How Anxiety Impacts the Way We Perceive and Think

Source: By fizkes/Shutterstock

How we see, hear, and think about what we experience within and outside ourselves determines who we are and how we relate to the world. Disorders such as anxiety not only interfere with but also impair these processes, creating a distorted view of our internal and external worlds.

According to many researchers, working memory is the most important of the perceptual and cognitive functions. Our ability to learn new skills—from driving and golfing to mathematics and meditation—to master attentional skills, meet goals, plan a vital activity, and make decisions and choices all rely heavily on an effective and efficient working memory.

Working memory acts as a sketchpad that enables the performance of the above wide-ranging tasks. Once the relevant set of information for a task is obtained, that information has to be held in memory, organized, manipulated, and updated so that the task can be performed accordingly. Take the example of the complex reading span test, which is a test used to measure the size of the working memory space. Subjects see a set of words depending on how many they can recall correctly. After each word, a statement is presented for the subject to determine if it is true or false. The task requires the subject to manipulate, encode, and hold the words in memory while carrying out the competing task of reading the sentence and determining whether it is true or false (Daneman & Carpenter, 1980).

Many complex cognitive processes, such as attention, inhibition of distractors, shifting from one sub-task to another, strategic online monitoring of performance, instant detection of errors and their correction, and the updating of ongoing information are necessary for the effective and efficient completion of working memory tasks.

Increasing evidence shows that anxiety hurts both working memory space and cognitive processes to varying degrees, and adverse effects occur. Studies have conclusively shown that people with anxiety automatically perceive threats over other stimuli at the expense of crucial ongoing tasks (Bar-Haim et al., 2007). A person with severe anxiety is also likely to have difficulty separating himself or herself from frightening images and words, preventing him or her from returning to perform the task (Grant et al., 2015).

The instant perceptual bias towards threats in anxiety persists into subsequent cognitive processes. The bias affects both the amount of verbal and visual-spatial information that working memory can hold, as well as the cognitive processing of the relevant information. When subjects were tested to determine how many digits they could hold in memory in a complex working memory capacity test, subjects with high anxiety held much fewer digits compared to those with low anxiety (Diamond, 2013). The capacity to hold verbal information was also a lot less with high anxiety subjects who were made to worry, as compared to those who were not. (Leigh & Hirsch, 2011). However, numerous studies show that the amount of information held in working memory during the performance of a task determines the degree of impairment caused by anxiety. When the amount of information held in memory is low to medium, anxiety impairs working memory capacity significantly because the cognitive processes that are not required for carrying out the task are available for processing threat distractors. However, when the load is high, anxiety impairs the capacity of working memory much less since all of the resources are consumed by processing the high load of information, and little to no working memory is available to attend to the distracting threats (Derakshan, N., et.al., 2009).

Robust evidence shows that anxiety impairs each of the specific cognitive processes responsible for carrying out the multicomponent tasks of working memory. Studies show that people with elevated anxiety are not able to inhibit threatening distractors as compared to neutral stimuli during a cognitive function. They fail to disengage from the threat and return to the task (Grant et al., 2015). Other studies show that people with elevated anxiety fail or take a long time to shift from one cognitive set to another during the performance of a working memory task (Ansari & Derakshan, 2011). Given that working memory tasks consist of multicomponent sets of a task, the ability to readily move from one to another is critical for the correct and rapid performance of the task.

Impairment of attention, inhibition, and shifting interferes with the functions of monitoring and updating. Constant updating of sub-tasks during the performance of any learning and goal-oriented task prevents awareness of errors (Folstein & Petten, 2008). Strategic online monitoring of performance at each of the various sub-stages of a task aims to identify the mistakes early on so they can be corrected instantly. Undetected errors compromise the performance of the subsequent tasks. Instant detection and correction of errors help to conserve and distribute the limited cognitive resources and their allocation to subsequent sub-tasks. Studies show that people with clinical anxiety tend to have elevated error-related negativity (ERN), a specific evoked response potential (ERP)—a method used to aggregate brain activity in a particular region of the brain—that measures error and its correction (Gehring et al., 1993).

Updating is a process of continuously adding new relevant information to existing ones according to the demands of the sub-task or when unforeseen situations occur during the ongoing performance of a task. During this process, the data undergoes multiple transformations and substitutions. The ability to update effectively has been shown to be a significant predictor of higher mental skills, such as fluid intelligence.

Based on these findings, researchers have developed two major treatment protocols, namely attentional bias modification (ABM) and cognitive bias modification (CBM) (Amir et al., 2009), (Macleod et al., 2012). These protocols involve the manipulation of attention away from threatening stimuli to the neutral. Studies show that both protocols demonstrate small to moderate effects. However, they also appear to be less effective than existing empirically proven treatments for anxiety. Moreover, researchers have raised questions about whether training an individual to move away from a threatening stimulus increases avoidance behavior, which has been shown to increase anxiety in the long run.

Anxiety Essential Reads

Helping Children with Performance Anxiety

How I Quickly Stopped a Panic Attack

Researchers have suggested that since attentional bias to threat is sustained for long periods, replacing the brief 500-millisecond presentations, used in ABM and CBM to move attention away from the threat, with more extended periods of presentations is likely to produce more effective results. However, anxiety disorders are complex and often have roots in stressful and conflictual early childhood environmental and developmental conditions. Without addressing these factors, it seems unlikely that prolonging the period of presentation and moving attention away from the threat, even though helpful, will resolve the underlying causes of anxiety.