Higher State Anxiety Research Articles

Abstract # 1802 Expectation shapes the behavioral response of experimentally-induced sickness

High inter-subject variability is observed in humans after administration of lipopolysaccharide (LPS). However, predictors of the sickness response remain poorly investigated. Notably, expectations can modulate treatment outcomes and may be involve in the sickness response. This hypothesis was assessed in 22 healthy human subjects, who received LPS injection (2 ng/kg body weight) and saline injection in randomized order. Subjects reported their expectation of treatment effect before the injection on a scale assessing how they think they will feel (much worse to much better) compared to how they usually feel when they are sick. LPS but not saline administration induced an increase in plasma cytokine concentrations. Subjects also exhibited increased sickness symptoms and altered affective state (e.g., increased state anxiety and negative affect, reduced positive mental state) after LPS administration in comparison to saline administration. An expectation to feel worse than usual when sick was associated with lower behavioral response, e.g., lower state anxiety, after LPS administration. Notably, higher difference between the expectation and the report of the effect (measured on the same scale than the expectation rating at the end of the day), indicating that subjects felt much worse than what they expected, was strongly related to higher state anxiety and negative affect. These results highlight the importance of treatment expectancies in experimentally-induced sickness.

Cognitive dysfunctions and psychological symptoms in migraine without aura: a cross-sectional study.

BackgroundThe occurrence of cognitive dysfunctions and psychological symptoms, as well as their mutual relationships, in migraine patients are still debated. The aim of the study was to characterize the cognitive profile and psychological symptoms (i.e. depression, anxiety and apathy) in drug-naïve migraine without aura (MwoA) patients.MethodsSeventy-two consecutive MwoA patients, referred to the Italian University Headache Clinic and 72 healthy subjects (HCs) were enrolled. Patients, during an attack-free period, and HCs completed Montreal Cognitive Assessment (MoCA), Beck Depression Inventory-II (BDI-II), Self-version of Apathy Evaluation Scale (AES-S) and State and Trait Anxiety Inventory (STAI-Y-1 and 2). Clinical parameters of disease severity (i.e. disease duration, migraine attacks per month, mean pain intensity during migraine attacks, migraine disability and impact on daily life) were recorded.ResultsAlthough performance of MwoA patients on MoCA was above Italian cut-off threshold (<15.5) suggesting presence of cognitive impairment, MwoA patients achieved significantly lower scores than HCs on total MoCA scale (22.3 ± 2.7 versus 25.4 ± 2.3) and on its attention (4.9 ± 1.1 versus 5.6 ± 0.7), memory (1.8 ± 1.4 versus 3.1 ± 1.3), visuospatial (3.2 ± 0.9 versus 3.6 ± 0.6) and executive subscales (2.6 ± 1.1 versus 3.1 ± 0.8). In addition, we observed significant correlations between MoCA executive domain subscore and the attack-related disability score (MIDAS).As for behavioral profile, the percentage of depressive symptoms (4.2 %), high state and trait anxiety (13.9 and 9.7 %, respectively), and apathy (11.1 %) in MwoA patients were similar to that of HCs. No significant associations of behavioural symptoms with cognitive performance and clinical parameters were found.ConclusionsDrug-naïve MwoA patients are characterized by subtle cognitive dysfunctions and low percentage of behavioural symptoms. The results support the importance of searching for subclinical cognitive disturbances in patients with MwoA, who deserve to be followed-up to verify whether they develop clinically relevant disorders over time.

Psicopatología en el paciente con obesidad

Resumen Introducción. En las dos últimas décadas se han multiplicado las publicaciones científicas que cuestionan la definición médica tradicional de la obesidad por haberse centrado en el tejido adiposo (menos inerte y más interconectado con los demás tejidos de lo que se pensaba), y en un modelo patogénico heredado del siglo XIX que reducía el problema a un mero desequilibrio entre la incorporación y el gasto de energía, todo ello vagamente modulado por factores que se analizaban como variables secundarias: psicosociales y neuroendocrinas. Objetivo. Relacionar la psicopatología y la obesidad, dando prioridad a los puntos de vista emocional y de comportamiento como focos para descomponer al grupo de obesos en perfiles emocional-conductuales que requerirían tratamientos diferenciales. Método. Se presentan datos descriptivos de los 180 primeros pacientes incluidos del programa de Estudio de los Aspectos Emocionales del Sobrepeso y la Obesidad del Hospital Universitario Infanta Leonor en Madrid; se realizó una entrevista semi-estructurada y una batería de test psicométricos; se presentan datos descriptivos y un análisis de asociación entre Índice de Masa Corporal (IMC) y ansiedad o depresión. Resultados. La mayoría de los pacientes tienen alta puntuación en psicopatología; el 80.9% tenía sintomatología depresiva importante, el 56.39% tenía elevada ansiedad-rasgo, el 48.26% tenía elevada ansiedad-estado, el 24.4% cumplía criterios de trastorno por atracones y el 11.9% de bulimia nerviosa (BN); un 17.3% tenía criterios de trastorno por estrés postraumático. Discusión y conclusión. Nuestros resultados apoyan la asociación esencial entre obesidad y psicopatología.

Attention bias to threat indicates anxiety differences in sheep.

Humans and animals show increased attention towards threatening stimuli when they are in increased states of anxiety. The few animal studies that have examined this phenomenon, known as attention bias, have applied environmental manipulations to induce anxiety but the effects of drug-induced anxiety levels on attention bias have not been demonstrated. Here, we present an attention bias test to identify high and low anxiety states in sheep using pharmacological manipulation. Increased anxiety was induced using 1-methyl-chlorophenylpiperazine (m-CPP) and decreased anxiety with diazepam, and then we examined the behaviour of sheep in response to the presence of a dog as a threat. Increased attention towards the threat and increased vigilance were shown in sheep that received the m-CPP and reduced in sheep receiving the diazepam. The modulated attention towards a threat displayed by the m-CPP and diazepam animals suggests that attention bias can assess different levels of anxiety in sheep. Measuring attention bias has the potential to improve animal welfare assessment protocols.

Validity and reliability of the Modified Stressor Scale for College Student among medical and medical science students in a private university in Japan

OBJECTIVES: To modify the Stressor Scale for College Student (SSCS) by including extracurricular activity-related stressors and to examine the validity and reliability of the Modified SSCS (M-SSCS) to evaluate psychosocial stressors in medical and medical science students. Methods: Third-year medical students (n = 103) and fourth-year medical technology students (n = 95) completed a cross-sectional questionnaire survey. We examined the factorial structure of the M-SSCS using factor analysis. Concurrent validity was assessed by examining the associations of M-SSCS scores with self-rated health status, K6 scale scores, and State-Trait Anxiety Inventory (STAI) scores. Cronbach's alpha coefficient was calculated to evaluate the reliability of the M-SSCS. Results: Factor analysis yielded seven factors. Stressors related to family, friends, part-time jobs, and extracurricular activity formed independent factors, but study- and fulfillment-related stressors were not distinct. High M-SSCS scores, indicating greater stressor levels, were significantly associated with poor self-rated health status (adjusted odds ratio [95% confidence intervals] = 2.80 [1.08, 7.25], p = 0.034), high K6 scale scores (2.99 [1.00, 8.96], p = 0.050), and high STAI state anxiety (3.32 [1.35, 8.20], p = 0.009) and trait anxiety scores (2.69 [1.31, 5.51], p = 0.007). Cronbach' s alpha coefficient was 0.916. Conclusions: The M-SSCS showed good concurrent validity and internal consistency in assessing psychosocial stressors in medical and medical technology students. However, further studies are necessary to fully determine the validity of the M-SSCS. Language: en

Effects of Anxiety on Caloric Intake and Satiety-Related Brain Activation in Women and Men.

To test the relationship of anxiety to caloric intake and food cue perception in women and men. Fifty-five twins (26 complete, 3 incomplete pairs; 51% women) underwent 2 functional magnetic resonance imaging (fMRI) scans (before and after a standardized meal) and then ate at an ad libitum buffet to objectively assess food intake. State and trait anxiety were assessed using the State-Trait Anxiety Inventory. During the fMRI scans, participants viewed blocks of fattening and nonfattening food images, and nonfood objects. In women, higher trait anxiety was associated with a higher body mass index (BMI) (r = 0.40, p = .010). Trait anxiety was positively associated with kilocalories consumed at the buffet (r = 0.53, p = .005) and percent kilocalories consumed from fat (r = 0.30, p = .006), adjusted for BMI. In within-pair models, which control for shared familial and genetic factors, higher trait anxiety remained associated with kilocalories consumed at the buffet (p = .66, p = .014), but not with BMI. In men, higher state anxiety was related to macronutrient choices, but not to total caloric intake or BMI. FMRI results revealed that women with high trait anxiety did not suppress activation by fattening food cues across brain regions associated with satiety perception after eating a standardized meal (low anxiety, mean difference = -15.4, p < .001; high anxiety, mean difference = -1.53, p = .82, adjusted for BMI). In women, trait anxiety may promote excess caloric consumption through altered perception of high-calorie environmental food cues, placing women with genetic predispositions toward weight gain at risk of obesity. Clinicaltrials.govidentifier:NCT02483663.

State anxiety reduces procrastinating behavior

Three experiments conducted in China and the US investigated the impact of state anxiety on behavioral procrastination. Participants were induced into a high- or a low-anxiety state and then given a period of 12 min either to practice for an upcoming test or entertain themselves (e.g., watch videos). The results showed that participants in a high-anxiety state spent more time practicing for the upcoming test than participants in a low-anxiety state. Impulsivity and trait procrastination were also measured. Impulsivity was found to be positively correlated with both trait procrastination and dilatory behavior. Overall the findings support a self-regulatory theory account such that the negative emotion associated with anxiety motivates people to increase the effort towards reaching a goal and take proactive measures for the most important task, thus reducing procrastination.

Does preoperative psychological status of patients affect postoperative pain? A prospective study from the Caribbean.

Patients with high anxiety states in the preoperative period often have more intense postoperative pain, despite adequate pain control during the intraoperative period. This study aimed to determine the relationship between the preoperative psychological status and the pain experienced postoperatively in a sample of Caribbean patients. A prospective study was conducted in elective surgical adult patients at a teaching hospital in the Caribbean. Patients' preoperative psychological status was assessed using Hospital Anxiety and Depression Scale (HADS), and a preoperative 'expected' pain score was recorded. Postoperatively, 'observed' pain scores at 4 and 24 hours and the maximum pain score during 24 hours were recorded. Demographic data and clinical details including data regarding postoperative analgesia were collected. Expected and observed pain scores were compared between patients with and without anxiety and depression. A total of 304 patients were enrolled. The overall prevalence of anxiety and depression was 43% and 27%, respectively, based on the HADS scores. There were significant associations between the postoperative pain scores and factors such as preoperative anxiety and depression (HADS) scores, preoperative expected pain scores, patient educational level, presence of preoperative pain and surgical duration. Age, gender, ethnicity and type of anaesthesia did not impact postoperative pain scores. The presence of preoperative anxiety and depression as indicated by HADS score may significantly influence postoperative pain. Other factors such as educational level, presence of preoperative pain and surgical duration may also impact postoperative pain. Some of these factors may be modifiable and must be addressed in the preoperative period.

Psycopathology in overweight and obese patients

Introduction Overweight and obesity are considered as a pandemic disease with a worrying prevalence and still growing. According to the World Health Organization, in 2014 the 39% adults were overweight and 13% were obese. Although it is an objective fact that obesity is an abnormal or excessive accumulation of fat detrimental to health, causes that lead a person to be obese are multifactorial and not yet well known. Objective Examine the relationship between psychopathology and obesity. Deepen in this sense, allows us to understand obesity from a broader perspective, where not only the nutritional factors are involved in these patients, but also different profiles. Methods The emotional aspects of overweight and the obesity study Program of the University Hospital Infanta Leonor attends to these patients from a multi-modal perspective, to offer a multidisciplinary and effective treatment that results in a permanent lost weight. Descriptive data of the first 180 patients are presented. Results A large percentage of patients presented psychopathology, highlighting a 80.9% of patients with depressive symptomatology, a 56.39% with high anxiety trait, a 48.26% with high anxiety state, a 24.4% meet criteria for binge eating disorder, a 11.9% bulimia nervosa and a 17.3% post-traumatic stress disorder. Conclusion Our findings support the association between obesity and psychopathology and, therefore, the conception of obesity as a bio-psycho-social problem requiring a multidisciplinary approach that go beyond the traditional nutritional guidance.

Ziconotide and amnesia: A case report

IntroductionZiconotide is a new class of non-opioid analgesic that selectively blocks the neuron-specific (N-type), voltage-gated calcium channels, preventing the release of substance P and calcitonin gene-related peptide.MethodsA literature search was conducted in September 2015 using Pubmed and Scopus databases. No articles speaking about the direct correlation between ziconotide and amnesia were found.DiscussionA 56-year-old female patient, in treatment with ziconotide for chronic phantom pain syndrome, reported amnesia and dysgeusia symptoms. No psychiatric pathologies were diagnosed except for the high anxiety state correlated to the amnesia for recent events. The ziconotide treatment was reduced from 2,4 μg/day to 1,5 μg/day. Clonazepam was prescribed to treat the anxiety state. The subject clinical conditions did not require hospitalization.ConclusionsIt is recommended that patients in treatment with ziconotide be monitored for changes in mood, suicidality ideation, thoughts or consciousness. Ziconotide could have serious neurological or psychiatric signs/symptoms (Table 1). Amnesia is a rare side effect of intrathecal administration of ziconotide. Severe psychiatric adverse effects may require ziconotide discontinuation, treatment with psychotropic agents and/or acute hospitalization.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Distinct state anxiety after predictable and unpredictable fear training in mice

Sustained fear paradigms in rodents have been developed to monitor states of anxious apprehension and to model situations in patients suffering from long-lasting anxiety disorders. A recent report describes a fear conditioning paradigm, allowing distinction between phasic and sustained states of conditioned fear in non-restrained mice. However, so far no prospective studies have yet been conducted to elucidate whether induction of phasic or sustained fear can affect states of anxiety. Here, we used CS (conditioned stimulus) and US (unconditioned stimulus) pairing with predictable and unpredictable timing to induce phasic and sustained fear in mice. State anxiety during various fear response components was assessed using the elevated plus-maze test. Training with unpredictable CS-US timing resulted in CS-evoked sustained components of fear (freezing), while predictable CS-US timing resulted in rapid decline. Data suggested the influence of training procedure on state anxiety which is dependent on progression of conditioned fear during fear memory retrieval. Animals trained with unpredictable CS-US timing showed an unchanged high anxiety state throughout behavioral observation. In contrast, mice trained with predictable CS-US timing showed anxiolytic-like behavior 3min after CS onset, which was accompanied by a fast decline of the fear conditioned response (freezing). Further systematic studies are needed to validate the phasic/sustained fear model in rodents as translational model for anxiety disorders in humans.

Effects of anxiety on anticipation and visual search in dynamic, time-constrained situations.

We tested the predictions of Attentional Control Theory (ACT) by examining how anxiety affects visual search strategies, performance efficiency, and performance effectiveness using a dynamic, temporal-constrained anticipation task. Higher and lower skilled players viewed soccer situations under 2 task constraints (near vs. far situation) and were tested under high (HA) and low (LA) anxiety conditions. Response accuracy (effectiveness) and response time, perceived mental effort, and eye-movements (all efficiency) were recorded. A significant increase in anxiety was evidenced by higher state anxiety ratings on the MRF-L scale. Increased anxiety led to decreased performance efficiency because response times and mental effort increased for both skill groups whereas response accuracy did not differ. Anxiety influenced search strategies, with higher skilled players showing a decrease in number of fixation locations for far situations under HA compared with LA condition when compared with lower skilled players. Findings provide support for ACT with anxiety impairing processing efficiency and, potentially, top-down attentional control across different task constraints.

Predictors of impaired breastfeeding initiation and maintenance in a diverse sample: what is important?

This study aimed to investigate socio-demographic, medical and psychological factors that have an impact on breastfeeding. Questionnaires were administered to 330 women prenatally (TI third trimester) and postpartum (TII 3-4days, TIII 4months). Medical data were collected from the hospital records. Self-reported data on initiation and maintenance of breastfeeding was collected simultaneously. Primary endpoint was breastfeeding initiation and maintenance. Data analyses were performed using Spearman's ρ correlations between breastfeeding and other study variables and generalized multiple ordinal logistic regression analysis. Neonatal admission to the NICU, high BMI, cesarean section, difficulties with breastfeeding initiation and high maternal state anxiety were the strongest predictors of impaired breastfeeding initiation, explaining together 50% of variance. After 4months, the strongest predictors of impaired maintenance of breastfeeding were maternal smoking, a high BMI and a history of postpartum anxiety disorder, explaining 30% of variance. Successful initiation and maintenance of breast feeding is a multifactorial process. Our results underline the need of interdisciplinary approaches to optimise breastfeeding outcomes by demonstrating the equality of medical and psychological variables. Whereas practices on maternity wards are crucial for optimal initiation, continuous lifestyle modifying and supporting approaches are essential for breastfeeding maintenance. Healthcare providers can also significantly influence breastfeeding initiation and maintenance by counselling on the importance of maternal BMI.

Ironic effects of performance are worse for neurotics

ObjectivesTo conduct the first examination of neuroticism as a predictor of (1) the incidence of what Wegner (1989, 2009) terms ironic processes of mental control and (2) the precision of ironic performance errors under high- and low-anxiety conditions. DesignAcross two studies we employed a repeated-measures design. MethodIn a football penalty-shooting task (Study 1) and a dart-throwing (Study 2) task, under high-anxiety and low-anxiety conditions, participants gained maximum points for hitting a target zone and fewer points for hitting a designated non-ironic error zone. Additionally, we instructed participants to be particularly careful not to hit a designated ironic error zone, because such hits would score minimum points. ResultsAcross both studies within-subjects moderation analyses revealed a consistent moderating effect of neuroticism on the incidence of ironic errors in the high-anxiety condition. Specifically, when anxious, neurotics displayed a significant increase in ironic performance error and a significant decrease in target hits. Importantly, non-ironic error did not differ across anxiety conditions. Additionally, Study 2 results revealed that neuroticism moderated the precision of ironic errors when anxious. Specifically, when anxious, neurotics' ironic error zone hits were significantly farther from the target zone and significantly farther into the ironic error zone than their relatively emotionally stable counterparts’ errors. ConclusionWe provide the first evidence that neuroticism moderates both the incidence and precision of ironic performance errors. These results will enable practitioners in coaching environments to make evidence-based predictions and interventions regarding which individuals are most prone to ironic performance breakdown when anxious.

Relationship between sustained, orientated, divided, and selective attention and simulated aviation performance: Training & pressure effects

The present study examined how different characteristics of visual attention are related to flying ability. Eighty participants completed one of four attentional tests designed to assess sustained attention (SUSTAIN), attentional orienting (ORIENT), divided attention (DIVIDE) or selective attention (SELECT). Median splits were used to create low and high groups. After completing training, participants executed simulated landings under conditions of high anxiety. For the DIVIDE test, there were significant group differences in: (i) landing ability after training and (ii) the effects of anxiety. The high DIVIDE group had lower root mean square (RMS) errors at the end of training and were less affected by anxiety as compared to the low DIVIDE group. For the ORIENT and SELECT tests, there were significant group effects for training but not for anxiety. The high groups for these tests displayed lower RMS errors following training. There were no group differences for the SUSTAIN test. The results suggest that a test of divided attention may be useful for operational assessment of pilots.

Assessing sedation need and managing referred dentally anxious patients: is there a role for the Index of Sedation Need?

To conduct an exploratory investigation of public dental service (PDS) practitioners' planned sedation modality using a structural equation modelling approach, in order to identify the explanatory value of using the Index of Sedation Need (IOSN), or its component parts, to predict sedation modality in patients referred with dental anxiety. A convenience sample of patients referred to the PDS for dental anxiety management was invited to take part. The IOSN was completed for each patient (patient dental anxiety, medical and behavioural indicators and dental treatment complexity) as well as the American Society of Anesthesiologists Physical Status Classification System and the Case Mix Tool. The practitioners completed details of their planned sedation modality and identified normative dental treatment need. The data were entered onto an SPSS v21 database and subjected to frequency distributions, t-tests, correlation analysis and exploratory partial structural equation modelling (SEM). Ninety-five percent of patients were ranked as MDAS 3 or 4, indicating high dental anxiety; 69% had a medical condition, which might impact on dental treatment and 82% had a dental treatment need, which was classified as intermediate/complex according to the IOSN. Eighty-eight percent of the patients in accordance with the IOSN required sedation: 62% of patients were assessed as requiring intravenous sedation. The IOSN discriminated between patients who were assessed as requiring more complex sedation modalities and had a greater normative treatment need. The SEM showed that the patient dental anxiety (P <0.02) and dental treatment complexity (P <0.02) predicted planned sedation modality. Functional morbidity was less strong, as a predictor, and was significant at the ten percent level. The IOSN is a useful and valid assessment of sedation need and predicted sedation modality for patients referred with high dental anxiety states and secondly, that component parts of the IOSN add explanatory value in practitioners' choice of planned sedation modality.

Lifetime victimization and sexual relationship power among substance-abusing African-American women

(HD;N=48), and polysubstance dependent individuals (PD;N=63) in protracted abstinence, and healthy controls (HC; N=95). Methods: We used the elastic net algorithm to identify predictors of group membership that are generalizable to new samples. Predictors included demographic, personality, psychiatric, and neurocognitive measures. Results: HC group membership was predicted by lower scores on externalizing personality (aggression, sensation seeking [SS], impulsivity) and psychiatric (antisocial personality, psychopathy) measures, and better neurocognitive performance on the Iowa Gambling Task and the Go/No-Go task. AD group membership was predicted by lower state anxiety, higher aggression, and higher SS, whereas HD group membership was predicted by the opposite pattern (i.e., higher state anxiety, lower aggression, and lower SS). Higher delay discounting uniquely predicted AD group membership, whereas higher delay aversion predicted HD group membership. History of childhood conduct disorder and higher anxiety sensitivity uniquely predicted PD group membership. Conclusions: These results suggest that different mechanisms may underlie stimulant, opiate, and polysubstance dependence. This line of work may shed light on the development of objective diagnostic tests and more effective treatment programs. Financial support: Supported by R01DA021421 from the National Institute on Drug Abuse (NIDA) and the Fogarty International Center.

Basomedial amygdala mediates top-down control of anxiety and fear.

Anxiety-related conditions are among the most difficult neuropsychiatric diseases to treat pharmacologically, but respond to cognitive therapies. There has therefore been interest in identifying relevant top-down pathways from cognitive control regions in medial prefrontal cortex (mPFC). Identification of such pathways could contribute to our understanding of the cognitive regulation of affect, and provide pathways for intervention. Previous studies have suggested that dorsal and ventral mPFC subregions exert opposing effects on fear, as do subregions of other structures. However, precise causal targets for top-down connections among these diverse possibilities have not been established. Here we show that the basomedial amygdala (BMA) represents the major target of ventral mPFC in amygdala in mice. Moreover, BMA neurons differentiate safe and aversive environments, and BMA activation decreases fear-related freezing and high-anxiety states. Lastly, we show that the ventral mPFC–BMA projection implements top-down control of anxiety state and learned freezing, both at baseline and in stress-induced anxiety, defining a broadly relevant new top-down behavioural regulation pathway.

Psychosocial Factors Associated With Withdrawal From the United Kingdom Collaborative Trial of Ovarian Cancer Screening After 1 Episode of Repeat Screening

The United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) aims to establish the efficacy of 2 different ovarian cancer screening schedules. The psychosocial substudy examines the psychological factors associated with the screening program. Women aged 50 to 75 years from 16 UK gynecologic centers randomized to annual multimodal screening or ultrasound screening (US) groups were followed up for 7 years. Psychosocial data from women who withdrew from the study after a repeat screen were examined. Sixteen percent (3499/21,733) of women requiring a repeat screening test in addition to annual screen withdrew from the study: 12.9% (1560/12,073) from the multimodal group and 20.1% (1939/9660) from the US group. An estimated relative risk of withdrawal is 1.46 (95% confidence interval, 1.36-1.56; P ≤ 0.001) for the US arm. High anxiety trait and increased psychological morbidity significantly influenced withdrawal, even when age, screening center, and group were taken into account (P < 0.001). The risk of withdrawal decreased significantly the longer a woman stayed in UKCTOCS, irrespective of the number of screens and intensity in the preceding year. Withdrawal rate was greater in women undergoing US screening and in those who had repeats earlier in UKCTOCS. Having a high predisposition to anxiety, high current state anxiety, and above threshold general psychological morbidity all increased the withdrawal rate.

Anxiety, anticipation and contextual information: A test of attentional control theory

We tested the assumptions of Attentional Control Theory (ACT) by examining the impact of anxiety on anticipation using a dynamic, time-constrained task. Moreover, we examined the involvement of high- and low-level cognitive processes in anticipation and how their importance may interact with anxiety. Skilled and less-skilled tennis players anticipated the shots of opponents under low- and high-anxiety conditions. Participants viewed three types of video stimuli, each depicting different levels of contextual information. Performance effectiveness (response accuracy) and processing efficiency (response accuracy divided by corresponding mental effort) were measured. Skilled players recorded higher levels of response accuracy and processing efficiency compared to less-skilled counterparts. Processing efficiency significantly decreased under high- compared to low-anxiety conditions. No difference in response accuracy was observed. When reviewing directional errors, anxiety was most detrimental to performance in the condition conveying only contextual information, suggesting that anxiety may have a greater impact on high-level (top-down) cognitive processes, potentially due to a shift in attentional control. Our findings provide partial support for ACT; anxiety elicited greater decrements in processing efficiency than performance effectiveness, possibly due to predominance of the stimulus-driven attentional system.