Difficulty concentrating in generalized anxiety disorder: An evaluation of incremental utility and relationship to worry
Difficulty concentrating in generalized anxiety disorder: An evaluation of incremental utility and relationship to worry
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DOI：
10.1016/j.janxdis.2017.10.007
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发表时间：
2018-01-01
影响因子：
10.3
通讯作者：
Kusmierski, Susan N.
中科院分区：
文献类型：
--
作者：
Hallion, Lauren S.;Steinman, Shari A.;Kusmierski, Susan N.
注意力难以集中是DSM-5分类中最常见的诊断标准之一，特别是在情绪（情绪和焦虑相关）障碍中。大量的文献已经使用客观（行为）计算机化认知任务描述了情绪障碍的认知功能。然而，诊断通常是基于对症状的主观（自我报告;临床医生评定）评估形成的，并且对作为症状的注意力集中困难知之甚少。这些问题对于广泛性焦虑症（GAD）尤其重要，它长期以来一直是疾病分类学辩论的主题，并且已经提出了几种理论模型，这些模型表明认知障碍（包括难以集中注意力）在维持精神病理学中的核心作用。本研究评估了175名GAD诊断的成年人的注意力集中困难的增量效用及其与担忧和其他症状的关系。即使在其他GAD症状得到控制后，临床医生评估的注意力集中困难增量预测临床医生评定的GAD、焦虑和抑郁严重程度。与广泛性焦虑症的理论模型一致，该模型提出了担忧和认知障碍之间的直接关系，难以集中注意力介导了特质担忧和临床严重程度之间的关系。这些发现表明，注意力难以集中作为一个诊断标准是有价值的，是一个潜在的机制，担心增加痛苦和损害。
Difficulty concentrating is one of the most common diagnostic criteria across DSM-5 categories, especially within the emotional (mood- and anxiety-related) disorders. A substantial literature has characterized cognitive functioning in emotional disorders using objective (behavioral) computerized cognitive tasks. However, diagnoses are typically formed on the basis of subjective (self-reported; clinician-rated) assessments of symptoms, and little is known about difficulty concentrating as a symptom. These questions are particularly important for generalized anxiety disorder (GAD), which has long been the subject of nosological debates, and for which several theoretical models that suggest a central role for cognitive impairments (including difficulty concentrating) in the maintenance of psychopathology have been proposed. The present study evaluated the incremental utility of difficulty concentrating and its relationship to worry and other symptoms in 175 GAD-diagnosed adults. Clinician assessed difficulty concentrating incrementally predicted clinician-rated GAD, anxiety, and depression severity even after other GAD symptoms were controlled. Consistent with theoretical models of GAD that propose a direct relationship between worry and cognitive impairment, difficulty concentrating mediated the relationship between trait worry and clinical severity. These findings suggest that difficulty concentrating has value as a diagnostic criterion and is a potential mechanism by which worry increases distress and impairment.