Worry and Stress – A Lit Review

At the SFAA meeting in Seattle, I attended a great session on Food Insecurity and Mental Health organized by Craig Hadley. The session was a follow-up to a National Science Foundation funded workshop on food insecurity and well being held last fall at the University of Kentucky.

David Himmelgreen, my colleague here at USF, gave a talk discussing food insecurity and the local understanding of stress at his field site in Costa Rica. There, stress is often discussed under the rubric of “preocupaciones,” literally preoccupations but better translated as worries or concerns. David linked this local model to both being stressed and to experiencing anxiety.

In the discussion, Tom Leatherman emphasized that notion of “worry” as an important linking factor from insecurity through stress to mental health outcomes, and also applauded the panel’s focus on a broad concept of stressors, including how work and transportation are basic worries for people across the globe.

David and I, along with Nancy Romero-Daza, are planning to look at insecurity, stress, and mental and behavioral health in their long-term fieldsite in Costa Rica. The SFAA panel, and this planned research, prompted me to look more closely at the literature at the intersection of “preocupaciones” and stress.

I have collected a bibliography below that ranges over psychology, neurobiology and anthropology. It becomes clear that worry, from rumination to anxiety, from sensation to language, is a great neuroanthropological problem.

Worry, whether as repetitive and intrusive thoughts or as a way to deal with life events and anticipate future problems, clearly mediates between stress and mental health problems like anxiety and depression. Worry works between the amygdala, the prefrontal cortices, and the insula (at a minimum), and works through rumination and anticipation, while also manifesting itself as a suite of sensations and taking concrete expression in dialogue with others.

Worry does mediate between stress and anxiety. For example, rumination, as internal or dialogic, could lead to anxiety in the face of uncontrolled, unpredictable stressors or in a lack of sense of control, of being able to do anything about it. However, worry, by driving anticipation and dealing better with life events, can also lead to meaning making and coping, as well as lowering the actual impact of potential major stressors.

While the neurobiology matters in this process, particularly in intrusive and repetitive worry that heightens anxiety, the stability of local contexts and the importance of cultural meaning and social relationships also shape how and in what ways worry matters for people.

Bibliography

Borkovec, T. D., J. Ray, and J. Stober
1998 Worry: A cognitive phenomenon intimately linked to affective, physiological, and interpersonal behavioral processes. Journal of Cognitive Therapy and Research 22(6):561-576.

Boutain, D.M
2001 Managing worry, stress and high blood pressure: African-American women holding it together through ‘family’. Ethnicity & Disease 11(4):773.

Boutain, D.M.
2001 Discourses of worry, stress, and high blood pressure in rural south louisiana. Journal of Nursing Scholarship 33(3):225-230.

Brosschot, J.F., W. Gerin, and J.F. Thayer
2006 The perseverative cognition hypothesis: a review of worry, prolonged stress-related physiological activation, and health. Journal of Psychosomatic Research 60(2):113-124.

Davey G.C.L. and Wells, A.
2006 Worry and its psychological disorders: Theory, assessment, and treatment: John Wiley & Sons Inc.

Hinton, D.E., and B. Good
2009 A medical anthropology of panic sensations. Culture and Panic Disorder. Stanford University Press.

Mathew, S.J. et al.
2008 Recent advances in the neurobiology of anxiety disorders: Implications for novel therapeutics. American Journal of Medical Genetics Part C: Seminars in Medical Genetics 148C(2):88-98.

Mohlman, K. et al.
2009 The relation of worry to prefrontal cortex volume in older adults with and without generalized anxiety disorder. Psychiatry Research: Neuroimaging 173(2):121-127.

Nicolson, P., et al.
2008 It’s just the worry about not being able to control it! A qualitative study of living with overactive bladder. British Journal of Health Psychology 13(2):343-359.

Nolen-Hoeksema, S., B. E. Wisco, and S. Lyubomirsky
2008 Rethinking rumination. Perspectives on Psychological Science 3(5):400-424.

Park, C.L., et al.
2008 Meaning making and psychological adjustment following cancer: The mediating roles of growth, life meaning, and restored just-world beliefs. Journal of Consulting and Clinical Psychology 76(5):863.

Park, C.L.
2010 Making sense of the meaning literature: An integrative review of meaning making and its effects on adjustment to stressful life events. Psychological Bulletin 136(2):257.

Roth,E., Ngugi, E., and Fujita,M.
2009 HIV/AIDS Risk and Worry in Northern Kenya. Abingdon, Royaume- UNI: Taylor; Francis

Schoenberg, N. E., et al.
2005 Situating stress: Lessons from lay discourses on diabetes. Medical Anthropology Quarterly 19(2):171-193.

Smith, J.M., and L.B. Alloy
2009 A roadmap to rumination: A review of the definition, assessment, and conceptualization of this multifaceted construct. Clinical Psychology Review 29(2):116-128.

Watkins, E.R.
2008 Constructive and unconstructive repetitive thought. Psychological Bulletin 134(2):163.

Wells, A., and C. Papageorgiou
1995 Worry and the incubation of intrusive images following stress. Behaviour Research and Therapy 33(5):579-583.

Wells, A.
1995 Meta-cognition and worry: A cognitive model of generalized anxiety disorder. Behavioural and Cognitive Psychotherapy 23(03):301-320.

Abstracts:

Borkovec, T. D., J. Ray, and J. Stober
1998 Worry: A cognitive phenomenon intimately linked to affective, physiological, and interpersonal behavioral processes. Journal of Cognitive Therapy and Research 22(6):561-576.

Research on worry during the past 15 years has revealed a remarkable amount of knowledge about this pervasive human phenomenon. Worry involves a predominance of verbal thought activity, functions as a type of cognitive avoidance, and inhibits emotional processing. Worry also produces not only anxious experience but depressive affect as well. Recent evidence suggests that the very private experience of worry is developmentally connected to enmeshed childhood relationships with the primary caregiver and is currently associated with significant interpersonal problems, especially those involving tendency to be overly nurturing to others. At the physiological level, worry is characterized peripherally by parasympathetic deficiency and autonomic rigidity and centrally by left-frontal activation.

Boutain, D.M.
2001 Managing worry, stress and high blood pressure: African-American women holding it together through’family‘. Ethnicity & Disease 11(4):773.

Strategies to manage worry, stress and high blood pressure (HBP) are little understood from the perspective of African Americans. Using data from a qualitative research study in south Louisiana, this article outlines how participants with HBP managed worry and stress through the formation of family. In an exploration of 314 conversations about ‘family,’ African-American women were cited by both women and men as mediators of worry, stress, and HBP. Participants did not necessarily define ‘family’ by blood or marriage relations, unlike the way in which ‘family’ is presented in most HBP research. ‘Family’ was often discussed in terms of how relationships with others were utilized to share knowledge about HBP, to address situations that produced HBP elevation, and to marshal resources to manage HBP.

Boutain, D.M.
2001 Discourses of worry, stress, and high blood pressure in rural south louisiana. Journal of Nursing Scholarship 33(3):225-230.

Purpose: To explore how a sample of rural Louisiana residents constructed accounts about worry and stress in relationship to their high blood pressure. Design: Qualitative study combining critical social theories, African American studies, and critical discourse concepts. Study participants consisted of a convenience sample (N=30) of African American women (n=15) and men (n=15) with high blood pressure. Methods: Over a 4-month period in 1999 a community-based population sample was interviewed twice. Field experiences in the community and the assistance of community consultants were critical to data analysis. Based on 60 interviews, 191 passages about worry and 58 passages about stress were analyzed using discourse analysis. Findings: Participants not only distinguished between worry and stress in their everyday lives, but they also highlighted how those concepts were interrelated. Participants’ concerns about themselves as well as their children, kin, and community were emphasized in passages about worry. Stress was primarily associated with doing multiple tasks and confronting multiple prejudices in the workplace and surrounding community. Conclusions: Participants perceived worry and stress as important health-related concepts that affected their high blood pressure. Nursing strategies designed to address these concerns may better facilitate holistic health.

Brosschot, J.F., W. Gerin, and J.F. Thayer
2006 The perseverative cognition hypothesis: A review of worry, prolonged stress-related physiological activation, and health. Journal of Psychosomatic Research 60(2):113-124.

Perseverative cognition, as manifested in worry and rumination, is a common response to stress, but biopsychological models of stress and health have largely ignored it. These models have generally focused on physiological activation that occurs during stress and have insufficiently addressed effects that occur in anticipation of, or following, stressful events. We argue that perseverative cognition moderates the health consequences of stressors because it can prolong stress-related affective and physiological activation, both in advance of and following stressors. We review evidence that worry, rumination, and anticipatory stress are associated with enhanced cardiovascular, endocrinological, immunological, and neurovisceral activity. The findings yield preliminary support for our hypothesis, suggesting that perseverative cognition might act directly on somatic disease via enhance activation via the cardiovascular, immune, endocrine, and neurovisceral systems.

Davey G.L.C. and Wells, A.
2006 Worry and Its Psychological Disorders: Theory, Assessment, and Treatment: John Wiley & Sons Inc.

Anxiety-based disorders are among the most common mental health problems experienced in the population today. Worry is a prominent feature of most anxiety-based disorders including generalized anxiety disorder, specific phobias, obsessive-compulsive disorder, panic disorder, and post-traumatic stress disorder. Written by international experts, Worry and its Psychological Disorders offers an up-to-date and complete overview of worry in a single volume. Divided into four sections, the book explores the nature of worry, the assessment of worry, contemporary theories of chronic and pathological worry, and the most recently developed treatment methods. It includes in-depth reviews of new assessment instruments and covers treatment methods such as Cognitive Behavioural Therapy and Metacognitive Therapy. Useful case studies are also included. This important volume provides an invaluable resource for clinical practitioners and researchers. It will also be of relevance to those studying clinical or abnormal psychology at advanced level.

Hinton, D.E., and B. Good
2009 A medical anthropology of panic sensations. Culture and Panic Disorder. Stanford University Press.

Chapter opening: This chapter provides an analysis of panic and panic disorder from the perspective of a medical anthropology of sensations. Our overall argument is that sensation is not precultural but is very much embedded in culture. It follows that cross cultural analysis of panic experiences and panic disorder, dependent as they are on the experience and interpretation of particular sensations, requires an explicit framework for the analysis of sensation. In the following pages we outline such a framework and illustrate its utility for understanding panic and panic disorder from a cultural perspective.

Book: Psychiatric classifications created in one culture may not be as universal as we assume, and it is difficult to determine the validity of a classification even in the culture in which it was created. Culture and Panic Disorder explores how the psychiatric classification of panic disorder first emerged, how medical theories of this disorder have shifted through time, and whether or not panic disorder can actually be diagnosed across cultures.

Mathew, S.J. et al.
2008 Recent advances in the neurobiology of anxiety disorders: Implications for novel therapeutics. American Journal of Medical Genetics Part C: Seminars in Medical Genetics 148C(2):88-98.

Anxiety disorders are a highly prevalent and disabling class of psychiatric disorders. This review focuses on new directions in neurobiological research and implications for the development of novel psychopharmacological treatments. Neuroanatomical and neuroimaging research in anxiety disorders has centered on the role of the amygdala, reciprocal connections between the amygdala and the prefrontal cortex, and, most recently, alterations in interoceptive processing by the anterior insula. Anxiety disorders are characterized by alterations in a diverse range of neurochemical systems, suggesting ample novel targets for drug therapies. Corticotropin-releasing factor (CRF) concentrations are elevated in a subset of anxiety disorders, which suggests the potential utility of CRF receptor antagonists. Pharmacological blockade of the memory-enhancing effects of stress hormones such as glucocorticoids and noradrenaline holds promise as a preventative approach for trauma-related anxiety. The glutamatergic system has been largely overlooked as a potential pharmacological target, although convergent preclinical, neuroimaging, and early clinical findings suggest that glutamate receptor antagonists may have potent anxiolytic effects. Glutamatergic receptor agonists (e.g., D-cycloserine) also have an emerging role in the treatment of anxiety as facilitators of fear extinction during concurrent behavioral interventions. The neuropeptides substance P, neuropeptide Y, oxytocin, orexin, and galanin are each implicated in anxiety pathways, and neuropeptide analogs or antagonists show early promise as anxiolytics in preclinical and/or clinical research. Each of these active areas of research holds promise for expanding and improving evidence-based treatment options for individuals suffering with clinical anxiety.

Mohlman, K. et al.
2009 The relation of worry to prefrontal cortex volume in older adults with and without generalized anxiety disorder. Psychiatry Research: Neuroimaging 173(2):121-127.

Despite the widespread prevalence of generalized anxiety disorder (GAD) in later life, almost nothing is known about the neural aspects of worry in adults over the age of 60. Given the ongoing rapid increase in the older adult population, the relatively poor response rates to current interventions for late life GAD, and the effects of age-related changes to the brain, additional research on worry neurobiology is needed. The study group comprised 15 older GAD patients and 15 matched controls who were compared on clinical measures and brain volumes. It was expected that prefrontal cortex (PFC) volumes [medial orbital cortex (mOFC), dorsolateral cortex (DLPFC)] would show positive relations to worry scores, and weaker relations to more general measures of anxiety and depression. Negative relations were expected between amygdala volumes and worry scores. As expected, mOFC volumes were positively related to worry scores; however, DLPFC and amygdala volumes were not. The mOFC is involved in emotional decision-making under uncertain conditions and has the ability to suppress the amygdala, both of which are hypothesized functions of worry. Results are partly consistent with GAD theory and suggest that worry may involve neural areas that are also involved in the successful control of anxiety.

Nicolson, P., et al.
2008 It’s just the worry about not being able to control it! A qualitative study of living with overactive bladder. British Journal of Health Psychology 13(2):343-359.

Objectives. This study reports the perceptions of patients with a diagnosis of OAB and people with undiagnosed OAB symptoms about their health-related quality of life (HRQL) and psychological consequences. Design. A qualitative study which employed a series of in-depth, semi-structured individual and group interviews using thematic and interpretive techniques of data analysis. Methods. A mixture of previously diagnosed patients and people bothered by OAB symptoms were recruited from three British cities. The interviews explored issues around HRQL. Data were transcribed verbatim and analysed thematically to draw out the context in which people experience OAB. The study design was reviewed by a Multi-Centre Research Ethics Committee and subjected to local research governance. Results. OAB has devastating consequences for sufferers of both sexes which impact upon their HRQL, self-esteem and relationships. OAB without incontinence causes anxiety, fear of incontinence, a sense of depression and hopelessness all of which are worse for those with incontinence. Many sufferers feel too embarrassed to seek medical care. Conclusions. The psychological and HRQL consequences for OAB sufferers overlap with trajectories associated with chronic illness. However, because many sufferers avoid admitting to the condition and/or seeking treatment the psychological costs to them are even greater than with a diagnosed illness because the disruption remains unacknowledged and therefore unresolved.

Nolen-Hoeksema, S., B. E. Wisco, and S. Lyubomirsky
2008 Rethinking rumination. Perspectives on Psychological Science 3(5):400-424.

The response styles theory (Nolen-Hoeksema, 1991) was proposed to explain the insidious relationship between rumination and depression. We review the aspects of the response styles theory that have been well-supported, including evidence that rumination exacerbates depression, enhances negative thinking, impairs problem solving, interferes with instrumental behavior, and erodes social support. Next, we address contradictory and new findings. Specifically, rumination appears to more consistently predict the onset of depression rather than the duration, but rumination interacts with negative cognitive styles to predict the duration of depressive symptoms. Contrary to original predictions, the use of positive distractions has not consistently been correlated with lower levels of depressive symptoms in correlational studies, although dozens of experimental studies show positive distractions relieve depressed mood. Further, evidence now suggests that rumination is associated with psychopathologies in addition to depression, including anxiety, binge eating, binge drinking, and self-harm. We discuss the relationships between rumination and worry and between rumination and other coping or emotion-regulation strategies. Finally, we highlight recent research on the distinction between rumination and more adaptive forms of self-reflection, on basic cognitive deficits or biases in rumination, on its neural and genetic correlates, and on possible interventions to combat rumination.

Park, C.L.
2010 Making sense of the meaning literature: An integrative review of meaning making and its effects on adjustment to stressful life events. Psychological Bulletin 136(2):257.

Interest in meaning and meaning making in the context of stressful life events continues to grow, but research is hampered by conceptual and methodological limitations. Drawing on current theories, the author first presents an integrated model of meaning making. This model distinguishes between the constructs of global and situational meaning and between “meaning-making efforts” and “meaning made,” and it elaborates subconstructs within these constructs. Using this model, the author reviews the empirical research regarding meaning in the context of adjustment to stressful events, outlining what has been established to date and evaluating the strengths and weaknesses of current empirical work. Results suggest that theory on meaning and meaning making has developed apace, but empirical research has failed to keep up with these developments, creating a significant gap between the rich but abstract theories and empirical tests of them. Given current empirical findings, some aspects of the meaning-making model appear to be well supported but others are not, and the quality of meaning-making efforts and meanings made may be at least as important as their quantity. This article concludes with specific suggestions for future research.

Park, C.L., et al.
2008 Meaning making and psychological adjustment following cancer: The mediating roles of growth, life meaning, and restored just-world beliefs. Journal of Consulting and Clinical Psychology 76(5):863.

Cancer survivors’ efforts at meaning making may influence the extent to which they successfully make meaning from their experience (i.e., experience posttraumatic growth, find life meaningful, and restore beliefs in a just world), which may, in turn, influence their psychological adjustment. Previous research regarding both meaning making processes and meanings made as determinants of adjustment has shown inconsistent effects, partly because of the lack of clearly articulated theoretical frameworks and problematic research strategies. In a 1-year longitudinal study, the authors distinguished the meaning making process from the outcomes of that process (meanings made), employing specific measures of both. The authors tested pathways through which meaning making efforts led to 3 different meanings made (growth, life meaning, and restored just-world belief) in a sample of 172 young to middle-age adult cancer survivors, and they explored whether those meanings made mediated the effect of meaning making efforts on psychological adjustment. Cross-sectional and longitudinal path models of the meaning making process indicate that meaning making efforts are related to better adjustment through the successful creation of adaptive meanings made from the cancer experience. The authors conclude with clinical implications and suggestions for future research.

Roth,E., Ngugi, E., and Fujita,M.
2009 HIV/AIDS Risk and Worry in Northern Kenya. Abingdon, Royaume- UNI: Taylor; Francis

Data from a 2003 survey of sexual behaviour (n = 400) conducted in the Ariaal community of Karare, Marsabit District, northern Kenya, were used to delineate patterns of risk and worry about contracting HIV/AIDS. Despite widespread reporting of high-risk sexual behaviours (including multiple partners, concurrency, sexual mixing and not using condoms) by survey participants, logistic regression analysis found only one statistically significant positive association between these behaviours and self-assessment of being at high risk of contracting HIV/AIDS. In contrast, log-linear analysis of worry patterns found highly significant relationships between self-assessment of high risk of HIV/AIDS and worry about one’s partner’s sexual behaviour. These findings indicate that in relation to contracting HIV/AIDS currently Ariaal are more concerned about the sexual behaviour of others, rather than their own behaviour. More generally, results point to the potential for combining concepts of worry with risk assessment in HIV/AIDS research to generate insights into how both concepts are linked to individual, dyadic and population-level factors within specific cultural settings

Schoenberg, N. E., et al.
2005 Situating stress: Lessons from lay discourses on diabetes. Medical Anthropology Quarterly 19(2):171-193.

In response to the serious toll diabetes takes on health and resources, researchers increasingly are examining physical and psychological pathways that affect and are affected by diabetes, including stress. Although biomedical researchers and practitioners are beginning to recognize the association between stress and diabetes onset and management, laypersons have long-standing and extensive insights into the multiple ways in which stress is associated with the diabetes disease process. In this article, we examine lay perspectives on stress and diabetes among a multiethnic sample of 80 adults. Participants suggest varying arenas in which stress intersects with diabetes, including stress as implicated in the origin of diabetes, as a threat to maintaining glycemic control, as a challenge to self-management, and as a precursor to and a consequence of diabetes complications. An improved understanding of such perspectives may enhance appropriate disease management and develop a more valid conceptualization of stress in research efforts.

Smith, J.M., and L.B. Alloy
2009 A roadmap to rumination: A review of the definition, assessment, and conceptualization of this multifaceted construct. Clinical Psychology Review 29(2):116-128.

Rumination has been widely studied and is a crucial component in the study of cognitive vulnerabilities to depression. However, rumination means different things in the context of different theories, and has not been uniformly defined or measured. This article aims to review models of rumination, as well as the various ways in which it is assessed. The models are compared and contrasted with respect to several important dimensions of rumination. Guidelines to consider in the selection of a model and measure of rumination are presented, and suggestions for the conceptualization of rumination are offered. In addition, rumination’s relation to other similar constructs is evaluated. Finally, future directions for the study of ruminative phenomena are presented. It is hoped that this article will be a useful guide to those interested in studying the multi-faceted construct of rumination.

Watkins, E.R.
2008 Constructive and unconstructive repetitive thought. Psychological Bulletin 134(2):163.

The author reviews research showing that repetitive thought (RT) can have constructive or unconstructive consequences. The main unconstructive consequences of RT are (a) depression, (b) anxiety, and (c) difficulties in physical health. The main constructive consequences of RT are (a) recovery from upsetting and traumatic events, (b) adaptive preparation and anticipatory planning, (c) recovery from depression, and (d) uptake of health-promoting behaviors. Several potential principles accounting for these distinct consequences of RT are identified within this review: (a) the valence of thought content, (b) the intrapersonal and situational context in which RT occurs, and (c) the level of construal (abstract vs. concrete processing) adopted during RT. Of the existing models of RT, it is proposed that an elaborated version of the control theory account provides the best theoretical framework to account for its distinct consequences.

Wells, A., and C. Papageorgiou
1995 Worry and the incubation of intrusive images following stress. Behaviour Research and Therapy 33(5):579-583.

This study investigated the effects of post-event processing on intrusive images following exposure to stress. It was hypothesized that ruminative activity, especially verbal worry about a stressor leads to an incubation of intrusions. Five groups which differed in the use of post-event processing strategies were used to test for a hypothesized co-joint mechanism underlying the effect. Worrying about a stressor for a period of 4 min after exposure led to significantly more intrusions in the next 3 days than a settle-down control condition. The strategies of imaging about the stressor, distraction, and worrying about usual concerns, produced a significant incremental linear pattern of intrusions across these groups. The pattern of results was as predicted by a co-joint model in which incubation results from ‘tagging’ of memories and blocked emotional processing. The clinical implications of these findings are briefly discussed.

Wells, A.
1995 Meta-cognition and worry: A cognitive model of generalized anxiety disorder. Behavioural and Cognitive Psychotherapy 23(03):301-320.

A meta-cognitive classification and analysis of factors contributing to the development of problematic worry is presented. Dimensions of meta-beliefs, meta-worry, cognitive consciousness, and strategies can be distinguished. A cognitive model of Generalized Anxiety Disorder is advanced based on this framework in which GAD results from an interaction between the motivated use of worry as a coping strategy, negative appraisal of worry, and worry control attempts. These factors result from combinations of dysfunctional meta-beliefs and contribute to subjectively diminished cognitive control. The model presents new implications for a cognitive therapy of GAD, and these are illustrated with a single case treatment study.

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4 Responses to Worry and Stress – A Lit Review

  1. Erin Finley says:

    This is a terrific area of focus – thank you for sharing your bibliography! So look forward to hearing more about the work in Costa Rica as it progresses.

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  2. Samantha Hurst says:

    Really impressed by this blog. Not just the wonderful bib + annotations (which are illuminating to the neurobiology component of this topic) … but also the cultural intuitiveness of providing examples of the variations in the lexicon of stress. The notion of “preoccupations” rather than the over-used, all inclusive idea of “stress” is a much better anchor for inquiry about repetitive or intrusive thoughts. Nice reminder!

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  3. Pingback: Stressed? Who isn’t? | ontheshelves

  4. Pingback: Great links for the weekend!

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