Document Type : Research Paper
Authors
1 Ph.D. student of psychology, Department of clinical Psychology, Faculty of Education Sciences and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran.
2 .Professor, Department of clinical Psychology, Faculty of Education Sciences and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran.(Corresponding Autuor)
3 .Professor, Department of clinical Psychology, Faculty of Education Sciences and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
Abstract
The Symptoms of the Generalized Anxiety Disorder (GAD) have been considered an index of cognitive control deficiency. The aim of this study was to investigate whether enhancing cognitive control over emotional stimuli can decrease worry intrusions and severity of the GAD symptoms. Based on the results of the structured clinical interview for the DSM-5 (SCID), 45 students of Ferdowsi University of Mashhad (FUM) who had GAD, were chosen to participate in this study. Then, they were assigned equally and randomly to the three conditions of intervention, control and active control groups. Subsequently, they completed the PSWQ, GAD-7, emotional stroop task, and Go/No Go task as pre-test. The intervention group received 16 sessions of the cognitive-affective control training using the emotional stroop with the trial-based feedback. Also, the active control group received the same amount of the training sessions of the emotional stroop with receiving no feedback, and finally, the control group was on a waiting list. After post-test assessments, the results of ANCOVA showed that the training sessions were effective for the stroop performance, reduction in worry intrusions, and GAD symptoms, while the training on the cognitive inhibition did not transfer to the behavioral inhibition. The findings revealed that not only cognitive control plays a major role in worry and GAD symptoms, but also cognitive control training might be a promising path to decrease the severity of anxiety disorders. Training with emotional stimuli can enhance performance, and using trial-based feedback can pave the way to get better clinical results.
Keywords
Abramowitz, J. S., Baucom, D. H., Wheaton, M. G., Boeding, S., Fabricant, L. E., Paprocki, C., & Fischer, M. S. (2013). Enhancing exposure and response prevention for OCD: A couple-based approach. Behavior Modification, 37(2), 189-210.
Alvarez, E., & Iacoviello, B. M. (2015). Neuroscience-informed cognitive-affective training interventions for mood and anxiety disorders. Current Treatment Options in Psychiatry, 2(3), 252-261.
Anderson, P. L., Price, M., Edwards, S. M., Obasaju, M. A., Schmertz, S. K., Zimand, E., & Calamaras, M. R. (2013). Virtual reality exposure therapy for social anxiety disorder: a randomized controlled trial. Journal of consulting and clinical psychology, 81(5), 751.
Association, A. P. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®): American Psychiatric Pub.
Bayrami, M., Movahedi, Y., Kazimi Razai, S. V., & Esmaili, S. (2015). The effect of mindfulness cognitive therapy on pathological worry and anxiety symptoms in students with generalized anxiety disorder. Iranian Journal of Rehabilitation Research, 2(1), 79-90.
Beck, A. T., & Clark, D. A. (1997). An information processing model of anxiety: Automatic and strategic processes. Behaviour research and therapy, 35(1), 49-58.
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of consulting and clinical psychology, 56(6), 893.
Behar, E., & Borkovec, T. D. (2020). The effects of verbal and imaginal worry on panic symptoms during an interoceptive exposure task. Behaviour Research and Therapy, 135, 103748.
Behar, E., DiMarco, I. D., Hekler, E. B., Mohlman, J., & Staples, A. M. (2009). Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of anxiety disorders, 23(8), 1011-1023.
Bishop, S. J. (2009). Trait anxiety and impoverished prefrontal control of attention. Nature neuroscience, 12(1), 92-98.
Borkovec, T. (1994). The nature, functions, and origins of worry.
Borkovec, T. D. (2019). The role of cognitive and somatic cues in anxiety and anxiety disorders: Worry and relaxation-induced anxiety. In Anxiety and the anxiety disorders (pp. 463-478). Routledge.
Borkovec, T. D., Robinson, E., Pruzinsky, T., & DePree, J. A. (1983). Preliminary exploration of worry: Some characteristics and processes. Behaviour research and therapy, 21(1), 9-16.
Bosley, H. G., Fisher, A. J., & Taylor, C. B. (2018). Differential responses of positive affect, negative affect, and worry in CBT for generalized anxiety disorder: A person-specific analysis of symptom course during therapy. Psychotherapy Research, 28(4), 630-642.
Brown, T. A., Antony, M. M., & Barlow, D. H. (1992). Psychometric properties of the Penn State Worry Questionnaire in a clinical anxiety disorders sample. Behaviour research and therapy, 30(1), 33-37.
Calabrese, F., Molteni, R., Racagni, G., & Riva, M. A. (2009). Neuronal plasticity: a link between stress and mood disorders. Psychoneuroendocrinology, 34, S208-S216.
Calkins, A. W., McMorran, K. E., Siegle, G. J., & Otto, M. W. (2015). The effects of computerized cognitive control training on community adults with depressed mood. Behavioural and cognitive psychotherapy, 43(5), 578-589.
Calkins, A. W., & Otto, M. W. (2013). Testing the boundaries of computerized cognitive control training on symptoms of obsessive compulsive disorder. Cognitive therapy and research, 37(3), 587-594.
Cavanagh, J. F., & Shackman, A. J. (2015). Frontal midline theta reflects anxiety and cognitive control: meta-analytic evidence. Journal of physiology-Paris, 109(1-3), 3-15.
Chiesa, A., Calati, R., & Serretti, A. (2011). Does mindfulness training improve cognitive abilities? A systematic review of neuropsychological findings. Clinical Psychology Review, 31(3), 449-464.
Cohen, J. D. (2017). Cognitive control: Core constructs and current considerations. The Wiley handbook of cognitive control, 1-28.
Cramer, S. C., Sur, M., Dobkin, B. H., O'brien, C., Sanger, T. D., Trojanowski, J. Q., . . . Chen, D. (2011). Harnessing neuroplasticity for clinical applications. Brain, 134(6), 1591-1609.
Crossfield, E., & Damian, M. F. (2021). The role of valence in word processing: Evidence from lexical decision and emotional Stroop tasks. Acta Psychologica, 218, 103359.
Dehshiri, G., Golzari, M., Borjali, A., & Sohrabi, F. (2010). Psychometrics particularity of farsi version of Pennsylvania State Worry Questionnaire for college students. Journal of Clinical Psychology, Vol. 1, No. 4.
DeMartini, J., Patel, G., & Fancher, T. L. (2019). Generalized anxiety disorder. Annals of internal medicine, 170(7), ITC49-ITC64.
Derryberry, D., & Reed, M. A. (2002). Anxiety-related attentional biases and their regulation by attentional control. Journal of abnormal psychology, 111(2), 225.
DeRubeis, R. J., Siegle, G. J., & Hollon, S. D. (2008). Cognitive therapy versus medication for depression: treatment outcomes and neural mechanisms. Nature Reviews Neuroscience, 9(10), 788-796.
Doniger, G. (2011). Mindstreams: Survey responses. support of PJ Snyder, CE Jackson, RC Peterson, AS Khachaturian, J. Kaye, M. Albert, & S. Weintraub (2011), The PAD2020 survey of cognitive instruments for the study of mild cognitive impairments. Alzheimer’s & Dementia: The Journal of Alzheimer’s Association.
Eysenck, M. W., & Derakshan, N. (2011). New perspectives in attentional control theory. Personality and Individual Differences, 50(7), 955-960.
Ferrari, G. R., Vanderhasselt, M. A., Rinck, M., Demeyer, I., De Raedt, R., Beisel, S., ... & Becker, E. S. (2021). A cognitive control training as add-on treatment to usual care for depressed inpatients. Cognitive Therapy and Research, 1-15.
Finkelstein, S., & Haleblian, J. (2002). Understanding acquisition performance: The role of transfer effects. Organization Science, 13(1), 36-47.
First, M. B. (2014). Structured clinical interview for the DSM (SCID). The encyclopedia of clinical psychology, 1-6.
Foa, E. B., Huppert, J. D., & Cahill, S. P. (2006). Emotional Processing Theory: An Update.
Fonzo, G. A., & Etkin, A. (2017). Affective neuroimaging in generalized anxiety disorder: an integrated review. Dialogues in clinical neuroscience, 19(2), 169.
Friedman, N. P., & Miyake, A. (2004). The relations among inhibition and interference control functions: a latent-variable analysis. Journal of experimental psychology: General, 133(1), 101.
Freund, M. C., Etzel, J. A., & Braver, T. S. (2021). Neural coding of cognitive control: The representational similarity analysis approach. Trends in Cognitive Sciences.
Goodwin, H., Yiend, J., & Hirsch, C. R. (2017). Generalized Anxiety Disorder, worry and attention to threat: A systematic review. Clinical Psychology Review, 54, 107-122.
Grahek, I., Everaert, J., Krebs, R. M., & Koster, E. H. (2018). Cognitive control in depression: Toward clinical models informed by cognitive neuroscience. Clinical Psychological Science, 6(4), 464-480.
Grahek, I., Shenhav, A., Musslick, S., Krebs, R. M., & Koster, E. H. (2019). Motivation and cognitive control in depression. Neuroscience & Biobehavioral Reviews, 102, 371-381.
Grol, M., Schwenzfeier, A. K., Stricker, J., Booth, C., Temple-McCune, A., Derakshan, N., ... & Fox, E. (2018). The worrying mind in control: An investigation of adaptive working memory training and cognitive bias modification in worry-prone individuals. Behaviour research and therapy, 103, 1-11.
Hallion, L. S., & Ruscio, A. M. (2013). Should uncontrollable worry be removed from the definition of GAD? A test of incremental validity. Journal of abnormal psychology, 122(2), 369.
Hallion, L. S., Ruscio, A. M., & Jha, A. P. (2014). Fractionating the role of executive control in control over worry: A preliminary investigation. Behaviour research and therapy, 54, 1-6.
Hallion, L. S., Tolin, D. F., Assaf, M., Goethe, J., & Diefenbach, G. J. (2017). Cognitive control in generalized anxiety disorder: relation of inhibition impairments to worry and anxiety severity. Cognitive Therapy and Research, 41(4), 610-618.
Han, K., Chapman, S. B., & Krawczyk, D. C. (2018). Neuroplasticity of cognitive control networks following cognitive training for chronic traumatic brain injury. NeuroImage: Clinical, 18, 262-278.
Hanrahan, F., Field, A. P., Jones, F. W., & Davey, G. C. (2013). A meta-analysis of cognitive therapy for worry in generalized anxiety disorder. Clinical psychology review, 33(1), 120-132.
Hare, T. A., & Casey, B. (2005). The neurobiology and development of cognitive and affective control. Cogn Brain Behav, 9(3), 273-286.
Hayes, S., Hirsch, C., & Mathews, A. (2008). Restriction of working memory capacity during worry. Journal of abnormal psychology, 117(3), 712.
Hirsch, C. R., & Mathews, A. (2012). A cognitive model of pathological worry. Behaviour research and therapy, 50(10), 636-646.
Hirsch, C. R., Mathews, A., Lequertier, B., Perman, G., & Hayes, S. (2013). Characteristics of worry in generalized anxiety disorder. Journal of Behavior Therapy and Experimental Psychiatry, 44(4), 388-395.
Hoorelbeke, K., Koster, E. H., Demeyer, I., Loeys, T., & Vanderhasselt, M.-A. (2016). Effects of cognitive control training on the dynamics of (mal) adaptive emotion regulation in daily life. Emotion, 16(7), 945.
Hoorelbeke, K., Koster, E. H., Vanderhasselt, M. A., Callewaert, S., & Demeyer, I. (2015). The influence of cognitive control training on stress reactivity and rumination in response to a lab stressor and naturalistic stress. Behaviour research and therapy, 69, 1-10.
Huppert, J. D., Fradkin, I., & Cahill, S. P. (2019). CBT for Anxiety Disorders: Memory Reconsolidation Theory and Its Relationship to Cognitive, Emotional Processing, and Inhibitory Models. In Neuroscience of Enduring Change (pp. 245-272). Oxford University Press.
Hung, Y., Gaillard, S. L., Yarmak, P., & Arsalidou, M. (2018). Dissociations of cognitive inhibition, response inhibition, and emotional interference: Voxelwise ALE meta‐analyses of fMRI studies. Human brain mapping, 39(10), 4065-4082.
Hussey, E. K., Harbison, J., Teubner-Rhodes, S. E., Mishler, A., Velnoskey, K., & Novick, J. M. (2017). Memory and language improvements following cognitive control training. Journal of Experimental Psychology: Learning, Memory, and Cognition, 43(1), 23.
Iacoviello, B., & Charney, D. (2015). Developing cognitive-emotional training exercises as interventions for mood and anxiety disorders. European Psychiatry, 30(1), 75-81.
Kim, H., Chey, J., & Lee, S. (2017). Effects of multicomponent training of cognitive control on cognitive function and brain activation in older adults. Neuroscience research, 124, 8-15.
Kohls, G., Peltzer, J., Herpertz‐Dahlmann, B., & Konrad, K. (2009). Differential effects of social and non‐social reward on response inhibition in children and adolescents. Developmental science, 12(4), 614-625.
Koster, E. H., Hoorelbeke, K., Onraedt, T., Owens, M., & Derakshan, N. (2017). Cognitive control interventions for depression: A systematic review of findings from training studies. Clinical Psychology Review, 53, 79-92.
König, N., Steber, S., Borowski, A., Bliem, H. R., & Rossi, S. (2021). Neural Processing of Cognitive Control in an Emotionally Neutral Context in Anxiety Patients. Brain Sciences, 11(5), 543.
Lang, P. J. (1977). Imagery in therapy: An information processing analysis of fear. Behavior therapy, 8(5), 862-886.
Lee, D., Kwak, S., & Chey, J. (2019). Parallel changes in cognitive function and gray matter volume after multi-component training of cognitive control (MTCC) in adolescents. Frontiers in human neuroscience, 13, 246.
Lee, H., Dvorak, D., Kao, H.-Y., Duffy, Á. M., Scharfman, H. E., & Fenton, A. A. (2012). Early cognitive experience prevents adult deficits in a neurodevelopmental schizophrenia model. Neuron, 75(4), 714-724.
Leotti, L. A., & Wager, T. D. (2010). Motivational influences on response inhibition measures. Journal of Experimental Psychology: Human Perception and Performance, 36(2), 430.
Liddle, E. B., Scerif, G., Hollis, C. P., Batty, M. J., Groom, M. J., Liotti, M., & Liddle, P. F. (2009). Looking before you leap: A theory of motivated control of action. Cognition, 112(1), 141-158.
Littman, M. L. (2015). Reinforcement learning improves behaviour from evaluative feedback. Nature, 521(7553), 445-451.
Lonigan, C. J., & Vasey, M. W. (2009). Negative affectivity, effortful control, and attention to threat-relevant stimuli. Journal of abnormal child psychology, 37(3), 387-399.
Löwe, B., Decker, O., Müller, S., Brähler, E., Schellberg, D., Herzog, W., & Herzberg, P. Y. (2008). Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Medical care, 266-274.
Mathews, A. (1990). Why worry? The cognitive function of anxiety. Behaviour research and therapy, 28(6), 455-468.
McKenna, F. P., & Sharma, D. (1995). Intrusive cognitions: an investigation of the emotional Stroop task. Journal of Experimental Psychology: Learning, Memory, and Cognition, 21(6), 1595.
McNally, R. J. (1995). Automaticity and the anxiety disorders. Behaviour research and therapy, 33(7), 747-754.
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the penn state worry questionnaire. Behaviour research and therapy, 28(6), 487-495.
Miyake, A., Friedman, N. P., Emerson, M. J., Witzki, A. H., Howerter, A., & Wager, T. D. (2000). The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: A latent variable analysis. Cognitive psychology, 41(1), 49-100.
Mnih, V., Kavukcuoglu, K., Silver, D., Rusu, A. A., Veness, J., Bellemare, M. G., . . . Ostrovski, G. (2015). Human-level control through deep reinforcement learning. Nature, 518(7540), 529-533.
Nainian, M. R., Shoeiri, M. R., Sharifi, M., & Hadian, M. (2011). investigating validity and reliability of GAD-7. CLINICAL PSYCHOLOGY & PERSONALITY, 4.
Nee, D. E., Wager, T. D., & Jonides, J. (2007). Interference resolution: insights from a meta-analysis of neuroimaging tasks. Cognitive, Affective, & Behavioral Neuroscience, 7(1), 1-17.
Nigg, J. T. (2000). On inhibition/disinhibition in developmental psychopathology: views from cognitive and personality psychology and a working inhibition taxonomy. Psychological bulletin, 126(2), 220.
Oliveira, J. S., Manning, M. C., & Kavanaugh, B. C. (2021). Cognitive Control Deficits in Depression: A Novel Target to Improve Suboptimal Outcomes in Childhood. The Journal of Neuropsychiatry and Clinical Neurosciences, appi-neuropsych.
Pascual-Leone, A., Amedi, A., Fregni, F., & Merabet, L. B. (2005). The plastic human brain cortex. Annu. Rev. Neurosci., 28, 377-401.
Peckham, A. D., & Johnson, S. L. (2018). Cognitive control training for emotion-related impulsivity. Behaviour research and therapy, 105, 17-26.
Peers, P. V., & Lawrence, A. D. (2009). Attentional control of emotional distraction in rapid serial visual presentation. Emotion, 9(1), 140.
Price, R. B., & Duman, R. (2020). Neuroplasticity in cognitive and psychological mechanisms of depression: an integrative model. Molecular psychiatry, 25(3), 530-543.
Rajabi, G., & Karju Kasmai, S. (2013). Psychometric properties of a Persian language version of the beck depression inventory second edition. Educational Measurment 10.
Riccio, C. A., Reynolds, C. R., & Lowe, P. A. (2001). Clinical applications of continuous performance tests: Measuring attention and impulsive responding in children and adults: John Wiley & Sons Inc.
Roberts, H., Mostazir, M., Moberly, N. J., Watkins, E. R., & Adlam, A. L. (2021). Working memory updating training reduces state repetitive negative thinking: Proof-of-concept for a novel cognitive control training. Behaviour Research and Therapy, 142, 103871.
Sandroff, B. M., Jones, C. D., Baird, J. F., & Motl, R. W. (2020). Systematic review on exercise training as a neuroplasticity-inducing behavior in multiple sclerosis. Neurorehabilitation and neural repair, 34(7), 575-588.
Schweiger, A., Abramovitch, A., Doniger, G. M., & Simon, E. S. (2007). A clinical construct validity study of a novel computerized battery for the diagnosis of ADHD in young adults. Journal of Clinical and Experimental Neuropsychology, 29(1), 100-111.
Segerstrom, S. C., Tsao, J. C., Alden, L. E., & Craske, M. G. (2000). Worry and rumination: Repetitive thought as a concomitant and predictor of negative mood. Cognitive Therapy and Research, 24(6), 671-688.
Scherer, R., Siddiq, F., & Sánchez Viveros, B. (2019). The cognitive benefits of learning computer programming: A meta-analysis of transfer effects. Journal of Educational Psychology, 111(5), 764.
Siegle, G. J., Ghinassi, F., & Thase, M. E. (2007). Neurobehavioral therapies in the 21st century: Summary of an emerging field and an extended example of cognitive control training for depression. Cognitive Therapy and Research, 31(2), 235-262.
Sokolowski, H. M., & Necka, E. A. (2016). Remediating math anxiety through cognitive training: potential roles for math ability and social context. Journal of Neuroscience, 36(5), 1439-1441.
Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of internal medicine, 166(10), 1092-1097.
Steenkamp, M. M., Litz, B. T., Gray, M. J., Lebowitz, L., Nash, W., Conoscenti, L., ... & Lang, A. (2011). A brief exposure-based intervention for service members with PTSD. Cognitive and Behavioral Practice, 18(1), 98-107.
Stroop, J. R. (1935). Studies of interference in serial verbal reactions. Journal of experimental psychology, 18(6), 643.
Swainston, J., & Derakshan, N. (2018). Training cognitive control to reduce emotional vulnerability in breast cancer. Psycho‐oncology, 27(7), 1780-1786.
Tallis, F., Eysenck, M., & Mathews, A. (1992). A questionnaire for the measurement of nonpathological worry. Personality and Individual Differences, 13(2), 161-168.
Taatgen, N. A. (2021). Theoretical models of training and transfer effects. In Cognitive training (pp. 41-54). Springer, Cham.
Teasdale, J. D., Segal, Z., & Williams, J. M. G. (1995). How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? Behaviour research and therapy, 33(1), 25-39.
Thorell, L. B., Lindqvist, S., Bergman Nutley, S., Bohlin, G., & Klingberg, T. (2009). Training and transfer effects of executive functions in preschool children. Developmental science, 12(1), 106-113.
Toh, G. Y. (2019). The Role of Verbal Worry in Cognitive Control and Anxious Arousal in Worry and Generalized Anxiety: A Replication and an Extension. The Ohio State University.
Van den Bergh, N., Hoorelbeke, K., De Raedt, R., & Koster, E. H. (2018). Remediation of depression-related cognitive impairment: cognitive control training as treatment augmentation. Expert review of neurotherapeutics, 18(12), 907-913.
Van den Bergh, N., Vermeersch, S., Hoorelbeke, K., Vervaeke, J., De Raedt, R., & Koster, E. H. (2020). Cognitive control training as an augmentation strategy to CBT in the treatment of fear of failure in undergraduates. Cognitive Therapy and Research, 44(6), 1199-1212.
Vervaeke, J., Hoorelbeke, K., Baeken, C., & Koster, E. H. (2021). Online cognitive control training for remitted depressed individuals: A replication and extension study. Cognitive Therapy and Research, 1-15.
Vinogradov, S., Fisher, M., & de Villers-Sidani, E. (2012). Cognitive training for impaired neural systems in neuropsychiatric illness. Neuropsychopharmacology, 37(1), 43-76.
WANG, Y., LI, K., GAI, X., & CAO, Y. (2020). Training and transfer effects of response inhibition training with online feedback on adolescents and adults’ executive function. Acta Psychologica Sinica, 52(10), 1212-1223.
Williams, J. M. G., Mathews, A., & MacLeod, C. (1996). The emotional Stroop task and psychopathology. Psychological bulletin, 120(1), 3.
Williams, M. O., Mathews, A., & Hirsch, C. R. (2014). Verbal worry facilitates attention to threat in high-worriers. Journal of Behavior Therapy and Experimental Psychiatry, 45(1), 8-14.
Zainal, N. H., & Newman, M. G. (2020). Within-person increase in pathological worry predicts future depletion of unique executive functioning domains. Psychological medicine, 1-11.
Zysberg, L., & Zisberg, A. (2020). Days of worry: Emotional intelligence and social support mediate worry in the COVID-19 pandemic. Journal of Health Psychology, 1359105320949935.
)