citing works
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Stevens, E. S., Jendrusina, A. A., Legrand, A. C., Nahin, E. R., Kaufman, M., Borkovec, T., & Behar, E. (2018) · Behavior Modification · doi:10.1177/0145445517732272 · Cited by 4 · see citing works
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Self-citation
- Authors
- Hirsch, C. R., Perman, G., Hayes, S., Eagleson, C., & Mathews, A.
- Affiliations
- King's College London (GB)
- Curtin University (AU)
- Corresponding author
- Hirsch, Colette R.
- Venue
- Clinical Psychological Science
- Publisher
- SAGE Publications
- Published
- 2015-05-06
- Volume
- 3
- Issue
- 4
- Pages
- 637-647
- ISSN
- 2167-7026 (ISSN-L)
- 2167-7034
- PMC
- PMC4827167
- OpenAlex
- W2228536202
- Cited by
- 44
- References
- 36
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 4 · 2023: 3 · 2022: 4 · 2021: 5 · 2020: 8 · 2019: 3 · 2018: 7 · 2017: 2 · 2016: 3 · 2015: 1
- FWCI
- 6.55
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Psychological Science (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- eSpace (Curtin University) (submittedVersion)
- Funders
- Wellcome Trust (WT083204)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Life Sciences › Neuroscience › Cognitive Neuroscience › Mind wandering and attention
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory Processes and Influences
- Keywords
- worry, generalized anxiety disorder, intrusive thoughts, threat perception, anxiety, coping
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