What's Worrying Our Students? Increasing Worry Levels over Two Decades and a New Measure of Student Worry Frequency and Domains.

BACKGROUND: The frequency and severity of mental health problems in student populations have been a growing cause for concern worldwide, and studies have identified measures of a number of mental health symptoms that have been steadily increasing in frequency and intensity over the past 20-25 years. METHODS: In two studies we investigate the levels and domains of pathological worrying in university student participants. Study 1 is a retrospective study of Penn State Worry Questionnaire (PSWQ) data collected between 2001 and 2019. Study 2 describes the development of the Student Worry Questionnaire, a short and easily delivered measure of student worrying that identifies both frequency of worry as well as the student-relevant domains across which worrying occurs. RESULTS: Study 1 revealed a steady increase in student worry scores of around 20% between 2001 and 2019, with a significant positive correlation between year of data collection and mean PSWQ score. The domain scores in Study 2 indicated that academic work was a significantly higher worry than any of the other domains, and worries about intimate relationships and 'what people think of me' were also worries that scored higher than either financial or health worries. CONCLUSIONS: The present studies indicate that pathological worrying can be added to the list of anxiety- and stress-related symptoms that have been shown to be on the increase in student populations in recent decades, and we discuss whether these increases represent a greater willingness to report symptoms or a genuine increase in experienced symptoms over time.

The effect of worrying on intolerance of uncertainty and positive and negative beliefs about worry.

BACKGROUND AND OBJECTIVES: The effect of a worry manipulation on the clinical constructs intolerance of uncertainty (IU), negative beliefs about the consequences of worry (NCOW), positive beliefs about the consequences of worry (PCOW), in addition to the emotions anxiety and sadness, was examined. METHODS: A non-clinical sample was split into two groups, a worry group (n = 29), who were asked to generate 20 potential worries about a hypothetical scenario, and a control group (n = 28), who were asked to generate 2 potential worries about the same scenario. Subsequently, participants were asked to complete measures of IU, NCOW, PCOW, sadness and anxiety. RESULTS: The worry group scored significantly higher than the control group on measures of IU, NCOW and PCOW but not on measures of sadness and anxiety. LIMITATIONS: Possible limitations of the current study include the use of a student sample and the use of a hypothetical worry scenario. CONCLUSIONS: The results suggest that engaging in worry can increase scores on measures of the beliefs and thought patterns often used to causally explain worry. The results are in line with recent research showing bidirectionality between anxiety related symptoms and their associated clinical constructs, and are consistent with an approach which sees anxiety symptoms as part of an evolved integrated threat management system that alerts the individual to threats to goals or challenges, and coordinates cognitive, behavioral, and affective reactions to enable effective responding to these threats and challenges.

Negative Mood and Obsessive-Compulsive Related Clinical Constructs: An Examination of Underlying Factors.

Emerging evidence suggests that many of the clinical constructs used to help understand and explain obsessive-compulsive (OC) symptoms, and negative mood, may be causally interrelated. One approach to understanding this interrelatedness is a motivational systems approach. This approach suggests that rather than considering clinical constructs and negative affect as separable entities, they are all features of an integrated threat management system, and as such are highly coordinated and interdependent. The aim of the present study was to examine if clinical constructs related to OC symptoms and negative mood are best treated as separable or, alternatively, if these clinical constructs and negative mood are best seen as indicators of an underlying superordinate variable, as would be predicted by a motivational systems approach. A sample of 370 student participants completed measures of mood and the clinical constructs of inflated responsibility, intolerance of uncertainty, not just right experiences, and checking stop rules. An exploratory factor analysis suggested two plausible factor structures, one where all construct items and negative mood items loaded onto one underlying superordinate variable, and a second structure comprising of five factors, where each item loaded onto a factor representative of what the item was originally intended to measure. A confirmatory factor analysis showed that the five factor model was preferential to the one factor model, suggesting the four constructs and negative mood are best conceptualized as separate variables. Given the predictions of a motivational systems approach were not supported in the current study, other possible explanations for the causal interrelatedness between clinical constructs and negative mood are discussed.

The effect of facial feedback on the evaluation of statements describing everyday situations and the role of awareness.

According to theories of embodiment enacting a smile or a frown can positively or negatively influence one's evaluations, even without awareness of one's facial activity. While some previous studies found evidence for facial feedback effects, recent replication attempts could not confirm these findings. Are our decisions throughout the day amenable to the state of our facial muscles? We tested the effect of smiling and frowning on the evaluation of emotional sentences describing everyday situations. While most previous studies based their assessment of awareness on verbal debriefing interviews without explicitly defined criteria, we employed a written debriefing questionnaire in order to avoid potential bias when identifying participants' awareness. Our results indicate that smiling/frowning increased/decreased sentence ratings only for participants aware of their expressions. This emphasizes the importance of more rigorous awareness tests in facial feedback studies. Our results support the view that facial feedback cannot necessarily influence us without conscious mediation.

Goal Directed Worry Rules Are Associated with Distinct Patterns of Amygdala Functional Connectivity and Vagal Modulation during Perseverative Cognition.

Excessive and uncontrollable worry is a defining feature of Generalized Anxiety Disorder (GAD). An important endeavor in the treatment of pathological worry is to understand why some people are unable to stop worrying once they have started. Worry perseveration is associated with a tendency to deploy goal-directed worry rules (known as "as many as can" worry rules; AMA). These require attention to the goal of the worry task and continuation of worry until the aims of the "worry bout" are achieved. This study examined the association between the tendency to use AMA worry rules and neural and autonomic responses to a perseverative cognition induction. To differentiate processes underlying the AMA worry rule use from trait worry, we also examined the relationship between scores on the Penn State Worry Questionnaire (PSWQ) and neural and autonomic responses following the same induction. We used resting-state functional magnetic resonance brain imaging (fMRI) while measuring emotional bodily arousal from heart rate variability (where decreased HRV indicates stress-related parasympathetic withdrawal) in 19 patients with GAD and 21 control participants. Seed-based analyses were conducted to quantify brain changes in functional connectivity (FC) with the amygdala. The tendency to adopt an AMA worry rule was associated with validated measures of worry, anxiety, depression and rumination. AMA worry rule endorsement predicted a stronger decrease in HRV and was positively associated with increased connectivity between right amygdala and locus coeruleus (LC), a brainstem noradrenergic projection nucleus. Higher AMA scores were also associated with increased connectivity between amygdala and rostral superior frontal gyrus. Higher PSWQ scores amplified decreases in FC between right amygdala and subcallosal cortex, bilateral inferior frontal gyrus, middle frontal gyrus, and areas of parietal cortex. Our results identify neural mechanisms underlying the deployment of AMA worry rules. We propose that the relationship between AMA worry rules and increased connectivity between the amygdala and prefrontal cortex (PFC) represents attempts by high worriers to maintain arousal and distress levels in order to feel prepared for future threats. Furthermore, we suggest that neural mechanisms associated with the PSWQ represent effortful inhibitory control during worry. These findings provide unique information about the neurobiological processes that underpin worry perseveration.

Emotional facial activation induced by unconsciously perceived dynamic facial expressions.

Do facial expressions of emotion influence us when not consciously perceived? Methods to investigate this question have typically relied on brief presentation of static images. In contrast, real facial expressions are dynamic and unfold over several seconds. Recent studies demonstrate that gaze contingent crowding (GCC) can block awareness of dynamic expressions while still inducing behavioural priming effects. The current experiment tested for the first time whether dynamic facial expressions presented using this method can induce unconscious facial activation. Videos of dynamic happy and angry expressions were presented outside participants' conscious awareness while EMG measurements captured activation of the zygomaticus major (active when smiling) and the corrugator supercilii (active when frowning). Forced-choice classification of expressions confirmed they were not consciously perceived, while EMG revealed significant differential activation of facial muscles consistent with the expressions presented. This successful demonstration opens new avenues for research examining the unconscious emotional influences of facial expressions.

The perseverative worry bout: A review of cognitive, affective and motivational factors that contribute to worry perseveration.

This paper reviews the cognitive, affective and attentional factors that contribute to individual perseverative worry bouts. We describe how automatic biases in attentional and interpretational processes contribute to threat detection and to the inclusion of negative intrusive thoughts into the worry stream typical of the "what if …?" thinking style of pathological worriers. The review also describes processes occurring downstream from these perceptual biases that also facilitate perseveration, including cognitive biases in beliefs about the nature of the worry process, the automatic deployment of strict goal-directed responses for dealing with the threat, the role of negative mood in facilitating effortful forms of information processing (i.e. systematic information processing styles), and in providing negative information for evaluating the success of the worry bout. We also consider the clinical implications of this model for an integrated intervention programme for pathological worrying.

Evaluation of a brief 4-session psychoeducation procedure for high worriers based on the mood-as-input hypothesis.

BACKGROUND & OBJECTIVES: Given the ubiquity of worrying as a consuming and distressing activity at both clinical and sub-clinical levels, it is important to develop theory-driven procedures that address worrying and allow worriers to manage this activity. This paper describes the development and testing of a psychoeducation procedure based on mood-as-input hypothesis, which is a transdiagnostic model that describes a proximal mechanism for perseverative worrying. The study used nonclinical participants meeting IAPT criteria indicating GAD symptomatology. METHODS: In 4 sessions, participants in experimental groups received psychoeducation about the basic principles of the mood-as-input hypothesis and received guidance on how to identify and change worry-relevant goal-directed decision rules and negative moods. Participants in the psychoeducation conditions were compared with participants in a befriending control group. RESULTS: Psychoeducation about the model significantly reduced PSWQ scores at follow-up compared with the befriending control condition (a between-groups large effect size, Cohen's d = 1.05), and the homework tasks undertaken by the psychoeducation groups raised mood and reduced worry immediately. At follow up 48.2% of participants in the psychoeducation groups were below the recommended cut-off for identifying GAD symptomatology compared with 20% of participants in the control condition. LIMITATIONS: This study was conducted on a small sample, high-worry student population, without a formal diagnosis. CONCLUSIONS: This brief, low-intensity procedure is potentially adaptable to online or self-help procedures, and can be integrated into fuller cognitive therapy packages.

Interrelationships between negative mood and clinical constructs: a motivational systems approach.

A series of three experiments was designed to test predictions from a motivational systems approach to understanding the role of clinical constructs in anxiety-based problems. Negative mood, inflated responsibility, and intolerance of uncertainty (IU) were separately manipulated within analog samples to examine their effect on the other two factors. In the first experiment (n = 59) the negative mood group scored significantly higher in terms of inflated responsibility than the positive mood group. In the second experiment (n = 63) the high responsibility group scored significantly higher in terms of both negative mood and IU than the low responsibility group. In the third experiment (n = 61) the high IU group scored significantly higher in terms of negative mood than the low IU group. Tests of indirect effects revealed an indirect effect of IU on inflated responsibility through negative mood and an indirect effect of negative mood on IU through inflated responsibility, suggesting all three constructs are causally interrelated. The findings are consistent with contemporary transdiagnostic views of clinical constructs, and support a view of anxiety that is underpinned by a coordinated and interdependent motivational system evolved to manage threat.

Systematic information processing style and perseverative worry.

This review examines the theoretical rationale for conceiving of systematic information processing as a proximal mechanism for perseverative worry. Systematic processing is characterised by detailed, analytical thought about issue-relevant information, and in this way, is similar to the persistent, detailed processing of information that typifies perseverative worry. We review the key features and determinants of systematic processing, and examine the application of systematic processing to perseverative worry. We argue that systematic processing is a mechanism involved in perseverative worry because (1) systematic processing is more likely to be deployed when individuals feel that they have not reached a satisfactory level of confidence in their judgement and this is similar to the worrier's striving to feel adequately prepared, to have considered every possible negative outcome/detect all potential danger, and to be sure that they will successfully cope with perceived future problems; (2) systematic processing and worry are influenced by similar psychological cognitive states and appraisals; and (3) the functional neuroanatomy underlying systematic processing is located in the same brain regions that are activated during worrying. This proposed mechanism is derived from core psychological processes and offers a number of clinical implications, including the identification of psychological states and appraisals that may benefit from therapeutic interventions for worry-based problems.

Understanding depressive rumination from a mood-as-input perspective: effects of stop-rule manipulation.

The current study tested the mood-as-input hypothesis account of perseverative rumination in 25 participants with a diagnosis of major depressive disorder and 25 healthy controls. It also examined the factors underlying mood changes within a bout of rumination and their relations with trait rumination and metacognitive beliefs about rumination. A structured rumination interview was used to facilitate participants' reflection on two previous depressive incidents while deploying a specific stop-rule for the task (either a goal-guided or feeling-guided stop-rule). As predicted by the mood-as-input hypothesis, perseveration exhibited by depressed participants was affected by the interaction between diagnosis and stop-rule, with levels of perseveration being greatest when depressed participants used the goal-guided stop-rule. Increases in negative mood over the rumination interview were shown to be influenced only by participants' diagnostic status, regardless of their stop-rule. Compared to healthy controls, depressed participants also reported a preferential use of the goal-guided stop-rule in response to negative mood states in their daily lives. The findings about the dependence of rumination on stop-rule use within the depressed sample support the use of metacognitive treatment approaches in which patients are encouraged to challenge negative beliefs about the controllability of rumination.

A meta-analysis of cognitive therapy for worry in generalized anxiety disorder.

We report a meta- and primary data-analysis investigating the efficacy of cognitive therapy (CT) for pathological worry in adults with GAD that includes an analysis of primary data not reported in previous meta-analyses. Eligible studies included those whose participants met the criteria for a diagnosis of GAD and those that used the PSWQ as an outcome measure. All eligible studies used a randomized controlled design. Analyses included a random-effects meta-analysis of between-study effect sizes and hierarchical linear models of both within study change over time and primary recovery data. The results show that CT was effective in reducing pathological worry when compared with non-therapy controls (d=1.81), and gains were largely maintained at follow-up. The magnitude of effects reported was larger than previously found, suggesting an increased efficacy of newer forms of CT. However, we found weaker evidence to suggest that CT for pathological worry was superior to non-CT treatment controls (d=0.63). Analysis of primary recovery data revealed that 57% of participants were classed as recovered at 12 months following CT, and CT had significantly better recovery rates than all other comparison treatments at post-treatment and 12-month follow-up. These findings support the increasing efficacy of CT as a treatment for GAD. However, CT interventions still need further refinement to help a greater proportion of sufferers achieve recovery.

Mood as input and perseverative worrying following the induction of discrete negative moods.

Previous research has demonstrated that a combination of negative mood and rigorous "as many as can" stop rules can be used to help explain a range of perseverative psychopathologies such as pathological worrying, compulsive checking, and depressive rumination (known as the mood-as-input hypothesis). The aim of the present study was to extend this work and examine whether specific emotions of the same valence will have similar or differential effects on task perseveration. The study experimentally induced discrete moods and manipulated task stop rules in an analog population. Results showed that perseveration at a worry-based interview task conformed to standard mood-as-input predictions in which perseveration was significantly greater when an "as many as can" stop rule was paired with a negative mood or a "feel like continuing" stop rule was paired with a positively valenced mood. The pattern of results revealed no significant inherent differences in processing depending on the type of discrete negative mood being experienced. These findings support a view of mood-as-input effects where overall valency is the important factor in determining perseveration.

An experimental investigation of the role of negative mood in worry: the role of appraisals that facilitate systematic information processing.

BACKGROUND AND OBJECTIVES: Negative mood is associated with increased worry levels, and also with deployment of a systematic information processing style. An experimental study assessed the potential role of systematic information processing in mediating the facilitative effect of negative mood on worry (e.g. Johnston & Davey, 1997). METHOD: Participants underwent appropriate vignette-based mood inductions (negative, neutral, and cognitive priming). Participants completed visual analogue scales measuring variables that reflect a raised processing sufficiency threshold and are known to increase systematic processing (responsibility, accountability, desire for control, and need for cognition), a measure of 'as many as can' worry stop rule deployment, and two measures of worry (the catastrophising interview and the Penn State Worry Questionnaire, PSWQ, Meyer, Miller, Metzger, & Borkovec, 1990). RESULTS: Experimentally-induced negative mood facilitated the endorsement of cognitive appraisals known to increase systematic as opposed to heuristic information processing. In addition, a meditational analysis showed that the systematic processing facilitators measure together with a measure of 'as many as can' worry stop rule deployment fully mediated the relationship between negative mood and a measure of worry frequency (PSWQ). LIMITATIONS: Future studies should develop and validate direct measures of systematic processing. CONCLUSIONS: Similarities and differences between systematic processing and chronic worrying as effortful forms of information processing are discussed, and a role for systematic processing as an information processing style relevant to understanding worrisome thought is described.

Disgust: the disease-avoidance emotion and its dysfunctions.

This review analyses the accumulating evidence from psychological, psychophysiological, neurobiological and cognitive studies suggesting that the disease-avoidance emotion of disgust is a predominant emotion experienced in a number of psychopathologies. Current evidence suggests that disgust is significantly related to small animal phobias (particularly spider phobia), blood-injection-injury phobia and obsessive-compulsive disorder contamination fears, and these are all disorders that have primary disgust elicitors as a significant component of their psychopathology. Disgust propensity and sensitivity are also significantly associated with measures of a number of other psychopathologies, including eating disorders, sexual dysfunctions, hypochondriasis, height phobia, claustrophobia, separation anxiety, agoraphobia and symptoms of schizophrenia--even though many of these psychopathologies do not share the disease-avoidance functionality that characterizes disgust. There is accumulating evidence that disgust does represent an important vulnerability factor for many of these psychopathologies, but when disgust-relevant psychopathologies do meet the criteria required for clinical diagnosis, they are characterized by significant levels of both disgust and fear/anxiety. Finally, it has been argued that disgust may also facilitate anxiety and distress across a broad range of psychopathologies through its involvement in more complex human emotions such as shame and guilt, and through its effect as a negative affect emotion generating threat-interpretation biases.

Mood-as-input hypothesis and perseverative psychopathologies.

Mood-as-input hypothesis is a theory of task perseveration that has been applied to the understanding of perseveration across psychopathologies such as pathological worrying, compulsive checking, depressive rumination, and chronic pain. We review 10 years of published evidence from laboratory-based analogue studies and describe their relevance for perseveration in clinical populations. In particular, mood-as-input hypothesis predicts that perseveration at a task will be influenced by interactions between the individual's stop rules for the task and their concurrent mood, and that the valency of an individual's concurrent mood is used as information about whether the stop rule-defined goals for the task have been met. The majority of the published research is consistent with this hypothesis, and we provide evidence that clinical populations possess characteristics that would facilitate perseveration through mood-as-input processes. We argue that mood-as-input research on clinical populations is long overdue because (1) it has potential as a transdiagnostic mechanism helping to explain the development of perseveration and its comorbidity across a range of different psychopathologies, (2) it is potentially applicable to any psychopathology where perseveration is a defining feature of the symptoms, and (3) it has treatment implications for dealing with clinical perseveration.

Mood-as-input and depressive rumination.

This article describes a test of mood-as-input theory predictions as applied to a rumination task in a nonclinical population. An experimenter-controlled interview was used to allow participants to reflect on a personal period of depression while in an experimentally-induced mood state (either negative or positive) or while deploying a specific stop rule for the task (either an "as many as can" or "feel like continuing" stop rule). As predicted by mood-as-input theory, persistence at the rumination task was greatest in the group experiencing negative mood while deploying an "as many as can" stop rule, and this suggests a mechanism that may contribute to perseverative depressive rumination. It is argued that the variables that contributed to perseveration in this study are already known to be characteristic of ruminative thinkers (e.g. negative mood and positive metacognitive beliefs about rumination that will command the deployment of "as many as can" stop rules for rumination). It is also argued that mood-as-input processes may provide a common mechanism for perseverative rumination and perseverative worry, and this common mechanism may account for many of the similarities between these two functionally-distinct activities.

Disgust and eating disorder symptomatology in a non-clinical population: the role of trait anxiety and anxiety sensitivity.

The present paper reports the results of a study investigating the relationship between a domains-independent measure of disgust (the Disgust Propensity and Sensitivity Scale-Revised) and measures of eating disorder symptomatology in a non-clinical population. Significant correlations between disgust sensitivity and disgust propensity and selected eating disorder symptomatology measures suggested that disgust is significantly correlated with measures of eating disorder symptomatology and is appraised more negatively. However, both measures of disgust propensity and sensitivity failed to predict any significant residual variance in scores on eating symptomatology measures when either trait anxiety or anxiety sensitivity was controlled for. This suggests that while the experience of disgust may be heightened in individuals with eating disorders, it may be linked to other relevant emotions such as anxiety and anxiety sensitivity rather than being an independent risk factor for symptoms.

Anger potentiates the reporting of threatening interpretations: an experimental study.

This paper reports the results of an experiment investigating the effect of induced anger on interpretational bias using the homophone spelling task. Four groups of participants experienced anger, anxiety, happy or neutral mood inductions and then completed the homophone spelling task. Participants who experienced anger and anxiety inductions reported significantly more threat/neutral homophones as threats compared to control participants; moods had an emotion-congruent effect on threat reporting, with negative moods increasing the tendency to report threat/neutral homophones as threats and positive moods increasing the tendency to report positive/neutral homophones as positive. The findings provide evidence that anger potentiates the reporting of threatening interpretations and does so independently of any effect of concurrent levels of state and trait anxiety. The mechanism mediating this effect is unclear, but the results do lend support to those theories of psychopathology--and especially of PTSD--that see a causal role for anger in the maintenance of symptoms.

The effect of disgust on anxiety ratings to fear-relevant, disgust-relevant and fear-irrelevant stimuli.

This study investigated the effect of an experimental disgust induction and experience of a homophone spelling task on subsequent anxiety to fear-relevant, disgust-relevant and fear-irrelevant stimuli in a non-clinical population. The design of the study allowed an assessment of (1) whether disgust facilitates anxiety only if the stimulus being evaluated is disgust-relevant and (2) whether experiencing the threat-interpretation bias induced by disgust facilitates anxiety generally. The results indicated that a disgust induction facilitated levels of self-reported anxiety to a range of scenarios regardless of whether they were disgust-relevant, fear-relevant or fear-irrelevant, and regardless of whether participants had experienced the disgust-induced threat-interpretation bias. This study provides evidence for a general effect of disgust on self-reported anxiety to stimuli regardless of the disgust-relevance or fear-relevance of those stimuli. The results lend support to the view that disgust has a causal effect on anxiety, and implicates disgust as a risk factor for anxious psychopathology.