Inhibitory control and symptom severity in late life generalized anxiety disorder

Department of Psychology, Rutgers, the State University of New Jersey, 152 Frelinghuysen Road, Piscataway, NJ 08854, USA.
Behaviour Research and Therapy (Impact Factor: 3.85). 12/2007; 45(11):2628-39. DOI: 10.1016/j.brat.2007.06.007
Source: PubMed


Contemporary models of generalized anxiety disorder (GAD) posit that worry functions as an avoidance strategy. During worry, individuals inhibit threat-related imagery in order to minimize autonomic reactivity to phobic topics. This conceptualization of worry suggests a role for the executive system in exerting top-down inhibitory control (IC) over threat processing. We tested the hypothesis that better performance on an IC task would be associated with greater severity of worry and concomitant anxious mood. Forty-three older adults (age 60-77) with GAD completed the Stroop color word task and a battery of self-report symptom measures. Fifteen of the GAD patients were paired with age- and sex-matched non-anxious controls. In the full GAD sample, age-normed t-scores of Stroop performance were positively correlated with measures of worry and trait anxiety, but not anxious arousal or depression. Positive relationships between IC and symptom severity were upheld in the smaller subsample of GAD patients, while in the matched control group, no relationships between Stroop scores and clinical measures were observed. Patients and controls did not differ in Stroop performance. In the context of a disorder-specific tendency to make maladaptive use of executive functions, better IC may be associated with more severe symptomatology.

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Available from: Rebecca Price, Aug 19, 2015
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    • "For example, Price and Mohlman (2007) found that inhibitory control was significantly positively associated with worry and trait anxiety, but not anxious arousal. These results were interpreted as suggesting that relatively higher inhibitory control may increase anxiety by facilitating worry and rumination as a strategy to inhibit, or avoid, the processing of threat information (Price and Mohlman, 2007). However, some have suggested that equivocal findings regarding relations between higher-order cognitive processes and anxiety may be due to a third variable confound, such as demographic differences in anxiety and cognitive abilities (e.g., Bardeen and Stevens, 2015). "
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    ABSTRACT: The purpose of the present study was to identify subgroups of participants who may be at particularly high risk for anxiety pathology based on specific combinations of demographic characteristics and higher-order cognitive abilities in a population at disproportionate risk for deficits in cognitive abilities (i.e., smokers within the criminal justice system). Participants (N=495) provided demographic information, were administered a semi-structured diagnostic interview, and completed a number of measures assessing cognitive abilities. A receiver-operating characteristic (ROC) model using signal detection theory indicated that the strongest predictor of anxiety disorder diagnosis was race, with White participants having a 30.6% likelihood of diagnosis and participants in the non-White category (97% of which identified as Black/African American) having a 18.9% likelihood of diagnosis. Interestingly, the individual risk profile associated with the highest probability of having a current anxiety disorder was characterized by White participants with impaired response inhibition (58.6%), and the lowest probability of having a current anxiety disorder was among non-White males (13.9%). The findings, which indicated that White individuals with impaired response inhibition are at a disproportionately high risk for anxiety disorders, suggest a potential target for prevention and intervention. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Psychiatry Research 05/2015; 229(1-2). DOI:10.1016/j.psychres.2015.05.020 · 2.47 Impact Factor
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    • "Although we are not aware of any study specifically testing this relationship, depressed individuals were slower on go trials and made less commission errors in a parametric go no-go paradigm, suggestive of heightened concern for errors (Langenecker et al., 2007). Similarly, in individuals with generalized anxiety disorder, better performance on a classic color-word Stroop has been linked to higher levels of worry and trait anxiety (Price and Mohlman, 2007). "
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    ABSTRACT: The influence of emotion on higher-order cognitive functions, such as attention allocation, planning, and decision-making, is a growing area of research with important clinical applications. In this review, we provide a computational framework to conceptualize emotional influences on inhibitory control, an important building block of executive functioning. We first summarize current neuro-cognitive models of inhibitory control and show how Bayesian ideal observer models can help reframe inhibitory control as a dynamic decision-making process. Finally, we propose a Bayesian framework to study emotional influences on inhibitory control, providing several hypotheses that may be useful to conceptualize inhibitory control biases in mental illness such as depression and anxiety. To do so, we consider the neurocognitive literature pertaining to how affective states can bias inhibitory control, with particular attention to how valence and arousal may independently impact inhibitory control by biasing probabilistic representations of information (i.e., beliefs) and valuation processes (e.g., speed-error tradeoffs).
    Frontiers in Human Neuroscience 09/2013; 7:508. DOI:10.3389/fnhum.2013.00508 · 3.63 Impact Factor
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    • "The poorer neuropsychological performance of our GAD young subjects supports the hypothesis that worry may interfere with the execution of some cognitive functions (Butters et al., 2011; Pietrzak et al., 2012). When a patient is worried, he or she devotes attentional resources to the ruminative linguistic processing of threatening stimuli (Price and Mohlman, 2007), the ability to shift resources between the cognitive tasks may be attenuated, thereby reducing task performance accuracy (Davis and Nolen-Hoeksema, 2000; Sumner et al., 2011). However, the direct comparison between the three groups (GAD, GAD-p and Controls) revealed that the decrease of performance accuracy is more evident in pharmacotherapy users (GAD-p group). "
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    ABSTRACT: The purpose of this study was to investigate the neuropsychological functioning and the effect of antidepressant drug intake on cognitive performance in a group of relatively young generalised anxiety disorder (GAD) patients. Forty patients with a DSM-IV diagnosis of GAD and 31 healthy subjects participated in the study (Control group, CON). None of the selected subjects had comorbid depression. GAD subjects were divided into two different subgroups: 18 were taking antidepressants, [GAD-pharmacotherapy (GAD-p group)] and 22 were treatment-naïve (GAD group). Each group was administered a comprehensive neuropsychological battery to assess attention, memory and executive functions. Performance on executive and non-verbal memory tasks of both GAD groups was largely worse than the CON group. However, these deficits seem to be more marked in patients taking antidepressants, especially in the domains of attention, non-verbal memory and executive functions. The present study indicates that GAD is associated with cognitive impairments among young adults. However, the observed association of neuropsychological deficits and the use of pharmacotherapy suggest a possible effect of antidepressant treatment on attention, executive functioning and non-verbal memory.
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