Making something out of nothing: neutral content modulates attention in generalized anxiety disorder

Abstract

Although an attentional bias for threat has been implicated in generalized anxiety disorder (GAD), evidence supporting such a bias has been inconsistent. The current study examines whether exposure to different emotional content modulates attention disengagement and impairs the perception of subsequently presented nonemotional targets in GAD. Patients with GAD (n = 30) and controls (n = 30) searched for a target embedded within a series of rapidly presented images. Critically, an erotic, fear, disgust, or neutral distracter image appeared 200 ms or 800 ms before the target. Impaired target detection was observed among GAD patients relative to controls following only fear and neutral distractors. However, this effect did not significantly vary as a function of distractor stimulus duration before the target. Furthermore, group differences in target detection after fear distractors were no longer significant when controlling for target detection after neutral distractors. Subsequent analysis also revealed that the impaired target detection among those with GAD relative to controls following neutral (but not fear) distractors was mediated by deficits in attentional control. The implications of these findings for further delineating the function of attentional biases in GAD are discussed.

Shared and Distinct Cognitive/Affective Mechanisms in Intrusive Cognition: An Examination of Worry and Obsessions

“…The observed AC/NU interaction suggests that motivational processes theorized to be relevant to worry (i.e., emotional avoidance; Borkovec et al, 2004) may only be associated with symptom severity when ‘cold’ cognitive control processes are intact, which is consistent with data demonstrating that behaviorally-indexed AC impairments in GAD patients were primarily observed with neutral stimuli (Olatunji et al, 2011). The relatively greater association between self-reported AC and worry compared to repugnant obsessions is also consistent with some neural data demonstrating that, across multiple groups characterized by varying amounts of OCD and worry symptoms, only worry symptoms predicted enhanced error-related negativity (ERN) amplitude during an AC task (Zambrano-Vazquez & Allen, 2014).…”

“…Poorer self-reported AC was also associated with greater worry symptoms in a clinical GAD sample (Armstrong et al, 2011) and distinguished GAD patients who sought treatment from those in the community (Hirsch, Mathews, Lequertier, & Perman, 2013); this suggests perceived AC may vary with GAD severity. Additionally, poor self-reported AC was found to mediate the relationship between GAD diagnosis and impaired target detection following distractors, with the effect driven by neutral, not affective, distractors (Olatunji, Ciesielski, Armstrong, Zhao, & Zald, 2011). This suggests that perceived AC may be related to worry via a domain-general attentional deficit, a possibility supported by neural evidence demonstrating an association between trait anxiety, which mediated the relationship between self-reported AC and worry in GAD patients (Armstrong et al, 2011), and altered recruitment of prefrontal cortex regions regardless of stimulus valence (Bishop, 2008; Telzer et al, 2008).…”

“…Thus, the equivocal role of self-reported AC in obsessions may be resolved through examination of symptom subtypes. Further, given data suggesting that affective context may be relevant for behaviorally-indexed AC deficits in OCD (Najmi et al, 2010) but not GAD (Olatunji et al, 2011), it is important to consider self-reported AC in conjunction with constructs that reflect the motivational aspects of worry and obsessional phenomena to understand the interactions of potential diatheses for obsessions/worry, especially in light of recent research suggesting that interactions between cognitive control and emotional processing may be the most important contributors to intrusive cognition (Genet, Malooly, & Siemer, 2013; Quinn & Joormann, in press; Stout, Shackman, Johnson, & Larson, 2015). …”

“…Second, there are no studies to our knowledge that have examined the interaction between self-reported AC and NU in the prediction of worry or obsessions. Given the dense interconnectivity between neural regions associated with AC and NU (Banks et al, 2007) as well as data suggesting that affective context may be relevant for behaviorally-indexed AC deficits in OCD (Najmi et al, 2010), particularly for those with repugnant obsessions (Morein-Zamir et al, 2010), but not GAD (Olatunji et al, 2011), it is possible that motivational variables (i.e, NU) are more important to obsessions and cognitive variables (i.e., AC) are more important to worry. Third, few studies have controlled for negative emotionality when examining relationships among these constructs, an important covariate to include given evidence that negative emotionality is positively related to intrusive thoughts (Horowitz, 1975), the propensity for negative mood-based rash action (Cooper, Agocha, & Sheldon, 2000; Settles et al, 2012), and impaired AC (Meesters, Muris, & van Rooijen, 2007).…”

“…Based on prior studies demonstrating symptom level associations between obsessions and NU (Cougle et al, 2012), but not AC (Armstrong et al, 2011), and data suggesting the importance of affective context to response suppression in OCD, especially for repugnant obsessions (Najmi et al, 2010; Morein-Zamir et al, 2010), we hypothesized an interaction between AC and NU such that perceived AC would only be related to repugnant obsessions for individuals with low NU, controlling for negative affect. Conversely, given self-report data revealing associations between AC and worry/GAD severity (Armstrong et al, 2011; Hirsch et al, 2013) and neural/behavioral data suggesting that AC deficits in GAD are not dependent on affective context (Bishop, 2008; Olatunji et al, 2011), we hypothesized that NU would only be associated with worry in individuals with good self-reported AC.…”