The relationship of child worry to cognitive biases: Threat interpretation and likelihood of event occurrence

doi:10.1016/S0005-7894(01)80029-0

Behavior Therapy

Volume 32, Issue 3, Summer 2001, Pages 425-442

https://doi.org/10.1016/S0005-7894(01)80029-0 Get rights and content

Worry, the cognitive component of anxiety, has been related to cognitive processing biases in adults. However, the relationship of child worry to cognitive biases has been largely unexplored. The present study examined this relationship. Worry in a community sample of 277 5th- and 6th-grade children was assessed with the Penn-State Worry Questionnaire for Children (Chorpita, Tracey, Brown, Collica, & Barlow, 1997). The Children's Opinions of Everyday Life Events (COELE) was designed to measure children's threat interpretation biases. Children's responses to worry-relevant vignettes were used to assess interpretation of ambiguous and threatening situations, degree of perceived threat, degree of situation-specific worry, and perceived likelihood of future occurrence. Results suggested strong relationships between child worry and threat interpretation biases. Compared to nonworriers, worriers interpreted both ambiguous and threatening situations as more threatening, expressed more worry in response to the events, and judged the events to have a higher probability of happening to them in the future. Temporal stability was only moderate, perhaps reflecting worry and cognitive biases as more variable phenomena in a community sample. Theoretical, clinical, and research implications of the findings are discussed.

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Interpretations can be generated at different stages of information processing: “online”, when individuals make immediate interpretations, to “offline”, when individuals generate them on reflection, thus requiring time to disambiguate the information (Hirsch, Meeten, Krahé, & Reeder, 2016). Initial studies (Krahé, Whyte, Bridge, Loizou, & Hirsch, 2019; Suarez & Bell-Dolan, 2001) show that negative offline interpretations are associated with greater trait worry. Feng et al. (2019) established that low worriers tend to interpret ambiguity in a benign manner (i.e., benign interpretation bias, including both positive and neutral interpretations) across both offline and online stages of processing when state worry was activated.
Worry, a stream of negative thoughts about the future, is maintained by poor attentional control, and the tendency to attend to negative information (attention bias) and interpret ambiguity negatively (interpretation bias). Memories that integrate negative interpretations (interpretation-memory) may also contribute to worry, but this remains unexplored. We aimed to investigate how these cognitive processes are associated with worry and anxiety cross-sectionally (Phase 1), and then explore which cognitive processes from Phase 1 would predict worry and anxiety during times of high stress, namely prior to examinations (Phase 2), and after the initial onset of the COVID-19 pandemic (Phase 3). Worry, anxiety, and cognitive processes were assessed in an undergraduate sample (N = 64). We found that whilst greater benign interpretation bias and benign interpretation-memory bias were associated with lower levels of concurrent worry and anxiety, only interpretation bias explained unique variance in worry and anxiety. No cognitive predictor significantly explained unique variance in prospective worry and anxiety prior to examinations. In relation to anxiety and worry during the stress of the COVID-19 pandemic, both benign attention bias and benign interpretation-memory bias predicted decreased worry; only benign attention bias predicted decreased anxiety. Findings suggest that cognitive processes can predict changes in worry and anxiety during future stressful contexts.
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However, understanding interpretation bias in adults with high levels of worry remains relatively unexplored since Suarez and Bell-Dolan (2001) used a sample of children and Krahé et al. (2019) used individuals with GAD in their sample. Although Suarez and Bell-Dolan (2001) compared groups of high and low worriers, they did not distinguish between the presence of negative interpretation bias and an absence of benign interpretation bias, which is important when developing strategies to lessen worry. If individuals have a negative interpretation bias, then reducing this negative bias may benefit individuals; while facilitating a benign bias may be more beneficial to individuals when they lack a benign interpretation bias.
The tendency to interpret ambiguous information in a consistent (e.g., negative) manner (interpretation bias) may maintain worry. This study explored whether high and low worriers generate different interpretations and examined at which stages of information processing these interpretations can occur. Participants completed interpretation assessment tasks yielding behavioural and N400 event-related potential indices, which index whether a given interpretation was generated. High worriers lacked the benign interpretation bias found in low worriers. This was evident for early “online” interpretations (reflected in reaction times to relatedness judgments and lexical decisions, as well as at a neurophysiological level, N400, for lexical decisions only), to later “offline” interpretations (observed at a behavioural level on the scenario task and recognition task) when participants had time for reflection. Results suggest that a benign interpretation bias may be a protective factor for low worriers, and that these interpretations remain active across online and offline stages of processing.
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Several reports have shown that different cognitive-processing errors/distortions, i.e., dichotomous thinking, overgeneralization, selective abstraction, etc. (Beck, 1979; Clark & Beck, 2011; Knapp & Beck, 2008) facilitate anxiety elaboration and maintenance. GAD patients were found to generate more imperative (“have to/should”) and catastrophic words (i.e. “death”, “pain”) than control individuals (Beck & Dozois, 2011; Suarez & Bell-Dolan, 2001). High anxiety individuals also show an “emotional reasoning” bias, in which the state of anxiety experienced is interpreted as evidence of imminent threat (“If I feel anxious, there must be danger”; Arntz, Rauner, & van den Hout, 1995; Barlow, 2004; Beck, 1979).
In normal settings, our brain is able to update its stored representations in content, strength, and/or expectations by the memory reconsolidation process. Thus, a reactivated memory enters in a transient labile state (destabilization) followed by a re-stabilization phase in order to persist (memory reconsolidation). Cognitive neuroscience and its insight into psychiatric problems attributed a close relationship between memory (formation, maintenance, and utilization) and several mental disorders. In this framework, the reconsolidation process could be not only the mechanism for maintenance of some psychopathologies, but also open a novel therapeutic window. Here we aim to integrate recent experimental and theoretical research on memory reconsolidation and anxiety disorders maintenance. We propose a bayesian-like model about anxiety disorders persistence and postulate a new theoretical framework for how anxiety disorders are maintained through impaired memory updating due to a dysfunctional prediction error minimization strategy and anticipatory responses to threat.
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But negative beliefs could play an initial inhibitory role although later be counterproductive. From an information-processing point of view, pathological worry would be characterized by attentional and interpretative bias linked to threat schemata (Bradley, Mogg, Millar, & White, 1995; Butler & Mathews, 1987; Eysenck & Derakshan, 1997; Prados, 2008; Pratt et al., 1997; Provencher, Freeston, Dugas, & Ladouceur, 2000; Suarez & Bell-Dolan, 2001). And attention is also directed to worry itself too.
Various theoretical models have pointed out the role of positive beliefs in the worry process (Dugas et al., 1998, Wells, 1995). Two studies were conducted to search for experimental support for this possibility. After trait worry was controlled, a persuasion procedure was used to induce diverse beliefs about worry (positive, negative, or neutral). It was hypothesized that participants persuaded of the usefulness of worry would be more worried and more anxious after listening to a worrisome message. In the first study, 90 participants (62 females and 28 males) were exposed to a novel worrisome message, and in the second study, 60 participants (34 females and 26 males) were exposed to a more personally relevant worry. Results indicate that persuasion about the utility of worry does not trigger worry, and when prior positive beliefs about worry were controlled, they do not correlate with the change in anxiety after worrisome induction.
Worry and the anxiety disorders: A meta-analytic synthesis of specificity to GAD
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Worry among youth also produces similar information processing biases as adults. For example, Suarez and Bell-Dolan (2001) found that among 5th- and 6th-grade children, worriers interpreted both ambiguous and threatening situations as more threatening, expressed more worry in response to the events, and judged these negative events to have a higher probability of occurring in the future compared to nonworriers. Furthermore, children and adults who worry at greater levels than others are more apt to detect potential threat (e.g., Taghavi, Dalgleish, Moradi, Neshat-Doost, & Yule, 2003), suggesting that worry may potentiate attention towards threat in the environment.
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Original ResearchThe relationship of child worry to cognitive biases: Threat interpretation and likelihood of event occurrence

Journal of the American Academy of Child and Adolescent Psychiatry

Behavioral Research and Therapy

Behavioral Research and Therapy

Advanced Behavior Research and Therapy

Behavior Research and Therapy

Clinical Psychology Review

Behaviour Research and Therapy

Personality and Individual Differences

Behavior Research and Therapy

Behaviour Research and Therapy

Journal of Anxiety Disorders

Behavior Research and Therapy

Journal of Behavior Therapy & Experimental Psychiatry

Journal of Applied Developmental Psychology

Diagnostic and statistical manual of mental disorders (4th ed.)

Trends in the “fears and worries” of school children as related to socio-economic status and age

Journal of Genetic Psychology

Anxiety and its disorders: The nature and treatment of anxiety and panic

Family enhancement of cognitive style in anxious and aggressive children

Journal of Abnormal Child Psychology

An exploratory study of developmental changes in children's fears

Journal of Child Psychology and Psychiatry

Comorbidity of test anxiety and other anxiety disorders in children

Journal of Abnormal Child Psychology

Social cue interpretation of anxious children

Journal of Clinical Child Psychology

Anxious children's social perceptions: Responses to provocation, peer group entry, and social failure situations

The nature of normal and pathological worry

Cognitive processing in children: Relation to anxiety and family influences

Journal of Clinical Child Psychology

A review and reformulation of social information-processing in children: Mechanisms in children's social adjustment

Psychological Bulletin

Original Research
The relationship of child worry to cognitive biases: Threat interpretation and likelihood of event occurrence