Effects of worry on physiological and subjective reactivity to emotional stimuli in generalized anxiety disorder and nonanxious control participants

The present study examined the effect of worry versus relaxation and neutral thought activity on both physiological and subjective responding to positive and negative emotional stimuli. Thirty-eight participants with generalized anxiety disorder (GAD) and 35 nonanxious control participants were randomly assigned to engage in worry, relaxation, or neutral inductions prior to sequential exposure to each of four emotion-inducing film clips. The clips were designed to elicit fear, sadness, happiness, and calm emotions. Self reported negative and positive affect was assessed following each induction and exposure, and vagal activity was measured throughout. Results indicate that worry (vs. relaxation) led to reduced vagal tone for the GAD group, as well as higher negative affect levels for both groups. Additionally, prior worry resulted in less physiological and subjective responding to the fearful film clip, and reduced negative affect in response to the sad clip. This suggests that worry may facilitate avoidance of processing negative emotions by way of preventing a negative emotional contrast. Implications for the role of worry in emotion avoidance are discussed.     

The effect of worry on cardiovascular response to phobic imagery

Cardiovascular response to phobic exposures has been shown to reflect the degree of emotional processing of phobic material and relates in important ways to outcome in exposure therapy. The present study investigated the effect of worry on such processing. Speech anxious subjects visualized a phobic scene for 10 trials. Three groups differed according to whether they engaged in relaxed, neutral, or worrisome thinking just prior to each scene presentation. Although the three types of thinking had no effect on cardiovascular activity during the thinking periods, subjects in the worry group displayed significantly less heart rate response to the phobic image than those in the neutral condition who had significantly less response than the relaxed condition. However, the worry group showed significantly greater subjective fear to the images than the neutral condition, with the relaxed group near to the level of the worry group and not significantly different from either of the other two conditions. The results suggest that worry may inhibit emotional processing and thus preserve cognitive/affective fear structure, and are discussed in terms of Gray's (Behavioral and Brain Sciences, 5, 469-534, 1982) theory of the behavioral inhibition system and semantic satiation effects in cognitive psychology.     

Worry and the suppression of imagery

This experiment investigates Borkovec's theory that the function of worry is to protect people from potentially distressing emotional imagery. The experiment builds on a previous one of Borkovec and Inz (Behaviour Research and Therapy, 28, 153–158, 1990) comparing the frequency of thoughts and images in imagery and relaxation. The present experiment confirms the previous finding that worry is associated with less imagery than relaxation, but shows that this is not distinctive to worry. Indeed, an additional control condition, ‘present-oriented mentation’, was associated with even less imagery than worry. The fact that other kinds of thinking are at least as effective as worry in suppressing emotional imagery indicates that this property of worry is not sufficient to explain its occurrence.     

The worried mind: autonomic and prefrontal activation during worrying

To study the psychophysiological correlates of worrying, the authors recorded heart rate, respiratory sinus arrhythmia (RSA), skin conductance level, and alpha electroencephalographic asymmetry in healthy males during baseline, relaxation, worry induction, and anticipation of an impromptu speech task. Compared with baseline, relaxation, and anticipation, worrying was associated with greater heart rate and lower RSA. Worrying was further characterized by higher skin conductance levels compared with baseline but lower levels than during anticipation. Finally, worrying was associated with relatively greater left frontal activity compared with anticipation. Trait public speaking anxiety was positively correlated with left frontal activity during worrying. These results support the notion that worrying is a unique emotional state that is different from fearful anticipation.     

The extent and nature of imagery during worry and positive thinking in generalized anxiety disorder

Clients in treatment for Generalized Anxiety Disorder (GAD) were compared to a control group to assess the extent and nature of imagery during worry or while thinking about a personally relevant positive future event. Two methods were used to assess mentation and were completed in counter balanced order within the worry and positive conditions. One method assessed the occurrence of imagery by requiring participants to categorize their mentation as verbal thoughts or images every 10 s. The other method involved participants estimating the duration of any imagery that occurred in the previous 10 s. Imagery during worry occurred less often than while thinking about a positive event for both groups, but GAD clients had a more pronounced deficit of imagery during worry than the control group. Images that occurred were briefer during worry than while thinking about a positive future event and were briefer in the GAD than the control group for both worry and positive conditions. The results thus confirmed that imagery is less common during worry in clients with GAD but also demonstrated that the imagery that does occur in GAD is briefer.     

Rethinking the Role of Worry in Generalized Anxiety Disorder: Evidence Supporting a Model of Emotional Contrast Avoidance

The Contrast Avoidance model (Newman & Llera, 2011) proposes that individuals with generalized anxiety disorder (GAD) are hypersensitive to sharp upward shifts in negative emotion that typically accompany negative events, and use worry to maintain sustained intrapersonal negativity in an attempt to avoid these shifts. Although research shows that worry increases negative emotionality and mutes further emotional reactivity to a stressor when compared to the worry period (e.g., Llera & Newman, 2010), no study has tracked changes in negative emotionality from baseline to worry inductions followed by a range of emotional exposures. Further, no study has yet assessed participants’ subjective appraisals of prior worry on helping to cope with such exposures. The present study tested the main tenets of the Contrast Avoidance model by randomly assigning participants with GAD (n = 48) and nonanxious controls (n = 47) to experience worry, relaxation, and neutral inductions prior to sequential exposure to fearful, sad, and humorous film clips. Both physiological (nonspecific skin conductance responses [NS-SCRs]) and self-reported emotional changes were observed. Results indicated that worry boosted negative emotionality from baseline, which was sustained across negative exposures, whereas low negative emotionality during relaxation and neutral inductions allowed for sharp increases in response to exposures. Furthermore, GAD participants found worry to be more helpful than other conditions in coping with exposures, whereas control participants reported the opposite pattern. Results provide preliminary support for the Contrast Avoidance model. This suggests that treatment should focus on underlying avoidance patterns before attempting to reduce worry behavior.     

Speech anxiety and rapid emotional reactions to angry and happy facial expressions

The aim was to explore whether people high as opposed to low in speech anxiety react with a more pronounced differential facial response when exposed to angry and happy facial stimuli. High and low fear participants were selected based on their scores on a fear of public speaking questionnaire. All participants were exposed to pictures of angry and happy faces while facial electromyographic (EMG) activity from the Corrugator supercilii and the Zygomaticus major muscle regions was recorded. Skin conductance responses (SCR), heart rate (HR) and ratings were also collected. Participants high as opposed to low in speech anxiety displayed a larger differential corrugator responding, indicating a larger negative emotional reaction, between angry and happy faces. They also reacted with a larger differential zygomatic responding, indicating a larger positive emotional reaction, between happy and angry faces. Consistent with the facial reaction patterns, the high fear group rated angry faces as more unpleasant and as expressing more disgust, and further rated happy faces as more pleasant. There were no differences in SCR or HR responding between high and low speech anxiety groups. The present results support the hypothesis that people high in speech anxiety are disposed to show an exaggerated sensitivity and facial responsiveness to social stimuli.     

Affective learning increases sensitivity to graded emotional faces

How does the affective significance of emotional faces affect perceptual decisions? We manipulated affective significance by pairing 100% fearful faces with aversive electrical stimulation and hypothesized that increasing the significance of a stimulus via its prior history would lead to enhanced processing. After fear conditioning, participants viewed graded emotional faces that ranged from neutral to fearful. Faces were shown either in a color that was previously paired with shock or a color not paired with shock during conditioning. Increases in the frequency of "fearful" responses for faces shown in the shock-paired color were most robust for faces at intermediate intensity levels (40-60% fearful). Psychometric fits to the data revealed significant increased sensitivity for shock-paired relative to unpaired faces. Thus, despite identical physical features for shock-paired and unpaired stimuli (aside from the color, which was counterbalanced), more frequent (and faster) "fearful" responses were made when participants viewed affectively significant stimuli.     

Fear and disgust processing during repeated exposure to threat-relevant stimuli in spider phobia

Although disgust plays a significant role in the etiology of spider phobia, there remains a paucity of research examining the role of disgust in the treatment of spider phobia. Spider fearful participants (N = 46) were randomly assigned to a disgust (view vomit images) or neutral activation (view inanimate objects) condition. They were then repeatedly exposed to a videotaped tarantula, during which time their fear, disgust, and physiological levels were assessed repeatedly. Growth curve analyses indicated that repeated exposure led to significant declines in fear and disgust with no statistically significant differences between the two conditions. However, there was marginal evidence for decreased physiological arousal during repeated exposure among spider fearful participants in the disgust activation condition compared to those in the neutral condition. Reduction in disgust during exposure in the disgust activation condition remained significant after controlling for change in fear, whereas change in fear was no longer significant after controlling for change in disgust. However, the opposite pattern of relations between change in fear and disgust was observed in the neutral activation condition. Higher fear and disgust activation during exposure was also associated with higher fear and disgust responding on a subsequent behavioral task and higher spider fear and disgust at 3-month follow-up. Baseline trait disgust propensity also predicted fear and disgust parameters during repeated exposure. The implications of these findings for the role of disgust in the treatment of spider phobia are discussed.     

Treating chronic worry: Psychological and physiological effects of a training programme based on mindfulness

The present study examines psychological and physiological indices of emotional regulation in non-clinical high worriers after a mindfulness-based training programme aimed at reducing worry. Thirty-six female university students with high Penn State Worry Questionnaire scores were split into two equal intervention groups: (a) mindfulness, and (b) progressive muscle relaxation plus self-instruction to postpone worrying to a specific time of the day. Assessment included clinical questionnaires, daily self-report of number/duration of worry episodes and indices of emotional meta-cognition. A set of somatic and autonomic measures was recorded (a) during resting, mindfulness/relaxation and worrying periods, and (b) during cued and non-cued affective modulation of defence reactions (cardiac defence and eye-blink startle). Both groups showed equal post-treatment improvement in the clinical and daily self-report measures. However, mindfulness participants reported better emotional meta-cognition (emotional comprehension) and showed improved indices of somatic and autonomic regulation (reduced breathing pattern and increased vagal reactivity during evocation of cardiac defense). These findings suggest that mindfulness reduces chronic worry by promoting emotional and physiological regulatory mechanisms contrary to those maintaining chronic worry.     

The voice of emotional memory: content-filtered speech in panic disorder, social phobia, and major depressive disorder.

We asked patients with either panic disorder, social phobia, or major depressive disorder and healthy control participants to describe their most frightening experience and to describe an emotionally neutral experience. Both fear and neutral autobiographical memories were audiotaped and processed through a low-pass filter that eliminated frequencies above 400 Hz, thereby abolishing semantic content but leaving paralinguistic aspects like rate, pitch, and loudness intact, and these convey emotional cues. Raters blind to content and diagnosis rated the content-filtered speech clips on emotional dimensions. The results revealed that content-filtered fear memories received significantly higher ratings on anxious, aroused, and dominant (but not sad or negative) scales than did content-filtered neutral memories, irrespective of the diagnostic status of the speaker. Content-filtered speech appears promising as an on-line probe of emotional processing during accessing of autobiographical memories.     

Undifferentiation of somatic responses to emotions in a case of functional amnesia

The term functional amnesia (FA) has been proposed for cases of memory impairment presenting with severe retrograde amnesia in the absence of cerebral injury or history of psychiatric disturbance. Emotional flattening has often been reported alongside FA, however the mechanism of such a modification is unknown. This study aimed to explore the emotional processing in a rare case of a patient with FA complaining of severe emotional flattening. We presented ecological dynamic video stimuli conveying strong peaceful and fearful emotions to the patient and 13 controls. We then explored their emotional responses considering both conscious emotional judgements and automatic psychophysiological responses (skin conductance) and facial muscular activity (corrugator supercilii). Both patient P.P. and controls perfectly recognized the emotions conveyed by the films. However, P.P. failed to show an increased skin conductance and corrugator activity as found in controls during fearful film extracts compared with peaceful extracts. Taken together, these finding demonstrate the presence of an emotional deficit, characterized by a failure to generate appropriate somatic responses to positive and negative stimuli. Although this altered somatic processing did not interfere with PP's explicit recognition of emotion, it modified his emotional experience, thereby constituting a possible explanation for his emotional flattening. This study therefore suggests that FA is not limited to a mnemonic impairment, but is a more complex disorder, involving also the processing of emotionally loaded experiences.     

Cognitive and personality characteristics of worriers

Worriers and nonworriers from a college population were compared on the Imaginal Processing Inventory, the Self-Consciousness scale, and the Sandler-Hazari Obsessionality Inventory. Subjects from both groups also engaged in either brief relaxing or stressful imagery. Before the imagery task, measures of cognitive activity were obtained from periods of relaxed wakefulness, focused attention and anagram performance. After the imagery task, focused attention and anagrams measures were repeated. Worriers reported a more negative daydreaming style, greater difficulty with attentional control, and greater obsessional symptoms, public self-consciousness and social anxiety. On thought sampling measures obtained during relaxed wakefulness periods and rated by objective judges, and on self-report measures obtained during the focused attention task, worriers evidenced significantly more negatively affect-laden cognitive intrusions. No differences were found on anagram performance, and imagery condition did not influence any measure, suggesting that instructed fear images are insufficient to initiate worrisome episodes.     

Engaging in imagery versus verbal processing of worry: Impact on negative intrusions in high worriers

Chronic, excessive, and uncontrollable worry is the defining characteristic of generalised anxiety disorder. Worry largely consists of verbal thought and it has been postulated that this predominance of verbal thought in worry may contribute to its perseveration. In an investigation of this issue, high worriers were trained to engage in either imagery or verbal processing. Mentation was sampled before and after a five-minute period of worry during which participants engaged in either imagery of the worry topic or verbal processing of the worry topic. Verbal worry resulted in a significant increase in negative intrusions, consistent with previous research. Furthermore, imagery was associated with a decrease in negative intrusions. The results support the theory that the predominantly verbal nature of worry may be responsible for the uncontrollability and maintenance of worry.     

Situation-Specific Scripts for Threat in Blood Fearful and Nonfearful Individuals

Self-schemata for threatening situations were examined in blood fearful and nonfearful individuals. In the context of 5 scenarios involving blood, injections, hospitals, or injury, participants listed events that they typically experience in these situations or events that occur when they witness another individual in these situations. Blood fearful and nonfearful individuals generally listed sequences of events corresponding to a similar macrostructure. However, blood fearful individuals included more negative emotional and physiological events than nonfearful individuals, and several of their sequences reflected higher levels of fear and lower levels of positive affect. These results suggest that the self-schemata of blood fearful individuals for situations involving harm or threat consist of both normal and maladaptive elements.     

Fear imagery and the startle-probe reflex

Blink reflexes to acoustic probes, heart rate, and subjective reports were studied during affective memory imagery. Thirty-six undergraduates memorized 6 pairs of neutral and fearful sentences. After learning each pair, they relaxed and listened to a series of uniform tones, one every 6 s. A change in tone pitch (higher or lower) cued recall of one of the two sentences. At the first cue tone, groups (n = 12) were under different instructions: (a) ignore the sentence and relax, (b) silently articulate the sentence, and (c) imagine the sentence content as a personal experience. At the second cue tone, all subjects performed the imagery task. Startle probes (50-ms, 95-dB white noise) were presented unpredictably during relaxation and recall trials. Probe blink reflexes were larger and cardiac rate faster at fear sentence recall than at neutral sentence recall or relaxation. For probe reflexes, this effect was greater for imagery than for nonsemantic recall tasks.     

A tale of two negatives: differential memory modulation by threat-related facial expressions

Facial expressions serve as cues that encourage viewers to learn about their immediate environment. In studies assessing the influence of emotional cues on behavior, fearful and angry faces are often combined into one category, such as "threat-related," because they share similar emotional valence and arousal properties. However, these expressions convey different information to the viewer. Fearful faces indicate the increased probability of a threat, whereas angry expressions embody a certain and direct threat. This conceptualization predicts that a fearful face should facilitate processing of the environment to gather information to disambiguate the threat. Here, we tested whether fearful faces facilitated processing of neutral information presented in close temporal proximity to the faces. In Experiment 1, we demonstrated that, compared with neutral faces, fearful faces enhanced memory for neutral words presented in the experimental context, whereas angry faces did not. In Experiment 2, we directly compared the effects of fearful and angry faces on subsequent memory for emotional faces versus neutral words. We replicated the findings of Experiment 1 and extended them by showing that participants remembered more faces from the angry face condition relative to the fear condition, consistent with the notion that anger differs from fear in that it directs attention toward the angry individual. Because these effects cannot be attributed to differences in arousal or valence processing, we suggest they are best understood in terms of differences in the predictive information conveyed by fearful and angry facial expressions.     

外显和内隐情绪韵律加工的脑机制：近红外成像研究

准确识别言语中的情绪韵律信息对社会交往非常重要。本研究采用功能近红外成像技术, 探索外显和内隐情绪加工条件下愤怒、恐惧、快乐三种情绪韵律加工过程中的大脑皮层神经活动。结果表明, 对愤怒、恐惧、快乐韵律进行特异性加工的脑区分别为左侧额极/眶额叶、右侧缘上回、左侧额下回, 其中右侧缘上回脑区同时受到情绪和任务的调控。此外, 右侧颞中回、颞下回和颞极在情绪外显任务中的激活明显强于内隐任务。本研究的结果部分支持了情绪韵律的层次模型, 也对该模型的第三层次, 即“额区对语音情绪信息的精细加工需要外显性情绪加工任务参与”提出了质疑。     

A preliminary study of medial temporal lobe function in youths with a history of caregiver deprivation and emotional neglect

Previous research findings have linked caregiver deprivation and emotional neglect with sensitivity to threatening cues. The present preliminary study investigated whether dysfunctions of the medial temporal lobe could underlie these associations. Using fMRI, we measured medial temporal lobe responses to emotional faces (angry, fearful, happy, neutral) among 30 youths. Eleven of the youths had a history of caregiver deprivation and emotional neglect. Attention states (i.e., attention to anger, fear, or physical attributes, or passive viewing) were systematically manipulated. Relative to comparison youths, youths with a history of caregiver deprivation and emotional neglect showed significantly greater left amygdala and left anterior hippocampus activation during the processing of threatening information. To our knowledge, these findings are the first to demonstrate altered medial temporal lobe function during the processing of threat cues in youths with a history of caregiver deprivation and emotional neglect.