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.     

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.     

Emotion regulation and biological stress responding: associations with worry,rumination, and reappraisal

ABSTRACT

Individual differences in the habitual use of emotion regulation strategies may play a critical role in understanding psychological and biological stress reactivity and recovery in depression and anxiety. This study investigated the relation between the habitual use of different emotion regulation strategies and cortisol reactivity and recovery in healthy control individuals (CTL; n?=?33) and in individuals diagnosed with social anxiety disorder (SAD; n?=?41). The tendency to worry was associated with increased cortisol reactivity to a stressor across the full sample. Rumination was not associated with cortisol reactivity, despite its oft-reported similarities to worry. Worry and rumination, however, were associated with increased cortisol during recovery from the stressor. The only difference between CTL and SAD participants was observed for reappraisal. In the CTL but not in the SAD group, reappraisal predicted recovery, such that an increased tendency to reappraise was associated with greater cortisol recovery. These results suggest an important role of the habitual use of emotion regulation strategies in understanding biological stress reactivity and recovery.     

Trait anxiety, defensiveness, and the structure of worry

A principal components analysis of the ten scales of the Worry Questionnaire revealed the existence of major worry factors or domains of social evaluation and physical threat, and these factors were confirmed in a subsequent item analysis. Those high in trait anxiety had much higher scores on the Worry Questionnaire than those low in trait anxiety, especially on those scales relating to social evaluation. Scores on the Marlowe-Crowne Social Desirability Scale were negatively related to worry frequency. However, groups of low-anxious and repressed individuals formed on the basis of their trait anxiety and social desirability scores did not differ in worry. It was concluded that worry, especially in the social evaluation domain, is of fundamental importance to trait anxiety.     

Why worry? Worry, risk perceptions, and willingness to act to reduce medical errors.

Through the domain of medical errors, the role of worry and perceived risk in precautionary behaviors was examined in a convenience sample (N = 195, mean age = 42 years, 71% female). Worry was linked to fatality estimates. A model of the antecedents and consequences of worry also was tested. Risk characteristics such as dread and preventability, negative reactivity, and vulnerability to medical errors appeared to motivate worry about medical errors. Worry about medical errors was a better predictor of intentions to take precautionary actions than were risk perceptions. An understanding of how worry influences preventive efforts will help in building communication strategies to the public and in effectively engaging patients in the role of vigilant partner in care.     

Pain catastrophizing mediates the relationship between worry and pain suffering in patients with irritable bowel syndrome

Although separate lines of behaviorally oriented pain research have drawn attention to the importance of pain catastrophizing and trait worry, little is known about how they work together to influence aspects of chronic pain. Integrating pain research with the broader anxiety, cognitive science, and learning literature, we hypothesized that the process (vs. content) of worry influences pain through catastrophizing. One hundred and eighty-six consecutive patients diagnosed (Rome II) with irritable bowel syndrome completed measures of three dimensions of pain (sensory pain, affective pain, long-term suffering), pain intensity, trait anxiety, worry, catastrophizing, and somatization during baseline assessment of an NIH-funded clinical trial of two psychological treatments. Worry was most strongly associated with the emotionally unpleasant aspects of pain, particularly suffering. Multivariate mediational analyses showed that catastrophizing mediated the link between worry and suffering. Worry, catastrophizing and control variables accounted for 46% of the variance in suffering. Chronic pain patients who worry excessively engage in more catastrophic thinking and through this cognitive process experience more intensely the suffering component of pain. Data are consistent with the notion that worry functions as an "experiential avoidance" strategy for aversive features of pain. Findings are discussed with respect to their relevance to behavioral models for understanding and treating anxiety-related chronic pain disorders.     

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.     

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.     

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.     

Worry and sleep length revisited: worry,sleep length,and sleep disturbance ascribed to worry

The author administered university students (N = 222; 152 women, 70 men) the Worry Domains Questionnaire (F. Tallis, G. C. L. Davey, & A. Bond, 1994) and a newly constructed scale (the Sleep Disturbance Ascribed to Worry Scale) to measure sleep disturbance attributed to worry. To revisit previous studies (i.e., E. Hartmann, F. Baekeland, & G. R. Zwilling, 1972; S. J. H. McCann & L. L. Stewin, 1988) that suggested that sleep length was positively related to worry, the author also asked the students a question about habitual sleep length. The results indicated that worry and sleep disturbance attributed to worry were negatively related to sleep length. A regression analysis revealed that worry was significantly negatively related to habitual sleep length irrespective of sleep disturbance ascribed to worry.     

Worry and Sleep Length Revisited: Worry,Sleep Length,and Sleep Disturbance Ascribed to Worry

The author administered university students (N = 222; 152 women, 70 men) the Worry Domains Questionnaire (F. Tallis, G. C. L. Davey, & A. Bond, 1994) and a newly constructed scale (the Sleep Disturbance Ascribed to Worry Scale) to measure sleep disturbance attributed to worry. To revisit previous studies (i.e., E. Hartmann, F. Baekeland, & G. R. Zwilling, 1972; S. J. H. McCann & L. L. Stewin, 1988) that suggested that sleep length was positively related to worry, the author also asked the students a question about habitual sleep length. The results indicated that worry and sleep disturbance attributed to worry were negatively related to sleep length. A regression analysis revealed that worry was significantly negatively related to habitual sleep length irrespective of sleep disturbance ascribed to worry.     

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.     

Anxiety,Depression, and Procrastination Among Students: Rumination Plays a Larger Mediating Role than Worry

Procrastination is prevalent among students and is associated with negative outcomes, including poor academic performance and psychological distress. Research also suggests that anxiety and depression can exacerbate procrastination; however, the mechanisms associated with the development of procrastination are less understood. The current study aimed to clarify the role of negative repetitive thought (i.e., rumination and worry) in the links between anxiety and procrastination, and depression and procrastination. Ninety-one undergraduate students completed self-report measures of anxiety, depression, worry, brooding rumination, and procrastination, and two multiple mediator models were tested. Procrastination was positively correlated with the study variables, including medium effects for anxiety and depression, a large effect for rumination, and a small effect for worry. Rumination independently mediated the relationships between anxiety and procrastination, and depression and procrastination. Worry did not independently mediate these relationships. The current findings suggest rumination plays a larger role in the links between anxiety, depression, and procrastination than worry. Thus, students with higher levels of anxiety and depression engage in more negative repetitive thought, which may contribute to procrastinatory behavior as a result of a preoccupation with depressing or painful thoughts about the past.     

The surprising upsides of worry

Worry is an aversive emotional experience that arises alongside repetitive unpleasant thoughts about the future. In this paper, we argue that although extreme levels of worry are associated with depressed mood, poor physical health, and even mental illness, worry has an upside. We focus on two empirically supported benefits of worry: its motivational benefits and its benefit as an emotional buffer. Regarding motivation, worry illuminates the importance of taking action to prevent an undesirable outcome and keeps the situation at the front of one's mind to ensure that appropriate action is taken. It also triggers efforts to mitigate the consequences of bad news, motivates productive behavior that in turn reduces worry, and enhances the effectiveness of goal‐directed action by prompting people to focus on obstacles that might derail best‐laid plans. Worry can also serve as an emotional buffer by providing a desirable contrast to subsequent affective reactions, particularly for people who are prone to high levels of worry.     

The relation between worrying and concerns: the importance of perceived probability and cost

The relation between worrying and individuals' concerns was examined in a sample of 197 college students. Participants described the five undesirable outcomes that they thought about most often, indicated how likely they thought the outcomes were, and how upset they would be by them. Worry severity was measured using the Penn State Worry Questionnaire. The relation between worry severity and the life domains about which individuals were concerned was quite weak. In contrast, as predicted, greater worry was associated with higher probability and cost estimates. In addition, cost estimates moderated the relation between worry severity and probability estimates. The potential importance of perceived threat for understanding worrying is discussed.     

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.     

Genetic Risk,Perceived Risk,and Cancer Worry in Daughters of Breast Cancer Patients

This study explored relationships between worry, perceived risk for breast cancer, consulting a genetic counselor, having genetic testing, and genetic risk for women whose mothers had breast cancer. Analyses involved data from a community-based phone survey of women whose mothers had breast cancer. Participants were categorized as having low, intermediate, or high genetic risk based on their reported family history, in accordance with an accepted classification scheme. The Lerman Breast Cancer Worry Scale measured worry, and participants reported their perceived lifetime likelihood of breast cancer, risk compared to others, and chance from 1 to 100. ANOVA, chi-square, and multiple regression analyses were conducted as appropriate. One hundred-fifty women participated. Mean age was 38 years, and 81% were Caucasian. Fifty-two women had low, 74 had intermediate, and 24 had high genetic risk for breast cancer. There were no significant differences in worry or perceived risk by hereditary risk category. Most high-risk women (91%) had not spoken with a genetic counselor, and no one had previous genetic testing. These findings suggest perceived risk, worry about breast cancer, and use of expert consultation do not match the genetic contribution to risk. There is a need for effectively stratifying and communicating risk in the community and providing tailored reassurance or referral for high-risk assessment.     

Effects of worry and somatic anxiety induction on thoughts, emotion and physiological activity

Thirty-six Ss received Velten (1968) emotion inductions designed to produce either worrisome, somatically anxious, or neutral states. A breathing-focus task assessed the frequency of negative thought intrusions before and after the emotion induction. Worry induction produced the greatest increase in negative intrusions, significantly greater than the neutral condition. Somatic anxiety induction produced some increase in intrusions, nonsignificantly between worry and neutral inductions. Both worry and somatic anxiety inductions generated significant increases in cardiovascular activity relative to the neutral condition, while no effect was observed on gastric myoelectric activity. Worry was characterized by emotions on the Multiple Affect Adjective Checklist that overlap with those of depression and somatic anxiety.     

Worry and rumination: differential associations with anxious and depressive symptoms and coping behavior

Worry and rumination are closely allied cognitive processes that impact on the experience of anxious and depressive symptoms. Using a prospective design, this study examined overlapping and distinct features of worry and rumination in relation to symptoms and coping behavior in a nonclinical sample of Singaporean college students. Worry and rumination were highly correlated, but they retained distinct components that predicted anxious and depressive symptoms differentially within and across time. Specifically, worry was uniquely associated with anxious and depressive symptoms whereas rumination was uniquely related to depression. In comparison to rumination, worry emerged as the dominant cognitive vulnerability factor that predicted increments in symptoms over time. With regards to coping behavior, low perceived coping effectiveness partially mediated the relation between worry and increases in anxiety and depression. Conversely, rumination uniquely predicted higher disengagement from problems, which resulted in further exacerbation of depressive mood. These results demonstrated not only the distinct features of worry and rumination on coping behavior, but also the different coping pathways by which they differentially impact on subsequent symptoms.     

The Metacognitive Model of Generalized Anxiety Disorder in Children and Adolescents

Worry is a common phenomenon in children and adolescents, with some experiencing excessive worries that cause significant distress and interference. The metacognitive model of generalized anxiety disorder (Wells 1995, 2009) was developed to explain cognitive processes associated with pathological worry in adults, particularly the role of positive and negative beliefs about worry. This review evaluates the application of the model in understanding child and adolescent worry. Other key issues reviewed include the link between cognitive and metacognitive development and worry, and the measurement of worry and metacognitive worry in young people. Implications of these findings and directions for future research are discussed.