Abstract
We present an evidence-based model of pathological worry in which worry arises from an interaction between involuntary (bottom-up) processes, such as habitual biases in attention and interpretation favouring threat content, and voluntary (top-down) processes, such as attentional control. At a pre-conscious level, these processes influence the competition between mental representations when some correspond to the intended focus of attention and others to threat distracters. Processing biases influence the probability of threat representations initially intruding into awareness as negative thoughts. Worry in predominantly verbal form then develops, influenced by conscious processes such as attempts to resolve the perceived threat and the redirection of attentional control resources to worry content, as well as the continuing influence of habitual processing biases. After describing this model, we present evidence for each component process and for their causal role in pathological worry, together with implications for new directions in the treatment of pathological worry.
Highlights
We present an evidence-based model of pathological worry in which worry arises from an interaction between involuntary processes, such as habitual biases in attention and interpretation favouring threat content, and voluntary processes, such as attentional control
We have suggested that attentional control resources in pathological worry may be pre-empted by worry and re-focused on worry content itself
We have presented a cognitive model of pathological worry, focusing on the origin of intrusive negative thoughts, and the transition from intrusions to protracted worry
Summary
Worry in predominantly verbal form develops, influenced by conscious processes such as attempts to resolve the perceived threat and the redirection of attentional control resources to worry content, as well as the continuing influence of habitual processing biases After describing this model, we present evidence for each component process and for their causal role in pathological worry, together with implications for new directions in the treatment of pathological worry. In other disorders worry tends to be focused on more specific events, such as the anticipation of social embarrassment in social phobia For this reason we will focus on worry in GAD as the clearest form of pathological worry (i.e. it is general, excessive, uncontrollable and distressing), while recognizing that similar processes occur in other disorders. In the present model we focus on component processes for which there is evidence that they have a causal role in worry, and that lead to implications for treatment
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