Pathological Worry

Generalized Anxiety Disorder (GAD) is characterized by uncontrollable, excessive and distressful worrying that is beyond one’s ability to control. Three processes contribute to its unpredictability: basic processing biases favoring threat content in attentional processing and interpretation, impairment in attentional control mechanisms and representations of possible negative outcomes in overly general verbal form.

Psychotherapy can help you learn to control your anxieties more effectively. One common form is cognitive behavioral therapy, or CBT.

What is pathological worry?

Generalized Anxiety Disorder (GAD) is characterized by excessive worrying that interferes with awareness. These intrusive negative thoughts tend to intrude and persist even though they’re considered harmful, suggesting three processes combine to sustain pathological worry: emotional processing biases, attentional control impairment and expressing potential threat outcomes over-generally verbally.

Emotional processing biases operate without conscious or deliberate intent and have been shown to impact task performance, for example when anxious individuals exhibit longer latencies than healthy controls to identify the colors of threatening words in a Stroop test. Such cognitive bias modification techniques (Mathews & Mackintosh 1998; Hertel & Mathews 2011) may help modify such biases (Mathews & Mackintosh 1998; Hertel & Mathews 2011).

Impairments to attentional control can be seen when individuals prioritize threatening information over non-threatening information, evidenced by increased reaction times for threatening versus benign stimuli on the Posner task. Furthermore, response inhibition impairment may cause individuals to interpret ambiguous events with threatening interpretations more frequently, as evidenced by higher anxiety levels being linked with slower disengagement from threatening content when shifting attention away from it and towards neutral or unthreatening material (Calvo & Castillo 2001).

Once threatening thoughts enter consciousness, they may compete more fiercely for top-down control resources than more benign thoughts – increasing their persistence (Fox, Cahill & Zougkou, 2010). It should be noted that this process differs from rumination which involves dwelling on past negative experiences or personal attributes that may have led to depression rather than GAD.

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Note that this model does not discount the role of strategic processes in maintaining pathological worry, such as misguided beliefs about its advantages (Wells, 2006) or using inappropriate rules about when and how to stop worrying (Davey, 2006). These strategies may operate after negative thoughts have already permeated consciousness as a result of non-conscious influences.

How do I know if I have pathological worry?

Pathological anxiety goes beyond normal levels of worry and becomes an ongoing condition that impairs daily functioning, often manifested through excessive worry, physical symptoms and difficulty functioning. Pathological anxiety may result from genetics or life experiences like trauma or abuse; often seen among children and teenagers but may occur throughout a person’s lifespan; more common in women than men, it can even be hereditary.

Generalized Anxiety Disorder (GAD) is characterized by excessive worrying. According to Hirsch and Mathews’ model, three processes combine to maintain this uncontrollable worry: emotional processing biases, impaired attentional control and the tendency of overgeneralising negative outcomes in overly specific verbalized forms. In the present study we assessed various methods designed to modify this last process among our sample of clinical GAD participants.

The primary aim of the study was to explore the relationship between perfectionism and pathological worry in a clinical GAD sample of participants, with particular attention given to Clinical Perfectionism Questionnaire (CPQ) and Worry Disengagement Training (WDT). After controlling for gender and depression levels, CPQ explained an impressive 20% variance in pathological worry levels.

Wood (1992) suggests that, unlike rumination, which often corresponds to depression, threatening thoughts can attract our attention regardless of their source (Wood 1992). A key distinction between rumination and worry lies in its latter’s representation of self-relevant ambiguous events as threats – possibly explaining why pathological worriers tend to focus more heavily on such thoughts than others when there are no actual threats present.

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Contrasting with rumination, which involves an internal dialogue, worry is largely verbal and abstract in its cognitive activity, with neuroimaging studies linking its characteristics with specific patterns of functional brain connectivity with the amygdala. Our findings support these observations, suggesting that pathological worry’s signature features, including its verbal nature and negative abstract content may represent a particular form of emotional processing bias distinct from other forms of cognition.

What are the symptoms of pathological worry?

The model presented here suggests that pathological worry can be affected both involuntary (bottom-up) processes, such as processing biases in attention and interpretation that favor threat content, as well as voluntary (top-down) control mechanisms which can restrict or divert thought-related attention. At an unconscious level, processing biases influence competition between threat-related representations for conscious access to attentional resources vs benign task representations; this reduces their chances of breaking through as negative intrusions into awareness versus persistence as worry.

Reducing automatic and repetitive worry has been shown to be effective, with various interventions typically focused on external cues or sensory modalities to redirect one’s focus away from it. Unfortunately, such attempts fail to take into account that worry remains present even when one isn’t thinking about it, and require investing attentional resources which may already be depleted in refocus efforts.

Studies conducted using the Posner task (Fox, Russo & Bowles 2001; Yiend & Mathews 2003) reveal that anxiety-prone individuals take longer to shift away from threatening cues than non-anxious controls. Furthermore, Leigh and Hirsch (2011) have demonstrated that thinking about worry topics verbally depletes attentional control resources more quickly than when considering them in imagery form.

Research investigating neural correlates of this phenomenon has demonstrated that inhibiting competing distracters correlates to how difficult it is to terminate worry episodes, as well as discovering that bottom-up and top-down influences make controlling pathological worry harder to do. Given this information, and given our observations about bottom-up/top-down influences making control harder of pathological worry persisting for longer, we believe the most effective treatments for GAD should combine practice-based bias modification (to decrease negative intrusions into daily life and negativity of worry) along with interventions designed to strengthen deliberate attempts by people trying to limit episodes by strengthening deliberate attempts by strengthening attempts made deliberately with deliberate intentions to control and limit episodes.

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How can I get help for pathological worry?

Feelings of anxiety are an understandable human response to stress or new situations, yet when those feelings become exaggerated for the situation at hand, doctors can diagnose pathological anxiety as a mental health disorder that manifests in various forms: increased symptoms of physical illness, hypervigilance and excessive worry among others. Although experts don’t fully understand its source(s), experts believe both genetics and trauma contribute to its development.

There are various treatments that may address this condition. Techniques such as thought replacement or stimulus control may provide temporary relief, while others focus on increasing top-down control by using techniques such as worry timetabling or cultivating alternative topics to dwell upon. However, these methods are limited by how easily processing biases can be changed, only targeting part of the pathological aspect of anxiety. Therefore, researchers are currently exploring Worry Disengagement Training (WDT). It provides a bottom-up approach that targets inability to disengage from and inhibit negative thoughts while replacing them with more adaptive ones.