In this section we have been able to give no more than a flavour of the large body of information-processing research in anxious individuals. We have illustrated that individuals with generalised anxiety problems show biases in favour of threat-related material on attention-type tasks such as the attentional deployment paradigm and the modified Stroop paradigm (other attention paradigms include: the dichotic listening task, e.g., Mathews & MacLeod, 1986; a two-string lexical decision task, e.g., MacLeod & Mathews, 1991; an attentional search task, e.g., Mathews, May, Mogg, & Eysenck, 1990; and numerous studies of self-focused attention, e.g., Wells, 2000). Similar threat-related biases have also been shown on interpretation paradigms such as the ambiguous sentences task (Eysenck et al., 1991) (other interpretation paradigms include the homophone task, e.g., Mathews, Richards, & Eysenck, 1989, and the anagram task, e.g., Dalgleish, 1994b) and judgement tasks (e.g., Butler & Mathews, 1983). Finally, we presented evidence that generally anxious individuals do not exhibit biases for threat-related material on tests of explicit memory such as recall and recognition, although there is some evidence of such a bias on an implicit memory task (Mathews et al., 1989).
So, what are we to make of this enormous body of research on information-processing biases in generally anxious participants? The findings of processing biases for personally relevant emotional (usually threat-related) material on attentional tasks, judgement tasks, and tasks that require the interpretation of ambiguous stimuli are in line with theoretical predictions from a range of models of anxiety (see Chapter 3) including our own SPAARS approach, and we have discussed these arguments in the section on panic above.
However, the surprising finding is that of an absence of explicit memory biases in generally anxious participants for threat-related material. This contrasts markedly with the state of affairs in depression (see Chapter 7) and in other anxiety disorders such as PTSD and panic states (see the relevant sections in this chapter). We propose that there are two reasons which may help to explain this profile of results in generally anxious participants. The first is methodological, in that many of the studies that have investigated memory for threat in generally anxious individuals have not chosen words that are specific to the person's exact domain of concern. In contrast, in such research with more circumscribed anxiety states such as panic the stimuli have meshed much more closely with the preoccupations of the participants. It is possible therefore that mnemonic biases are a function of generally anxious states but that they have yet to be properly tested for. However, it seems unlikely that such methodological inadequacies can account for the wealth of negative findings in this area, and for this reason we are sympathetic to Williams et al.'s (1997) suggestion that depression is characterised by biases at the elaborative stages in processes, whereas anxiety is characterised by biases at the preattentive stage (see Chapter 4). We would couch it somewhat differently in the SPAARS model and suggest that the configuration of the SPAARS system in the sadness module is such as to direct the system to reflect on lost goals and to assess resources in order to compensate for the lost goals. In contrast, the configuration of SPAARS in the fear module serves to focus resources on current and possible future threat.
Are there any clinical implications of this information-processing research? Perhaps the biggest potential for this area of research is that it can shed new light on issues of vulnerability. Several extant theories of emotional disorder (e.g., Beck et al., 1979; see Chapter 3) argue for cognitive differences between those individuals who are vulnerable to the disorder and those who are not. Self-report measures are limited in their detection of such differences and researchers have looked to cognitive paradigms to provide better answers. The preliminary evidence does not provide any clear indications as to the causal relationship between processing biases, anxious state, and anxiety disorder; for such answers large-scale prospective studies would be the optimal methodology. A compromise has been to use groups of recovered individuals, and the few studies that have done so have produced equivocal findings with the recovered participants performing in a manner intermediate to both clinical and control groups or showing no differences from the controls. As a result, the jury is still out on this issue with respect to anxiety; however, work on cognitive vulnerability in depression (e.g., Clark & Beck, 1999) indicates that the approach has considerable potential (see Armfield, 2006). There are several ways in which processing biases of the type discussed above could operate as diathesis factors. Individuals could be biased towards selective processing of threat-related information; this would increase the probability of an anxious appraisal of that information and the onset of an anxious state, which in turn could increase the extent of the bias towards threat-related information and so on. The vulnerable individual would thus be caught in a vicious circle similar to that proposed as a maintaining factor in depression (e.g., Teasdale, 1983). Alternatively, in terms of appraisal processes, vulnerable individuals could be conceptualised as those whose criteria for what is sufficiently threat-related to warrant an appraisal related to the onset of anxiety are very low, such that a whole range of stimuli that are ordinarily regarded as having little emotive value act as anxiety triggers.
So far there has been relatively little research on the use of cognitive paradigms in assessment and treatment evaluation. One interesting development is the work of MacLeod and Hagan (1992) described above, in which the masked emotional Stroop showed an ability to predict participants' reactions to a diagnosis of cancer better than a range of self-report measures. This has potential for use in screening individuals at risk for psychopathology either prior to a potentially traumatic event (e.g., colposcopy as in the study) or immediately following a traumatic event (such as a natural or man-made disaster). Perhaps the most interesting recent development is the work on the training of biases and anxiety by Andrew Mathews and colleagues (e.g., Mathews & Mackintosh, 2000; Mathews & MacLeod, 2002). This work has shown that induced interpretative and attentional biases can increase stress and anxiety, which has considerable potential for the reversal training of existing biases in individuals who are already highly anxious. This work also provides the strongest evidence that processing biases are actually causal of anxious states, as opposed to being simply epiphenomenal.
In summary, generalised anxiety has proved the focus of an enormous amount of attention from cognition and emotion researchers. This focus is not because it is inherently more enthralling than other so-called anxiety disorders, but because it involves such a clear cognitive component in the form of worry and overlaps extensively with the preoccupations of healthy individuals regarding the domains of concern involved. Such research interest has reaped dividends, principally in the greater understanding of the various information-processing biases involved in anxiety, and this research has been highly influential on progress in work with other anxiety disorders, not least PTSD, which we consider next.
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