Transdiagnostic dimensions of anxiety: Neural mechanisms, executive functions, and new directions

doi:10.1016/j.ijpsycho.2015.07.001

International Journal of Psychophysiology

Volume 98, Issue 2, Part 2, November 2015, Pages 365-377

https://doi.org/10.1016/j.ijpsycho.2015.07.001 Get rights and content

Highlights

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Anxiety conceived as a unitary construct has stymied research on biological mechanisms and treatment of anxiety disorders.
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Studies on anxious apprehension and anxious arousal constructs have refined our understanding of brain mechanisms of anxiety.
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These anxiety constructs have informed an understanding of how anxiety relates to diverse executive dysfunctions.
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More research is needed to test trait models of these anxiety constructs and the neural mechanisms that instantiate them.

Abstract

Converging neuroscientific and psychological evidence points to several transdiagnostic factors that cut across DSM-defined disorders, which both affect and are affected by executive dysfunction. Two of these factors, anxious apprehension and anxious arousal, have helped bridge the gap between psychological and neurobiological models of anxiety. The present integration of diverse findings advances an understanding of the relationships between these transdiagnostic anxiety dimensions, their interactions with each other and executive function, and their neural mechanisms. Additionally, a discussion is provided concerning how these constructs fit within the Research Domain Criteria (RDoC) matrix developed by the National Institutes of Mental Health and how they relate to other anxiety constructs studied with different methods and at other units of analysis. Suggestions for future research are offered, including how to (1) improve measurement and delineation of these constructs, (2) use new neuroimaging methods and theoretical approaches of how the brain functions to build neural mechanistic models of these constructs, and (3) advance understanding of the relationships of these constructs to diverse emotional phenomena and executive functions.

Section snippets

Introduction: transdiagnostic constructs in psychopathology

Since Paul Meehl's (1962) discussion of schizotaxia, clinical scientists have been faced with an imperative to uncover a specific, sine qua non etiology for any of the numerous forms of mental illness. For the past six decades, however, little progress has been made, due in part to a stagnant nosology. That nosology, the Diagnostic and Statistical Manual (DSM: now in its 5th edition), defines disorders based on how symptoms covary within a clinical population. One is diagnosed with a disorder

RDoC: dimensional and categorical constructs

RDoC remains agnostic in terms of how psychopathology should be conceptualized, remaining open to traditional or new categorical constructs while encouraging research using dimensional constructs. The present review argues that two transdiagnostic types of anxiety are best conceptualized dimensionally, given the empirical coherence across psychological and neurobiological domains for these constructs. This contention does not assume either (1) that RDoC will prioritize psychological or

Past and current conceptualizations

To clarify some potential misconceptions in previous literature, we now define anxious apprehension and anxious arousal as traits that describe psychologically and neurally separable dimensions of anxiety. Anxious apprehension is marked by a propensity to engage in negative, repetitive thinking (Burdwood et al., in revision, Ruscio et al., 2001), which can also be thought of as an enduring pattern of state worry. Anxious arousal consists of an enduring pattern of hypervigilance, sympathetic

Problems when treating anxiety as a unitary construct

Research on the neural correlates of anxiety was stymied entering the so-called “Decade of the Brain” (1990–2000) due to inconsistent and sometimes conflicting findings across studies (for review, see Heller and Nitschke, 1998, Baxter et al., 1988, Reiman et al., 1989). Psychological models of anxiety were not adequately integrated into neuroscience research to reflect the diverse pattern of results, a long-standing problem (Lang, 1968, Lang, 1978, Kozak and Miller, 1982) with the consequence

Neural mechanisms associated with transdiagnostic anxiety constructs

Anxious apprehension and anxious arousal are dissociable constructs when measured psychometrically and neurobiologically via multiple methods and task paradigms. In particular, these dimensions have been studied in relation to tasks probing executive function, in which high levels of these anxiety dimensions are differentially associated with executive function impairments observed in both neural dysfunction and concomitant maladaptive behavior (e.g., Silton et al., 2011).

Studies reviewed below

Avoiding reification of anxious apprehension and anxious arousal

Although empirical evidence from clinical neuroscience suggests that anxious apprehension and anxious arousal are useful constructs in explaining phenomena that occur across several DSM anxiety disorders, other work parsing anxiety symptoms has found alternative constructs to explicate the latent structure of anxiety (e.g., Watson et al., 2007). In these factor analyses of several anxiety and depression self-report measures, worry (state counterpart of anxious apprehension) does not emerge as

Mapping transdiagnostic anxiety constructs onto the RDoC matrix

There are a number of places that anxious apprehension and anxious arousal could fit within the domain of negative valence in the RDoC matrix. For anxious apprehension, the most obvious place is under the construct “potential threat”. If one conceptualizes anxious apprehension as a type of negative repetitive thinking, then anxious apprehension could be offered as a subconstruct of potential threat (on the NIMH website there are no subconstructs offered for any constructs within the negative

DSM-defined anxiety disorders and executive function impairments

Although this article advances a transdiagnostic, dimensional framework for conceptualizing dimensions of anxiety and their interactions with executive function, many well-established categorically conceived anxiety disorders have been shown to involve executive dysfunction. DSM-defined disorders are related to poor executive function including obsessive–compulsive disorder (OCD), post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and panic disorder (PD). Findings

Implications for prevention, diagnosis, and treatment of psychopathology

In a review of the shortcomings of the DSM, Hyman (2010) expressed concern that its categorical approach “denies an appropriate clinical status to early or milder symptom presentations, thus impeding preventive interventions.” Clinicians may eventually use transdiagnostic, dimensional anxiety constructs in prevention, diagnosis, and treatment. To determine how the use of these constructs can improve clinical practice, research is needed to determine which clinical interventions are most

Future directions

More work is needed to understand how best to measure these psychological constructs, how they are instantiated in neural networks, how they relate to diverse emotional phenomena and executive functions, and what role they play in the etiology of psychopathology.

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Transdiagnostic dimensions of anxiety: Neural mechanisms, executive functions, and new directions

Highlights

Abstract

Section snippets

Introduction: transdiagnostic constructs in psychopathology

RDoC: dimensional and categorical constructs

Past and current conceptualizations

Problems when treating anxiety as a unitary construct

Neural mechanisms associated with transdiagnostic anxiety constructs

Avoiding reification of anxious apprehension and anxious arousal

Mapping transdiagnostic anxiety constructs onto the RDoC matrix

DSM-defined anxiety disorders and executive function impairments

Implications for prevention, diagnosis, and treatment of psychopathology

Future directions

J. Psychiatr. Res.

Neurosci. Biobehav. Rev.

Biol. Psychiatry

Neuron

Neuron

Behav. Res. Ther.

Brain Cogn.

Curr. Opin. Neurobiol.

Trends Cogn. Sci.

Trends Cogn. Sci.

Behav. Res. Ther.

Biol. Psychol.

Cogn. Psychol.

Neurosci. Lett.

Biol. Psychiatry

Neurobiol. Learn. Mem.

J. Res. Pers.

Executive function: the search for an integrated account

Curr. Dir. Psychol. Sci.

Disorders of emotion

Psychological Inquiry

The conceptual act theory: A précis

Emotion Review

Cerebral glucose metabolic rates in nondepressed patients with obsessive–compulsive disorder

Am. J. Psychiatr.

An inventory for measuring clinical anxiety: psychometric properties

J. Consult. Clin. Psychol.

Classification and psychopathology research

J. Abnorm. Psychol.

Verbalization and imagery during worry activity

Depress. Anxiety

Avoidance theory of worry and generalized anxiety disorder

Natural selective attention: orienting and emotion

Psychophysiology

Screening for depressive disorders using the Mood and Anxiety Symptoms Questionnaire Anhedonic Depression Scale: a receiver-operating characteristic analysis

Psychol. Assess.

Clinical utility of the Mood and Anxiety Symptom Questionnaire (MASQ) in a sample of young help-seekers

BMC Psychiatry

Population coding of affect across stimuli, modalities and individuals

Nat. Neurosci.

Whatever next? Predictive brains, situated agents, and the future of cognitive science

Brain Behav. Sci.

Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications

J. Abnorm. Psychol.

Frontal EEG asymmetry as a moderator and mediator of emotion

Biol. Psychol.

Paying attention to emotion: an fMRI investigation of cognitive and emotional Stroop tasks

Cogn. Affect. Behav. Neurosci.

Control of goal-directed and stimulus-driven attention in the brain

Nat. Rev. Neurosci.

Top-down causation without top-down causes

Biol. Philos.

Neural mechanisms of attentional control differentiate trait and state negative affect

Front. Psychol.

Relationships among cognition, emotion, and motivation: implications for intervention and neuroplasticity in psychopathology

Front. Hum. Neurosci.

Constructing constructs for psychopathology: the NIMH Research Domain Criteria

J. Abnorm. Psychol.

Phasic vs sustained fear in rats and humans: role of the extended amygdala in fear vs anxiety

Neuropsychopharmacology

Differential lateralization of trait anxiety and trait fearfulness: evoked potential correlates

Personal. Individ. Differ.

Affect is a form of cognition: A neurobiological analysis

Cognition and emotion

An argument for basic emotions

Cognition and Emotion.