Marianna Szabó

The cognitive content of naturally occurring worry episodes

Fifty-seven participants were selected to represent a wide range on the dimension of worry proneness. They monitored and listed their worrisome thoughts in a diary for 7 days, and rated the uncontrollability of each recorded worry episode. Content analysis revealed that 48% of worrisome thoughts could be categorized as reflecting a problem-solving process, 17% as anticipation of future negative outcomes, 11% as “rumination,” and 5% as reflecting “palliative” thoughts and “self blame.” The extent of negative outcome anticipation or problem solving did not covary with worry severity. Higher trait worry proneness and more frequent and uncontrollable worrying during the monitoring period were associated with more rumination and fewer reports of successful solutions to problems. The results suggest that worry consists largely of attempted problem solving, and that one possible mechanism in the emergence of pathological worry may be a failure to bring problem solving to a satisfactory conclusion.

Probability and cost estimates for social and physical outcomes in social phobia and panic disorder.

Individuals with Social Phobia (SP) (n = 23) and Panic Disorder (n = 22), and a non-anxious comparison (NAC) group (n = 62) rated the probability and cost of negative outcomes in the physical and the social domains. Overall, participants rated physical events as less probable but more costly than social events. Compared to the non-anxious group, participants with Social Phobia made significantly higher probability and cost estimates for social events, but not for physical events. Multiple regression analyses demonstrated that perceived cost of negative social events was the strongest unique predictor of scores on the Fear of Negative Evaluation Scale (FNE). Participants with Panic Disorder made significantly higher probability and cost estimates for both physical and social outcomes, compared to non-anxious participants. Both physical probability and social cost estimates predicted scores on the Body Sensations Questionnaire (BSQ). Findings support the disorder-specificity of cognitive biases in Social Phobia, but suggest that individuals with Panic Disorder have a wider range of judgment biases than previously thought.

The Cognitive Content of Thought-Listed Worry Episodes in Clinic-Referred Anxious and Nonreferred Children

We investigated the cognitive content of worry in 8- to 13-year-old clinic-referred anxious (n = 38) and nonreferred (n = 51) children. The children were interviewed individually. They thought-listed their latest worry episodes, rated the uncontrollability of the episodes, and reported on the strategies they used to terminate worry. Content analyses showed that childrens worry episodes contained predominantly thoughts reflecting negative outcome anticipation, but other types of thought content also were present. These included problem-solving, ruminating, and self-blaming thoughts. Compared to clinic-referred children, nonreferred children reported more problem solving and less ruminating. In the nonreferred group, increasing age was associated with more problem solving and less ruminating. No such age-related associations were found in the clinic-referred group. The 2 groups did not differ in the types of worry-termination strategies they reported, but clinic-referred children were more likely to keep worrying until the perceived threat was removed. The results suggest that the problem-solving function of worry is still emerging during late childhood and that developmental delays in problem solving may be associated with excessive and uncontrollable worrying.

The emotional experience associated with worrying: anxiety, depression, or stress?

Abstract Avoidance theories propose that worrying results in a reduction of the physiological arousal symptoms of anxiety. However, relatively little is known about the emotional symptoms that remain associated with worrying. This study explored whether the emotional states of anxiety, depression, or stress are specifically associated with excessive and uncontrollable worry. A group of 126 university students were selected to represent a wide range on the dimension of worry proneness. They completed a worry questionaire, monitored the frequency and uncontrollability of their worry episodes for 1 week, and completed the Depression Anxiety Stress Scales (DASS) to indicate their level of negative affect during the monitoring period. Hierarchical regression analyses showed that all measures of worrying had a unique positive association with stress, over and above their associations with anxiety and depression. Item-level analyses showed that stress symptoms were uniformly strongly associated with worrying, while anxiety symptoms had the weakest associations. These results increase our knowledge regarding the phenomenology of worrying and underline the potential theoretical significance of the emotional state assessed by the DASS Stress scale. This scale fills the current need for a psychometrically sound instrument to assess the emotional experience associated with worrying.

The Bifactor Model of the Maslach Burnout Inventory–Human Services Survey (MBI‐HSS)—An Alternative Measurement Model of Burnout

The purpose of the present study was to examine the construct validity of the Hungarian language version of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). A sample of 653 healthcare professionals (420 physicians and 233 nurses and nursing assistants) completed the MBI-HSS. A series of confirmatory factor analyses showed that a hierarchical bifactor model including a global burnout factor and three specific factors of emotional exhaustion, depersonalization and reduced personal accomplishment had the closest fit to the data, compared with an alternative second-order three-factor hierarchical model as well as to non-hierarchical one-factor, two-factor, three-factor, four-factor and five-factor models. However, only the global burnout factor and the specific personal accomplishment factor explained a considerable unique proportion of variance in observed scores. Our study confirms the validity of the MBI-HSS and suggests an alternative structural model, which may contribute to further understanding of the burnout construct.

Worry episodes and perceived problem solving: A diary-based approach

Abstract Thirty-nine university students monitored their naturally occurring worry episodes for 7 days. They rated each episode in terms of six cognitive content categories, labeled Negative Outcome Anticipation, Problem-Solving Process, Solution Selection, Self-Blame, Rumination, and Palliative Thoughts. The results reinforced previous findings that a large proportion of the self-reported cognitive content of worry reflects problem-solving attempts, and that these attempts can sometimes lead to a selection of subjectively satisfying solutions. Solution Selection was also reported as a frequently used worry termination strategy. Individuals who rated their worry episodes as more uncontrollable reported fewer instances of solution selection and engaged in more negative solution evaluation while worrying. They were also more likely to keep worrying until they became distracted by an external event. Collectively, the data support the notion that normal worry involves problem-solving attempts and suggest that difficulties at the solution evaluation and solution selection stages may be important mechanisms underlying excessive worry.

Worry in Children Changing Associations With Fear, Thinking, and Problem-Solving

Worry in adults has been conceptualized as a thinking process involving problem-solving attempts about anticipated negative outcomes. This process is related to, though distinct from, fear. Previous research suggested that compared to adults, children’s experience of worry is less strongly associated with thinking and more closely related to fear. The present study further explored children’s worrying. Ninety-three 7- to 12-year-olds rated how much they worry, fear and think about the same list of negative outcomes, and reported on their positive beliefs about worrying. Children associated worrying more strongly with fear than with thinking. However, this relationship was moderated by age. Older children reported that worry was more closely related to thinking and less closely related to fear. Furthermore, children who reported more thinking, rather than fear, about negative outcomes were also more likely to report that worrying had beneficial effects. Results suggest important changes in the nature of worrying during late childhood.

Cognitive emotion regulation and stress: a multiple mediation approach

Background and purposeChronic stress leads to deficits in executive functions; its effect on cognitive emotion regulation has yet to be investigated. The present study explores the possible role of cognitive emotion regulation strategies in mediating the well-established association between perceived stress and anxiety. We assumed it should be that, via impaired prefrontal activity and executive functions, stress leads to the reduced use of executive strategies and the increased use of non-executive strategies, resulting in higher levels of anxiety.MethodsA cross-sectional sample of 162 university students completed the Perceived Stress Scale, the Spielberger Trait Anxiety Inventory, and the Cognitive Emotion Regulation Questionnaire.ResultsMultiple mediation analysis resulted in a significant model, in which cognitive emotion regulation strategies mediated the effect of perceived stress on anxiety (Adjusted R2 = 0.68, F12,149 = 29.30, p < 0.001, effect ratio = 0.22). Specifically, greater stress was found to be uniquely related to increased use of non-executive strategies (self-blame, rumination, and catastrophizing) and decreased use of cognitive strategies involving executive functions (positive reappraisal and putting into perspective). Greater use of non-executive strategies and reduced use of executive strategies (except for putting into perspective) was in turn found to be associated with higher levels of anxiety.ConclusionsThese results seem to suggest that under stressful conditions — precisely when control is most needed — cognitive regulation may be ineffective in controlling emotional responses. Implications for preventing the negative effects of stress are highlighted.

Adult Attention Deficit Hyperactivity Disorder Symptoms, Perceived Stress, and Well-Being: The Role of Early Maladaptive Schemata.

Abstract Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent chronic neuropsychiatric disorders, severely affecting the emotional well-being of children as well as of adults. It has been suggested that individuals who experience symptoms of ADHD develop maladaptive schemata of failure, impaired self-discipline, social isolation, and shame. These schemata may then contribute to impaired emotional well-being by increasing unhelpful responses to stressful life events. However, to date, no empirical research has tested this theoretical proposition. In a sample of 204 nonclinical adults, we conducted a serial multiple mediator analysis, which supported the proposed model. More severe ADHD symptoms were associated with higher levels of perceived stress both directly and indirectly through stronger maladaptive schemata, which, in turn, were related to lower levels of emotional well-being. Results suggest that identifying and modifying maladaptive schemata may be an important addition to psychotherapy for adult ADHD patients.