Heterogeneity in Autonomic Arousal Level in Perseverative Worry: The Role of Cognitive Control and Verbal Thought

Abstract

One puzzle in high worry and generalized anxiety disorder (GAD) is the heterogeneity in the level of autonomic arousal symptoms seen among affected individuals. While current models agree that worry persists, in part, because it fosters avoidance of unpleasant internal experiences, they disagree as to whether worry does so by suppressing activation of autonomic arousal or by fostering persistent autonomic hyperarousal. Our Cognitive Control Model predicts that which pattern of autonomic arousal occurs depends on whether or not a worrier has sufficient cognitive control capacity to worry primarily in a verbal versus imagery-based manner. Because this model has been supported by only one study to date, the present study sought to replicate and extend that study’s findings. Results from an online survey in an unselected sample of over 900 college students provide further support for our model’s central tenet and initial support for its prediction that higher effortful control is associated with a higher percentage of verbal thought during worry. Finally, we report tentative evidence that autonomic arousal symptoms in worry and GAD vary as a function of individual differences in cognitive control capacity because higher capacity is linked to a greater predominance of verbal thought during worry.

Heart Rate Variability Moderates the Association Between Beliefs About Worry and Generalized Anxiety Disorder Symptoms

“…Furthermore, many individuals with GAD fail to respond to current treatments and those who do respond often fail to maintain improvement over several years (e.g., Cuijpers et al, 2014 ), suggesting there may be sources of heterogeneity that moderate treatment response. One candidate domain of heterogeneity is the capacity for top-down control over cognition ( Toh and Vasey, 2017 ; Vasey et al, 2017 ). Understandably, scholars have linked pathological worry to deficits in such cognitive control (e.g., Borkovec et al, 1983 ; Hirsch and Mathews, 2012 ).…”

Effortful control moderates relationships between worry and symptoms of depression and anxious arousal

“…The avoidance model of worry posits that individuals with GAD use the cognitive activity of worry in order to avoid more intense AA (e.g., Borkovec, Alcaine, & Behar, 2004). Worry is thought to somewhat lower, but not eliminate, AA due to its largely verbal‐linguistic content (e.g., Toh & Vasey, 2017). This idea is supported by experimental studies demonstrating that verbal processing leads to lower AA compared with imagery‐based processing (Holmes, Mathews, Mackintosh, & Dalgleish, 2008; Vrana, Cuthbert, & Lang, 1986).…”

“…Findings are inconsistent regarding whether high worriers experience higher AA than low worriers; these findings are inconsistent within all current forms of measuring AA, including 1) objective measures (i.e., heart rate, skin conductance, and salivary alpha amylase), 2) subjective measures, 3) measures at resting baseline, and 4) measures in response to emotion/threat induction (see Toh & Vasey, 2017 for review). Some studies find that individuals with GAD demonstrate higher baseline AA than healthy controls (e.g., Pruneti, Lento, Fante, Carrozzo, & Fontana, 2010; Thayer, Friedman, & Borkovec, 1996), while other studies find that these individuals demonstrate levels of baseline AA that do not significantly differ from healthy controls (e.g., Fisher, Granger, & Newman, 2010; Llera & Newman, 2014).…”

“…For individuals lower in EC, worry is thought to lead to more drastic increases in AA due to a lack of ability to use verbal‐linguistic worry to shift attention away from more intense emotion‐inducing images (Vasey et al, 2017). Two studies with samples of undergraduate students found support for the cognitive control model, demonstrating that in individuals with lower EC, the relationship between worry and AA was stronger (Toh & Vasey, 2017; Vasey et al, 2017). Importantly, Vasey et al (2017) noted that although both state and trait worry are associated with lower EC (e.g., Etkin, Prater, Schatzberg, Menon, & Greicius, 2009; Hayes, Hirsch, & Mathews, 2008), there is meaningful variability in levels of EC in high worriers and in individuals with GAD, which may explain the heterogeneity in outcomes for individuals with GAD (Aldao, Mennin, & McLaughlin, 2013; Armstrong, Zald, & Olatunji, 2011; Olatunji, Ciesielski, Armstrong, Zhao, & Zald, 2011; Rosellini & Brown, 2011).…”

“…In the current study, we aimed to investigate EC as a moderator of the relationship between worry and AA, as well as worry and depression, in a non‐college, non‐clinical sample of adults. Previous studies investigating EC’s role in the association between worry and symptoms have exclusively utilized undergraduate samples composed of largely young adults (Fergus et al, 2012; Toh & Vasey, 2017; Vasey et al, 2017). We posited that the current sample would demonstrate greater variability in EC, as higher EC is associated with older age in adults (e.g., Wong & Rowland, 2013).…”