Capturing worry in daily life: are trait questionnaires sufficient?

Worry is crucial in the development and maintenance of anxiety disorders and has been associated with several other adverse health outcomes. Yet, little is known about the frequency and perseveration of worry in daily life, and its predictability by widely used trait questionnaires. In this study 432 students completed the Penn State Worry Questionnaire (PSWQ), the Worry Domains Questionnaire (WDQ) and the State-Trait Anxiety Inventory-Trait version (STAI-T) and kept a log of worry frequency and duration during six consecutive days and nights. The results showed that worry is a very common phenomenon that is predicted by the two trait worry questionnaires, independent of trait anxiety. The often clinically utilized PSWQ predicted worry duration better than the WDQ, and exclusively predicted night-time worry and several other indices of perseverative and potentially pathogenic worry. Although this study provides some support for the predictive validity of the PSWQ and the WDQ, these questionnaires did not account for the larger part of variance in daily worry. Future studies of worry and its associated perseverative processes should consider using momentary assessments.     

Worry, anxiety, and preferred length of sleep

Sixty-three female and 43 male undergraduates responded to a "worry" scale, a trait anxiety measure, and a question asking preferred length of sleep to clarify conflicting findings regarding the relationship between worry and anxiety and length of sleep (e.g., Hartmann, 1973; Hicks & Pellegrini, 1977; Kumar & Vaidya, 1984). Worry and length of sleep were positively correlated, supporting Hartmann's contentions. Anxiety was related to sleep in a U-shaped curvilinear fashion. Anxiety and worry were substantially correlated (r = .60) for subjects above the median on worry but were not correlated for subjects below the median. Worry may be the underlying construct in the positive relationship between anxiety and length of sleep for highly anxious persons. Comparison of high worry-low anxiety and low worry-high anxiety groups also suggests that our understanding of the relationships among sleep, anxiety, and worry may benefit from the simultaneous consideration of worry and anxiety factors.     

Separation,self‐disclosure,and social evaluation anxiety as facets of trait social anxiety

In the current article, we propose an expansion of the trait anxiety concept to include interpersonal or social facets of trait anxiety involving separation from significant others and disclosing aspects of the self to others, as a supplement to the existing focus on social evaluation anxiety. Participants in three studies completed a modified version of the Endler Multidimensional Anxiety Scales that included a measure of trait social evaluation anxiety, as well as new measures of trait separation anxiety and trait self‐disclosure anxiety (i.e., three measures of trait social anxiety). Results showed that the social evaluation, separation, and self‐disclosure trait anxiety scales have strong psychometric properties and that they represent distinct but related components of trait anxiety. With respect to validity, the facets of trait social anxiety were predictive of related variables including self‐concealment, anxiety sensitivity, and trait worry. The theoretical and practical implications of a multifaceted approach to trait social anxiety are discussed in terms of an expanded multidimensional interaction model of anxiety. Copyright © 2002 John Wiley & Sons, Ltd.     

Relationship of worry and emotionality to test performance in a juku environment

The relationships between trait and state worry and emotionality and performance in a Juku environment were explored; these Japanese anxiety data were also compared in an international context. The Juku or ‘cram school’ provides additional after-school instruction to improve the probability of students getting into select private junior high schools. The subjects were 362 students in the fourth, fifth and sixth grades. Test anxiety was measured by the Japanese Children's Trait Worry and Emotionality Scale and the Japanese Children's State Worry and Emotionality Scale. The performance tests measured achievement in mathematics, social studies, Japanese language, and science. As expected, the relationship between the state worry measures and performance was stronger than between either state emotionality or the trait measures. The data also indicate that trait anxiety was dramatically less here than in other international contexts while state anxiety was moderately less.     

Japanese children's trait and state worry and emotionality in a high-stakes testing environment

Our previous research using both Japanese Children's Trait and State Worry and Emotionality Scales indicated that there were several issues that needed resolution in a high-stakes testing environment. High-stakes testing environments are those in which there are serious consequences to the individual of how well he or she scores on a particular test. In this study, the high-stakes environment was characterized by higher state worry and emotionality but not higher trait worry and emotionality scores than in the previous study. A clear two-factor solution was found for the state measures but not for the trait measures. Males performed better on the achievement tests than females. The relationship of state anxiety to performance was non-linear. State worry was more highly predictive of poor performance than state emotionality.     

The relationship of thought-action fusion to pathologicial worry and generalized anxiety disorder

Meta-cognitive beliefs associated with pathological worry and generalized anxiety disorder (GAD) may encompass the likelihood subtype of thought-action fusion (TAF), the belief that one's thoughts can influence outside events. In the current study of 494 undergraduate college students, positive correlations between scores on the Penn State Worry Questionnaire (PSWQ) and the two Likelihood subscales of the TAF Scale were found, and participants endorsing at least some DSM-IV diagnostic criteria for GAD scored significantly higher on both TAF-Likelihood subscales than participants reporting no GAD symptoms. However, these TAF scales did not predict GAD diagnostic status with PSWQ included as a predictor. In contrast to previous research, the TAF-Moral scale did not correlate with worry. Relationships between TAF, pathological worry, and meta-cognition are discussed in relation to GAD.     

Night-time thoughts in high and low worriers: reaction to caffeine-induced sleeplessness

There is ample evidence for the existence of an association between sleeplessness and worry. Not much is known, however, concerning the nature of this relationship. Therefore, a study was conducted investigating the causal relationship between sleeplessness and nocturnal worry. A 2 x 2 (Worry x Induced sleeplessness) analysis of covariance design was used. The first factor consisted of a subject variable defined by scoring either high or low on a trait measure of worry (the Penn State Worry Questionnaire) and the second factor consisted of 300 mg caffeine or placebo. A total of 96 female undergraduate students participated. The dependent variables comprised measures of nocturnal worry (the Night-Time Thoughts Questionnaire) and subjective and objective sleep parameters. Overall, caffeine caused an increase in nocturnal worry and sleeplessness. A significant interaction effect occurred between Worry and Induced sleeplessness on one of the objective sleep parameters, but no other interaction effects were significant. The results suggest that worry may occur as an epiphenomenon of sleeplessness.     

Psychometric properties of the Penn State Worry Questionnaire in a clinical anxiety disorders sample.

With the advent of DSM-III-R, the diagnostic criteria for generalized anxiety disorder (GAD) shifted in emphasis from the autonomic arousal to the cognitive component of the disorder, namely worry. The Penn State Worry Questionnaire was developed to assess the trait of worry and has proven to be a reliable and valid measure in a series of studies largely based on college student samples. The purpose of the present study was to assess the psychometric properties and utility of the PSWQ in a clinical sample of 436 anxiety disorder patients and 32 normal controls. Factor analysis indicated that the PSWQ assesses a unidimensional construct. Furthermore, the PSWQ evidenced quite favorable internal consistency using GAD patients and each of the other anxiety disorder groups and normal controls. The validity of the PSWQ was supported by an analysis indicating that the measure distinguished. GADs from each of the other anxiety disorder groups including those with obsessive-compulsive disorder. Moreover, correlations between the PSWQ and measures of anxiety, depression, and emotional control supported the convergent and discriminant validity of the measure. Collectively, the findings speak favorably to the use of the PSWQ in research examining the nature and treatment of GAD and the processes of normal and pathological worry.     

A Taxometric Investigation of the Latent Structure of Worry: Dimensionality and Associations With Depression, Anxiety, and Stress

Worry has been described as a core feature of several disorders, particularly generalized anxiety disorder (GAD). The present study examined the latent structure of worry by applying 3 taxometric procedures (MAXEIG, MAMBAC, and L-Mode) to data collected from 2 large samples. Worry in the first sample (Study 1) of community participants (n = 1,355) was operationalized by worry engagement, absence of worry, and the worry feature of trait anxiety. Worry in the second sample (Study 2) of undergraduate participants (n = 1,171) was operationalized by the tendency to experience worry, intolerance of uncertainty, beliefs about worry, and symptoms of GAD. Results across both samples provided converging evidence that worry is best conceptualized as a dimensional construct, present to a greater or lesser extent in all individuals. Findings from Study 2 also indicated that the latent dimension of worry generally has an equal association with symptoms of depression, anxiety, and stress across the entire continuum. These findings are discussed in relation to the conceptualization and assessment of worry in GAD and related disorders.     

Culture, Health, and Financial Appraisals: Comparison of Worry in Older Japanese Americans and European Americans

There is limited understanding of the potential impact of cultural identification and values on the emotional experiences of older adults. This study considered potential differences in worry based on culture and acculturation type. The study also evaluated differences in worry based on self-appraisals of perceived health and financial status. Sixty-six older community-based Japanese Americans (JAs) and 65 older European Americans (EAs) completed the Penn State Worry Questionnaire (PSWQ) and the Worry Scale–Revised (WSR). Cultural differences were not found. Social desirability scores were elevated, particularly among JAs who had been relocated to internment camps during World War II. Irrespective of cultural status, elevated average daily worry frequency scores and WSR–Health scores were found in the group who perceived their health status to be poor/fair. Irrespective of cultural status, elevated average daily worry frequency scores, PSWQ scores, and WSR–Financial scores were found in the group who perceived their financial status to be poor/fair. Recommendations for using the WSR with older populations are discussed.     

The Penn State Worry Questionnaire—Past Day: Development and Validation of a Measure Assessing Daily Levels of Worry

Based on the widely used Penn State Worry Questionnaire for trait worry, a scale was developed to measure the level of worry experienced during the past 24 h. This instrument, the Penn State Worry Questionnaire—Past Day (PSWQ-PD), was administered to a student sample and two clinical samples. The PSWQ-PD demonstrated high internal consistency, good convergent validity and adequate test-retest reliability. A confirmatory factor analysis revealed that a unifactorial solution provided the best fit. Moreover, it was shown that the PSWQ-PD is a more state-like worry measure than the original PSWQ. The PSWQ-PD is a promising, brief tool for daily worry assessment, which is apt for frequent administration.     

Regulation strategies during COVID-19 quarantine: The mediating effect of worry on the links between coping strategies and anxiety

IntroductionThe COVID-19 outbreak forced Italian citizens into a generalized quarantine from March to May 2020. The quarantine is a successful measure to reduce the virus's spread through physical and social distancing, but it can also have negative psychological consequences on the population. People experience high levels of worry and anxiety and have to cope with the consequences of the health emergency. The aim of this study was to preliminarily assess the causal relations among coping, worry and state anxiety at the time of COVID-19 first wave, and the mediation role of worry between coping and state anxiety.MethodsDuring March 2020, 1273 Italian citizens completed an ad hoc online survey composed of sociodemographic and preoccupation-related questions, and standardized self-report questionnaire (Brief COPE, Penn State Worry Questionnaire and State-Trait Anxiety Inventory-State form). Three separate mediation models were performed.ResultsThe relationship between coping strategies (i.e.: problem-focused coping, emotion-focused coping and dysfunctional coping) and state anxiety resulted to be mediated by worry. Dysfunctional and problem-focused coping had a negative effect on anxiety scores and this effect was amplified by high levels of worry. Emotion-focused coping reduced state anxiety scores through its effect on reducing the levels of worry, which in turn was related to a reduction in anxiety.ConclusionThe present study offers first evidence for the mediation role of worry in the relation between coping and anxiety during quarantine caused by COVID-19 pandemic. It supports the clinical importance of investigating people's coping strategies along with the levels of (cognitive) worry and their long-term effects on the psychological well-being during the outbreak, in order to deliver adequate personalized interventions. Psychological support should enhance emotion-focused coping strategies that have a protective effect on both worry and anxiety.     

Acute exercise effects on worry,state anxiety,and feelings of energy and fatigue among young women with probable Generalized Anxiety Disorder: A pilot study

BackgroundLittle is known about the acute effects of exercise among individuals with clinical or subclinical Generalized Anxiety Disorder (GAD).PurposeThus, this study examined worry, state anxiety, and feelings of energy and fatigue responses to acute aerobic exercise and quiet rest, and explored potential moderators of response among young adult women with worry scores indicative of GAD.MethodsSeventeen young women with Penn State Worry Questionnaire scores ≥45 (60 ± 8) completed 30-min treadmill running at 65%–85% heart rate reserve (%HRR) and 30-min seated quiet rest in counterbalanced order. Outcomes included worry, state anxiety, and feelings of energy and fatigue. Two condition X two time repeated measures ANOVA examined differences across condition and time. Hedges’ d effect sizes (95%CI) were calculated to quantify and compare the magnitude of change. Independent-samples t-tests explored potential moderators of outcome response.ResultsTotal exercise time was 35.8 ± 3.4min with a mean 30.3 ± 0.16 in-zone minutes (65%-85%HRR); participants exercised at ∼72.9 ± 0.03 %HRR (range 66%–79%). Compared with quiet rest, acute exercise significantly improved worry engagement, state anxiety, and feelings of energy and fatigue (all p ≤ 0.031). Moderate-to-large (d = 0.44 to 1.69) reductions in state anxiety and feelings of fatigue and improvements in feelings of energy were found. Exercise-induced reductions in worry engagement were significantly larger among non-high trait anxious participants. Compared to normal sleepers, quiet rest significantly increased feelings of fatigue among poor sleepers.ConclusionFindings provide support for the positive effects of acute aerobic exercise on worry, state anxiety, and feelings of energy and fatigue among young women with worry indicative of GAD.     

The effects of worry and rumination on affect states and cognitive activity

The effects of worry and rumination on affective states and mentation type were examined in an unselected undergraduate sample in Study 1 and in a sample of individuals with high trait worry and rumination, high rumination, and low worry/rumination in Study 2. Participants engaged in worry and rumination inductions, counterbalanced in order across participants to assess main and interactive effects of these types of negative thinking. During mentation periods, the thought vs. imaginal nature and the temporal orientation of mentations were assessed 5 times. Following mentation periods, negative and positive affect, relaxation, anxiety, and depression were assessed. Both worry and rumination produced increases in negative affect and decreases in positive affect. Worry tended to generate greater anxiety, and rumination tended to generate greater depression. Interactive effects were also found indicating that worry may lessen the anxiety experienced during subsequent rumination. Moreover, worry lessened the depressing effects of rumination. Worry was associated with significantly greater thought than imagery, compared to rumination. Rumination involved a progression from mentation about the past to mentation about the future over time. Implications for understanding the generation of negative affect and comorbid anxiety and depression are discussed.     

Searching for Danger: On the Link Between Worry and Threat-Related Confirmation Bias in Children

The present study examined the relationship between worry and threat-related confirmation bias in children. Forty non-clinical children aged 10–12 years completed the child version of the Penn State Worry Questionnaire as a cognitive index of anxiety proneness, and then were administered a modified version of the Wason Selection Task to assess verifying and falsifying reasoning strategies in response to conditional danger rules. Results demonstrated that children with high levels of worry displayed a stronger tendency towards verification and a weaker inclination towards falsification than children with low levels of worry. This finding indicates that confirmation bias occurs in individuals with a general vulnerability to anxiety, and fits well with current theoretical models in which cognitive distortions are viewed as risk factors predisposing to the development of fear and anxiety problems.     

Factor structure of the Penn State Worry Questionnaire: examination of a method factor

The Penn State Worry Questionnaire (PSWQ) was originally designed as a unifactorial measure of pathological trait worry. However, recent studies supported a two-factor solution with positively worded items loading on the first factor and reverse-scored items loading on a second factor. The current study compared this two-factor model to a negative wording method factor solution among college students. A method factor model with all PSWQ items loading on a single worry factor and reverse-scored items loading on a negative wording method factor provided as good a fit as the two-factor model. This method factor alone did not predict a generalized anxiety disorder diagnosis. Finally, the psychometric properties of an abbreviated scale containing only positively worded items were examined. The PSWQ appears to measure a single unitary construct, but response patterns differ between positively worded and reverse-scored items. Theoretical implications for pathological worry and assessment-related issues are discussed.     

Development and validation of the penn state worry questionnaire

The present report describes the development of the Penn State Worry Questionnaire to measure the trait of worry. The 16-item instrument emerged from factor analysis of a large number of items and was found to possess high internal consistency and good test-retest reliability. The questionnaire correlates predictably with several psychological measures reasonably related to worry, and does not correlate with other measures more remote to the construct. Responses to the questionnaire are not influenced by social desirability. The measure was found to significantly discriminate college samples (a) who met all, some, or none of the DSM-III-R diagnostic criteria for generalized anxiety disorder and (b) who met criteria for GAD vs posttraumatic stress disorder. Among 34 GAD-diagnosed clinical subjects, the worry questionnaire was found not to correlate with other measures of anxiety or depression, indicating that it is tapping an independent construct with severely anxious individuals, and coping desensitization plus cognitive therapy was found to produce significantly greater reductions in the measure than did a nondirective therapy condition.     

Intolerance of Uncertainty–Focused Treatment for Adolescents With Excessive Worry: A Pilot Feasibility Study

Bouts of excessive worry are common across the lifespan, increasing in frequency and complexity during adolescence and adulthood, and are found in several psychiatric disorders, particularly the anxiety disorders. There are evidence-based treatments for adolescents with anxiety disorders but psychological treatments designed specifically to target excessive worrying in adolescents are rare. Intolerance of uncertainty (IU), a cognitive predisposition described as a fear of the unknown, is highly associated with worry among adolescents. This study investigated the feasibility, acceptability, and preliminary efficacy of IU-focused cognitive behavioral therapy (IU-CBT) for adolescents with excessive worry. Twelve participants (aged 13–17 years) with excessive worry, irrespective of psychiatric diagnosis, were provided weekly face-to-face sessions, primarily including therapist and self-guided exposure to situations involving uncertainty. Sessions were supplemented with an internet-delivered educational program for parents, designed to teach parents about worry, IU and helpful parental behaviors. The main outcome measure was the Penn-State Worry Questionnaire for Children (PSWQ-C). The treatment was well tolerated with no dropouts and families reporting being satisfied with the treatment. Participants were able to grasp the notion of IU and its relationship to worry and avoidance. Significant reductions were observed for self-reported worry, anxiety, depression, IU, and parent-reported worry, as were significant increases in global functioning. Based on a clinician rating, 58.3% were categorized as much or very much improved at posttreatment, rising to 66% at 3-month follow-up. Participants with generalized anxiety disorder (GAD) benefitted more from treatment than those with social anxiety disorder. The findings suggest that this IU-focused psychological intervention is acceptable and feasible to adolescents with excessive worry but may be most effective for those with GAD.     

Trait anxiety, trait depression, worry, and memory

A study is reported which investigated the proposal that high trait anxiety is associated with a memory bias for worry themes. Forty-five participants were categorised as being high or low trait anxious on the basis of scores on the (Spielberger et al., 1983) (Manual for the State-Trait Anxiety Inventory (Form Y) (1983)). The participants were requested to rate a number of worry and non-worry statements for how much they generally thought about the issues represented by them. Analysis of the ratings given by the participants showed that low trait anxiety individuals thought about the non-worry items significantly more than worry items. The high trait anxiety participants, however, showed little or no difference in the amount of time spent thinking about worry and non-worry themes. In a subsequent free recall task of the statements it was observed that the low trait anxiety group recalled significantly more non-worry than worry items, whereas there was no such difference for the high trait group. It was also found that the degree of memory bias was related to both positive affectivity and trait anxiety. The implications of such findings are discussed.     

The association of anxiety,depression, and worry symptoms on cognitive performance in older adults

Emerging research suggests that a relationship exists between the cognitive aspects of anxiety (e.g. worry) and cognitive decline in older adults. The current study examined the association between anxiety, depressive, and worry symptoms on cognitive performance. Participants were 156 older adults enrolled in the Nathan Kline Institute-Rockland Sample Study (NKI-RS). Hierarchical linear regression analysis was used to determine the unique associations of anxiety, depressive, and worry symptoms on cognitive performance as measured by the Penn Computerized Neurocognitive Battery (Penn CNB), the Delis-Kaplan Executive Function System (D-KEFS), and the Rey Auditory Verbal Learning Test (RAVLT). Worry symptoms were a significant predictor of Penn CNB social cognition, complex cognition, executive function, and episodic memory performance as well as RAVLT immediate and short-delay recall, but not of D-KEFS performance or RAVLT long-delay recall. In contrast, anxiety and depressive symptoms had few unique associations with cognitive performance. Given that worry symptoms have a negative impact on many aspects of neurocognitive performance, they may have utility in predicting and preventing cognitive decline in older adults.