Difficulty concentrating is one of the most common diagnostic criteria across DSM-5 categories, especially within the emotional (mood- and anxiety-related) disorders. A substantial literature has characterized cognitive functioning in emotional disorders using objective (behavioral) computerized cognitive tasks. However, diagnoses are typically formed on the basis of subjective (self-reported; clinician-rated) assessments of symptoms, and little is known about difficulty concentrating as a symptom. These questions are particularly important for generalized anxiety disorder (GAD), which has long been the subject of nosological debates, and for which several theoretical models that suggest a central role for cognitive impairments (including difficulty concentrating) in the maintenance of psychopathology have been proposed. The present study evaluated the incremental utility of difficulty concentrating and its relationship to worry and other symptoms in 175 GAD-diagnosed adults. Clinician-assessed difficulty concentrating incrementally predicted clinician-rated GAD, anxiety, and depression severity even after other GAD symptoms were controlled. Consistent with theoretical models of GAD that propose a direct relationship between worry and cognitive impairment, difficulty concentrating mediated the relationship between trait worry and clinical severity. These findings suggest that difficulty concentrating has value as a diagnostic criterion and is a potential mechanism by which worry increases distress and impairment.
Worry has been experimentally linked to a range of cognitive consequences, including impairments in working memory, inhibition, and cognitive control. However, findings are mixed, and the effects of worry on other phenomenologically-relevant constructs, such as sustained attention, have received less attention. Potential confounds such as speed-accuracy tradeoffs have also received little attention, as have psychometric and related design considerations, and potential moderators beyond trait worry. The present study investigated the effects of experimentally-induced worry versus a neutral control condition on speed-accuracy tradeoffcorrected performance on a validated measure of sustained attention (88 participants; withinsubjects). Moderation by trait worry and trait mindfulness was probed in confirmatory and exploratory analyses, respectively. Worry led to faster and less accurate responding relative to the neutral comparison condition. There was no main effect of condition or trait worry on sustained attention after accounting for speed-accuracy tradeoffs. In exploratory analyses, higher trait mindfulness was robustly related to better post-worry performance, including after controlling for trait worry, general distress, and post-neutral performance, and correction for multiple comparisons. Follow-up analyses exploring dissociable mindfulness facets found a robust relationship between present-moment attention and post-worry performance. Future research should experimentally manipulate mindfulness facets to probe causality and inform treatment development.
Background: Like diagnostic status, clinically-relevant thought remains overwhelmingly conceptualized in terms of discrete categories (e.g., worry; rumination; obsessions). However, definitions can vary widely. The area of perseverative thought (or clinically-relevant thought more broadly) would benefit substantially from a consensus-based, empirically-grounded taxonomy similar to the Hierarchical Taxonomy of Psychopathology (HiTOP; Kotov et al., 2017) or the “Big Five” for personality. This paper addresses three major barriers to establishing such a taxonomy: 1) a lack of research explicitly comparing categorical (subtype) versus dimensional models; 2) primary reliance on trait (between-person) measures rather than multilevel models in the extant literature; 3) insufficient emphasis on replication and refinement.Methods: Participants included an unselected crowdsourced sample (691 observations from 248 participants) and an independent anxious-depressed replication sample (757 observations from 260 participants). Participants made dimensional ratings for three idiographic clinically-relevant thoughts on a range of features. Multilevel latent class analysis and multilevel exploratory factor analysis were applied to identify and extract natural patterns of covariation among features at the level of the thought, controlling for person-level tendencies. Support vector regression machine learning probed the validity of features and dimension for predicting established trait measures.Results: A consistent five-dimension solution emerged across both samples and reliably outperformed the best-fitting categorical solution in terms of fit, replicability, and explanatory power. Identified dimensions were dyscontrol, self-focus, valence, interpersonal content, and uncertainty.Conclusions: Findings support a five-factor latent structure of PT. Theoretical, empirical, and clinical implications and future directions are discussed.
Background: Like diagnostic status, clinically-relevant thought remains overwhelmingly conceptualized in terms of discrete categories (e.g., worry; rumination; obsessions). However, definitions can vary widely. The area of perseverative thought (or clinically-relevant thought more broadly) would benefit substantially from a consensus-based, empirically-grounded taxonomy similar to the Hierarchical Taxonomy of Psychopathology (HiTOP;Kotov et al., 2017) or the "Big Five" for personality. This paper addresses three major barriers to establishing such a taxonomy: 1) a lack of research explicitly comparing categorical (subtype) versus dimensional models; 2) primary reliance on between-person measures rather than modeling at the level of the thought (within-person); 3) insufficient emphasis on replication and refinement.Methods: Participants included an unselected crowdsourced sample (790 observations from 286 participants) and an independent anxious-depressed replication sample (808 observations from 277 participants). Participants made dimensional ratings for three idiographic clinically-relevant thoughts on a range of features. Multilevel latent class analysis and multilevel exploratory factor analysis were applied to identify and extract natural patterns of covariation among features at the level of the thought, controlling for person-level tendencies.Results: A consistent five-dimension solution emerged across both samples and reliably outperformed the best-fitting categorical solution in terms of fit, replicability, and explanatory power. Identified dimensions were dyscontrol, self-focus, valence, interpersonal, and uncertainty.Conclusions: Findings support a five-factor latent structure of PT. Theoretical, empirical, and clinical implications and future directions are discussed.
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