The role of systematic processing in worry

1. MARS Mood and Anxiety Research in Sussex Dr Suzanne Dash s.dash@sussex.ac.uk The role of systematic processing in worry

2. Outline • Worry • Heuristic Systematic Model • What is systematic processing? • When does it happen? • Why might worriers systematically process? • Clinical Implications • Conclusions

3. Worry • “ a chain of thoughts and images, negatively affect-laden and relatively uncontrollable” (Borkovec et al., 1983, p.10) • Catastrophising (Davey & Levy, 1998a) • Themes of personal inadequacy (Davey & Levy, 1998b)

4. Why worry about worry? • Generalized Anxiety Disorder (APA, DSM-IV-TR, 4thed, 2000) • Social anxiety (Purdon & Harrington, 2006) • Panic disorder (Purdon & Harrington, 2006) • Hypochondriasis(Purdon & Harrington, 2006) • OCD checking and doubting (Tallis & DeSilva, 1992) • Psychosis(Startup, Freeman & Garety, 2007)

5. Mechanisms of worry • Negative mood • Intolerance of uncertainty • Problem-solving confidence Q. How do these variables increase worry? A.(???) Alter the way we process information Increase worry perseveration

6. Dual process models of information processing 17 × 24

7. Dual process models of information processing 17 × 24

8. Why might worriers be using systematic processing (SP)? • SP: detailed, analytical processing Worry: persistent, detailed processing • Worry and SP arise through unconscious/non-deliberative means • SP deployed when confidence is unsatisfactory Worriers strive to feel prepared, consider all possible negative outcomes, feel confident that they can cope • Influenced by similar cognitive appraisals and cognitive states • Similar functional neuroanatomy

9. Heuristic Systematic Model • Systematic processing • “An analytic orientation in which perceivers access and scrutinize all informational input for its relevance and importance... and integrate all useful information in forming their judgements” (Chaiken et al., 1989, p. 212)

10. The sufficiency threshold Q. How much processing do I need to do to be confident in my judgement? Not much, I don’t need to be that confident Lots, I need to be very confident Systematic processing Heuristic processing

11. The sufficiency threshold Trivial task Heuristic processing Systematic processing Maheswaran & Chaiken (1991)

12. The sufficiency threshold Important task Heuristic processing Systematic processing Maheswaran & Chaiken (1991)

13. The sufficiency threshold Q. How much processing do I need to do to be confident in my judgement? Actual Desired

14. Raised sufficiency thresholds

15. Negative Mood • Worriers experience greater endemic negative affect (Davey, Hampton, Farrell, & Davidson, 1992; Meyer, Miller, Metzger, & Borkovec, 1990; Tallis, Eysenck, & Mathews, 1991; Metzger, Miller, Cohen, Sofka, & Borkovec, 1990; Wisocki, Handen & Morse, 1986)

16. Dash & Davey (2012) Sufficiency threshold Negative mood Worry (PSWQ) Unmediated: b = 8.21, p= .01 Mediated: b = 4.13, p= .12

17. High intolerance of uncertainty • Correlates with trait worry (Buhr & Dugas, 2006) • Causes worry (Meeten et al. 2012) • Drives ‘what if...?’ thinking • Seek more information before decision-making (Carleton et al., 2007) • Is associated with desire for control • OCD (Moulding & Kyrios, 2007) • Anorexia nervosa (Sternheim et al., 2011) Desired IU increases desired confidence

18. Low problem-solving confidence • Correlates with worry (Belzer et al., 2002; Davey, 1994; Davey & Levy, 1998a) • Causes worry (Davey, Jubb & Cameron, 1996) • Deplete confidence that goals are met for worry • Low PSC increases uncertainty (Tormala et al., 2008)  detailed processing (e.g. Weary & Jacobson, 1997) Actual Low PSC decreases actual confidence

19. Summary • Raised sufficiency thresholds • Experience negative mood • Intolerant of uncertainty • Discrepancy between desired confidence and actual confidence • Feel accountable and responsible • Desire control of, and have a high need for cognition about, worry-related cognitions

20. Clinical Implications • Socialisation to two processing modes allows dialogue of when it is useful to deploy effortful processing, and when it is unnecessary • Attention should be paid to appraisals that raise sufficiency thresholds • Responsibility, accountability, desire for control • Hirsch & Mathews – top-down and bottom-up processes – most effective treatments may tackle both. Combine with cognitive bias modification? • Treat comorbid low mood

21. Conclusions • Worry occurs across a range of psychopathologies, as well as in the general population • Key dispositional factors exhibited by worriers – low PSC, IU and negative mood – are all likely to widen the gap between actual and desired confidence – raising the sufficiency threshold • Worriers will deploy systematic processing in an attempt to meet their sufficiency threshold • Clinical implications include challenging appraisals that raise sufficiency thresholds in conjunction with targeting heuristic processes

22. Collaborators and funding Professor Graham Davey Graduate Teaching Assistantship Dr Frances Meeten

23. Thank you for listening • Any questions? • S.dash@sussex.ac.uk