19 minute read
Attentional control and its correlation with symptoms of generalised anxiety disorder
Attentional control and its correlation with symptoms of generalised anxiety disorder
Chloe Little
Willoughby Girls High School
Abstract
Generalised anxiety disorder (GAD) is one of the most common mental disorders in adults and is characterised by abnormal, ongoing and unrealistic worry about multiple different aspects of daily life. Attentional control, or one’s ability to focus and shift attention in a flexible manner, impacts mood disorders by affecting information processing and emotional regulation. Much research has been conducted to link anxiety and facets of cognitive functioning associated with stimuli processing and attention, e.g., attention to threatening stimuli. Less research targets the connection between anxiety and attentional control in Western participants. In this study, a correlation between generalised anxiety and attentional control was investigated using a crosssectional correlational study with a single group of US adults (N = 213) aged 18 and over (M = 35.29 years old, SD = 13.19), using the self-report questionnaires Generalised Anxiety Disorder Questionnaire-IV (GAD-Q-IV) and the Attention Control Scale (ATTC). A statistically significant (p < 0.05) correlation of -0.508 was obtained. Thus, the presence of a moderate negative link between generalised anxiety and attentional control was found.
Literature review
Generalised anxiety disorder (GAD) is characterised by abnormal, unrealistic, and persistent worry about several different aspects of daily life, such as health, family, finance, and the future. It is one of the most common mental disorders, as an estimated 5.7% of US adults experience it at some point in their lives (National Institute of Mental Health, 2022). Excessive worry is the central feature of GAD. It is difficult to control and often accompanied by many psychological and physical symptoms such as restlessness, fear, irritability, nausea, and dizziness amongst others. The disorder was first introduced by the American Psychological Association in the Diagnostic and Statistical Manual of Mental Disorders-III (DSM-III) where its diagnosis required uncontrollable anxiety or worry that is excessive relative to objective life circumstances and persists for one month or longer.
The Generalised Anxiety Disorder Questionnaire-IV (GAD-Q-IV) is a psychological questionnaire designed to measure self-reported symptoms of GAD, in accordance with updated criteria for the disorder in the DSM-IV. It has 5 yes/no questions and 8 questions where symptoms are rated on a Likert scale ranging from 0 (none) to 8 (very severe). The GAD-Q-IV produces a single score for anxious feelings present and aims to differentiate those with social phobias and panic disorder from those suffering with GAD (Newman et al., 2002). This is important as some symptoms between these disorders are shared. However, the purpose of this questionnaire is not to replace a professional diagnosis of GAD, as it only aims to measure self-reported symptoms Overall, the GAD-Q-IV scale has demonstrated significant clinical validity (Newman et al., 2002), thus it was appropriate for use in this study to determine symptoms of anxiety.
Attentional control is defined as one’s ability to voluntarily focus and shift attention in a flexible manner (Najmi et al., 2014). Attentional control has been observed to play an important role in affective disorders by impacting information processing and emotional regulation (Heitland et al., 2020). Individuals with less control over their attention will have frequent attention shifts, issues maintaining a state of intense focus, and difficulties redirecting and refocusing their attention.
Developed by Derryberry and Reed (2002), the Attention Control Scale (ATTC) is a self-report psychological questionnaire designed to assess individual differences in attentional control (Abasi et al., 2017). It consists of 20 questions measuring two main facets: attention shifting and attention focusing. Each question is measured on a 4-point Likert scale, from 1 (almost never) to 4 (always). The value used in this study was a third value for total attention, an overall sum found by reverse scoring some questions. In a key study by Reinholdt-Dunne et al. (2013), the attention shifting measure was associated with traits of anxiety, and the attention focusing measure was inversely associated with symptoms of depression. This study therefore aimed to measure associations between anxiety and the ATTC scale through the holistic measure of total attention, as anxiety had not yet been explored separately from depression or from the total measure of both shifting and focusing facets.
Key studies investigating the relationship between anxiety and attentional control have been conducted in demographics not generalisable to Western demographics. In a 2011 study, Ólafsson et al. performed a correlational study pertaining to Icelandic adults. Similarly, Abasi et al. (2017) conducted a cross-sectional correlational test concerning the Iranian adult demographic. Both reports conclude correlations between anxiety and attentional control. Alternative questionnaires were used to measure GAD, though both used the ATTC scale which would suggest applicability. While these results are valid, the findings of Ólafsson et al. (2011) and Abasi et al. (2017) are not generalisable to Western populations. Thus, further research is necessary to investigate attentional control and anxious feelings in the United States adult demographic.
Another key example is Pacheco-Unguetti et al. (2012), who investigated whether emotional or anxiety-inducing stimuli impacted attentional control in a Spanish demographic. They concluded that highly anxious participants showed greater impairment (i.e. low attentional control) in disregarding emotional stimuli due to their inflexible attention responses. Similarly, Koster et al. (2006) investigated links between attention to threatening stimuli and high anxious states in a Belgian sample. It was found that attentional biases towards threatening information were highly impactful in highly anxious individuals, as they oriented more strongly to threatening pictures than low anxious individuals. Both Pacheco-Unguetti et al. (2012) and Koster et al. (2006) were key in suggesting links between impaired attentional control and emotional or threatening stimuli. However, they did not examine an individual’s baseline level of attentional control outside the influence of negative stimuli. Due to their respective demographics, further research is required to both apply these findings to English-speaking participants and investigate links between anxiety and baseline attentional control.
Liang (2021) investigated whether socially anxious individuals exhibit poorer attentional control than their non-anxious counterparts by introducing socially evaluative stimuli to both types. Results revealed that the high cognitive load of socially anxious individuals impaired mechanisms of attentional control. This study draws valid conclusions; however, the Taiwanese demographic is not generalisable to Western populations, and social anxiety is only one subset of generalised anxiety. Therefore, further research is necessary to draw wider conclusions. Overall, a broad range of international research has investigated different aspects of attentional control in anxious individuals and suggested links between low attentional control and high anxiety. This study thus aims to expand on previous work through measures of attentional control and GAD in a US sample.
Scientific research question
Does an increased prevalence of anxious feelings correlate with poor attentional control in US adults?
Scientific hypothesis
A negative correlation will be observed between anxiety and attention. As anxiety increases, total attention will decrease.
Methodology
Study was firstly approved with the UNSW ethics board. The questionnaire form was then designed to include the scales PWB-18, DASS-21, ATTC, IUS-12, GAD-Q-IV, DOSPERT, RPS, SCS, PSWQ, CEI-II, MPS, and IS respectively, each measuring a separate psychological construct. Variables of interest (ATTC and GAD-Q-IV) were then selected for comparison, and hypotheses preregistered on the OSF (Open Science Framework). An online cross-sectional correlational study was then conducted with 220 respondents, set location and age (US adults 18 and over), and autobalanced gender demographics, using Qualtrics software on the Prolific Academic paid survey website to maintain controlled demographic variables. Exclusion factors (too long to complete survey, survey completed too quicky, failed attention check) and prescreening criteria (fluent English, one submitted attempt allowed) were applied to participants, reducing valid respondents to 213 of 220. Data was collected in 3 lots, then compiled and cleaned using RStudio (version 2022.12.0+353) and R programming language, including the age and gender demographics of the study. RStudio was also used to calculate means, Pearson Correlation value, determine statistical significance, and construct distribution graph.
Demographics
Respondents consisted of N = 213 people residing in the United States (M = 35.29 years old, SD = 13.19)
Results
Note. N = 213.
* p-value = 2.111e-15 (p < 0.05)
Distribution Graph
Relationship between anxious feelings and attentional control
Discussion
Demographics and conditions of study
Survey respondents consisted of N = 213 people aged 18 and over, residing in the set location of the United States (M = 35.29 years old, SD = 13.19). Exclusion factors, such as taking too long to complete survey, completing survey too quickly, and a failed attention check question, were applied to participants, alongside pre-screening criteria (fluent English, one submitted attempt allowed), which reduced valid respondents to 213 out of the 220 total participants. For a fair and valid test, set demographics such as location and minimum age of respondents were employed as control variables. This was also done to prevent survey fraud by removing invalid responses from the dataset.
As seen in Table 1, the average education level of respondents was a bachelor’s degree, pertaining to 42.25%. Overall, 81.22% of respondents were of an education level higher than high school, with only 1.41% having achieved less than high school. This demographic largely representative of the US population, as the average US high school graduation rate is currently 91.1% (US Census Bureau, 2022). This sample was thus representative of individuals with higher education levels, and further research is required for specific results pertaining to those with lower levels of education. The controlled demographic of the study was beneficial for obtaining valid results for the adult US population specifically. However, this could also be a limitation, as due to the specificity of respondent demographics, the results are not representative of global populations or groups beyond US adults. Thus, these results could vary globally and in different age demographics.
The Qualtrics auto-balanced gender demographics lent validity to the results, as observed in Table 1. Paid survey participants were balanced near-equally between men (49.77%) and women (46.95%), with the remaining 3.3% of participants selfidentifying as non-binary or preferring not to respond. This removed the risk of gender bias and ensured more representative results were obtained, as America’s adult population is 50.4% female and 49.6% male (US Census Bureau, 2022).
Analysis of results
As seen in Table 2, a Pearson correlation (rvalue) of -0.508 was obtained, suggesting the presence of a moderate negative link between GAD and attentional control. This correlation was statistically significant with a p-value less than 0.05, which led to a rejection of the null hypothesis (no significant correlation obtained). In the Figure 1 distribution graph, a negative trend is observed between the variables, which suggests an inverse relationship between generalised anxiety and attentional control, i.e., as anxiety increases, attentional control decreases. However, this trend should not be mistaken for a causative relationship, and further research is needed to establish a causational relationship between high GAD and poor attentional control beyond the presence of a correlation.
Self-selection of online participants
Self-selection of participants was utilised in this study, where all participants individually elected to participate in the paid survey. One limitation of self-selected respondents was that their willingness to participate online as opposed to in-person may correlate with traits such as higher anxiety related to interpersonal interaction, impacting wider representativeness of results. Voluntary participation in online surveys can result in respondents with biases selecting themselves into the sample (Andrade, 2020). Thus, the self-selection of participants held no guarantee that the whole population of US English-speaking adults was represented. If sample frame of this study excluded parts of the population, results may have stronger biases for certain characteristics or behaviours. As the survey was online, it was restricted to people with access to technology and are more likely to be financially stable, thus results could present different psychological traits to those in less financially secure locations worldwide, e.g., in developing countries.
Self-reported data
As it was composed of self-report questionnaires, the study had advantages in the way of efficiency, simplicity and cost-effectiveness. However, biases in respondents may impact the validity and accuracy (truthfulness) of self-report responses. Social desirability bias describes the tendency of survey participants to choose the most socially acceptable option, thereby reducing the validity and truthfulness of their responses (Larson, 2019). However, an advantage of online as opposed to in-person research is the lack of an interviewer reduces the presence of social desirability bias (Ball, 2019). Acquiescence bias describes the general tendency of survey respondents to agree or confirm questionnaire items regardless of their content (Hinz et al., 2007). This negatively impacts validity and distorts the accuracy of results. It tends to be more pronounced in children and adolescents (Kreitschmann et al., 2019). Thus, to reduce the risk of this bias, respondents were of the set age 18 and over as a controlled variable, with M = 35.29 years old (SD = 13.19).
The data quality of self-reported questionnaires depends on the honesty of respondents. Inclusion of dishonest responses will contribute to incorrect estimates of data means, and correlations between constructs (Chandler et al., 2020). This was the reason for the use of exclusion factors, e.g., a failed attention check question, to reduce the prevalence of dishonest or fraudulent responses in the dataset and thus improve its quality overall.
Overall, psychological biases and fraud are key problems in assessing self-report study designs. Nevertheless, when correctly utilised, self-report can provide a wider and more specific range of responses than many other data collection instruments (Althubaiti, 2016).
Accuracy of methodology
Developed by Newman et al. (2002), the fourth edition of the Generalised Anxiety Disorder Questionnaire (GAD-Q-IV) is a selfreport measure commonly used to screen for generalised anxiety disorder (Moore et al., 2014). Since its development, various studies have revealed excellent diagnostic specificity and sensitivity of the GAD-Q-IV, alongside good test-retest reliability and convergent and discriminant validity (Robinson et al., 2010). Thus, the GAD-Q-IV scale can be described as an accurate measure of generalised anxiety disorder symptoms.
Derryberry and Reed (2002) developed the Attentional Control Scale (ATTC) to measure differences in attentional control, or an individual’s ability to voluntarily focus and shift attention in a flexible manner (Najmi et al., 2014). The ATTC scale can validly assess long-term individual differences in attentional skills related to voluntary executive functions. Overall, analysis of its content, internal and construct validity provided evidence of the scale's significant accuracy compared to other attentional tests (Fajkowska and Derryberry, 2010). Therefore, the ATTC has demonstrated considerable accuracy and validity to justify its use in this study.
Future improvements
One key future improvement would be the use of stratified random sampling, which was not used in this study due to its time-consuming and costly nature. In stratified random sampling, the whole population is divided into subgroups (strata) based on a demographic factor (gender, age, socio-economic status, etc.), which random samples are then drawn from. Stratified sampling makes apparent any intergroup differences while obtaining adequate samples from all strata in the population, including those commonly underrepresented (Elfil and Negida, 2017). As the United States is a highly diverse group, its future use would ensure that smaller subgroups within the population are proportionally represented, leading to more accurate and representative findings.
The online survey utilised in this study was efficient and cost effective, but by reproducing the experiment in-person the validity and reproducibility of the experiment could be ensured, given results remain consistent. One benefit of self-report data is it reduces social desirability bias due to the lack of an interviewer (Larson, 2019). Alternatively, in-person interviews are beneficial in eliminating the risk of fraudulent responses and combatting respondent biases to ensure validity (Kreitschmann et al., 2019). A professional in-person assessment of objective physical symptoms in participants, if used in conjunction with self-report, would improve validity while ensuring an individual’s inward experiences and external symptoms can both be measured (Cook, 2017). Thus, by using and comparing results from all measures of participant assessment, the study’s reproducibility could be examined.
The sample size of this study (N = 213) was large enough to make a reasoned claim about a relationship between the chosen variables, and the p-value was less than 0.05, suggesting statistical significance. However, increasing the sample size would further reduce the chance of random correlated results and improve reliability of the data. A larger sample size would also enhance the relevance and applicability of the data to a wider population, and aid in improving precision of results. Future projects might aim to reproduce this study through large-scale census measures, e.g., nationwide or in multiple countries.
Future direction for research
Further research is needed to establish a causational relationship between GAD and poor attentional control beyond the presence of a moderate negative correlation, and could investigate neural similarities between anxiety responses and attentional control as a potential explanation. Correlations could differ in other countries or samples due to cultural and situational differences; global research involving different strata would thus provide more in-depth and representative results for different populations worldwide.
Other ideas for future study may include investigating if correlations change for people professionally diagnosed with anxiety or attention disorders, as the scales used in this research measured symptoms in a general sample not selecting for diagnosis. It is also worth studying the impact of emotions on attentional control, such as happiness or grief. Other potential impacts on attentional control, e.g., sleep or socio-economic status, could also be investigated. These concepts could also be examined in different countries and cultures to determine differences between the groups.
Overall, these findings contribute to our wider understanding of the possible effects of anxious feelings on the attentional control of adults; as a correlation has been established, future researchers should aim to determine whether a causational relationship exists between increased anxious feelings and poor attentional control.
Conclusion
This study aimed to investigate a possible correlation between high generalised anxiety and poor attentional control through a crosssectional correlational study with a single group of US adults (N=213) aged 18 and over, using the self-report questionnaires
Generalised Anxiety Disorder QuestionnaireIV (GAD-Q-IV) and the Attention Control Scale (ATTC). It was hypothesised that a negative correlation would be observed between anxiety and attention; as anxiety increased, total attention would decrease. A statistically significant (p < 0.05) Pearson correlation of0.508 was found and the null hypothesis (no significant correlation) was rejected. The hypothesis of this study was therefore supported, and results suggested the presence of a moderate negative link between GAD and attentional control. Overall, it can be concluded that as symptoms associated with generalised anxiety disorder increase, total attentional control in an individual will decrease.
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