Understanding the cognitive mechanisms of worry and interpretation training using behavioural and Event-Related Potentials (ERPs) markers

Student thesis: Doctoral ThesisDoctor of Philosophy

Abstract

Worry is a chain of negative thoughts about future events that everyone experiences from time to time. However, worry can be excessive and uncontrollable, thereby leading to emotional distress and impairments in daily life.This PhD thesis aimed to explore the cognitive processes associated with worry based on Hirsch and Mathews’ (2012) cognitive model of worry (introduced in Chapter 1) using both behavioural and neurophysiological measures across four empirical studies (Chapters 3 to 6). In order to have appropriate measures for assessing online interpretation bias, i.e., the immediate interpretation generated when encountering ambiguous situations, materials were developed systematically (see Chapter 2). Study 1 (Chapter 3; Feng et al., 2019) aimed to explore whether individuals with high or low levels of worry interpret ambiguity differently at different interpretative stages, i.e., from the moments when they first encounter information (online interpretation) to when they have time to reflect (offline interpretation). Both behavioural and event-related potentials (ERPs) indices supported the hypothesis that high worriers lack the benign interpretation bias evident in low worriers at all interpretive stages. Study 2 (Chapter 4; Feng et al., 2020) further examined whether high worriers generate more benign online (as well as replicating the finding of changes in offline interpretations) following a brief single-session interpretation training, and if so, whether this facilitation of a benign bias reduces worry. The findings indicate the causal role of interpretation bias in maintaining worry, and the utility of reducing worry via this computer-based interpretation training. A cross-sectional Study 3 (Chapter 5) used an integrated approach to explore how different cognitive processes work together in relation to worry. Cognitive processes assessed in this study included interpretation bias and for the first time in worry research examining the integration of the interpretation into the veridical memory of the original information (interpretation-memory bias). Study 3 also assessed individuals’ tendency to attend to negative or benign (positive or neutral) information (attention bias), and whether they have enough cognitive resources to ignore the irrelevant distractors (e.g., emotional information) while focusing on the current task (attention control). In addition to exploring the relationship between worry and individual cognitive processes, how cognitive processes work in combination was also investigated. For example, the tendency to attend to threatening information (i.e., negative attention bias) may be associated with worry severity, but only when individuals also have poor attention control (in keeping with established findings for anxiety). This study established that different cognitive processes combine and provide unique variance in explaining worry above the individual cognitive processes. A prospective study (Study 4; Chapter 6) investigated whether cognitive processes and their combinations predict future worry when individuals are under stress (i.e., examinations). The study used the cognitive processes assessed in Study 3 to predict worry and anxiety at follow-up during a stressful event (examinations). Findings showed that individuals with negative offline interpretation bias and poor attention control were more likely to have high levels of worry or anxiety during a stressful time. The results indicate that assessing key cognitive processes might help identify those at risk of developing severe worry and anxiety, thus opening up the possibility of selecting individuals who may benefit from preventive interventions to decrease the likelihood of escalating anxiety and worry. In summary (discussed in Chapter 7), this thesis extends the understanding of the cognitive mechanisms of worry and raises important implications for the development of future effective interventions and prevention programs, and means to identify individuals at risk of severe worry at times of high stress.
Date of Award1 Oct 2020
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorColette Hirsch (Supervisor), Yun Fai Lau (Supervisor) & Charlotte Krahé (Supervisor)

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