Worry Amplifies Theory-of-Mind Reasoning of Negatively Valenced Social Stimuli in Generalized Anxiety Disorder

Restricted (Penn State Only)
Zainal, Nur Hani
Graduate Program:
Master of Arts
Document Type:
Master Thesis
Date of Defense:
May 01, 2017
Committee Members:
  • Michelle Gayle Newman, Thesis Advisor
  • Amy Dyanna Marshall, Committee Member
  • Reginald Adams Jr., Committee Member
  • generalized anxiety disorder
  • theory-of-mind
  • anxiety disorders
  • cognition
  • cognitive behavioral therapy
Background: Theory-of-mind (ToM) is the ability to accurately infer others’ thoughts and feelings. In generalized anxiety disorder (GAD), ToM is likely to be conditional on the degree of individuals’ state worry, a hallmark symptom. However, no experiments have directly tested such interactional hypotheses, and used ToM as a framework to advance understanding of social cognition in GAD. This study aimed to address this gap by primarily examining the interactional effect of state worry and trait GAD. Method: 171 participants (69 GAD, 102 Controls) were randomly assigned to either a Worry or Relaxation induction and completed two well-validated ToM decoding (Reading the Mind in the Eyes Test) and reasoning (Movie for the Assessment of Social Cognition) tasks. Results: Clinical trait GAD significantly interacted with state worry to predict accuracy of overall reasoning, cognitive-reasoning, positive-reasoning, and negative-reasoning ToM. Worry, as opposed to relaxation, led GAD sufferers to display more accurate overall reasoning and cognitive-reasoning ToM than controls, especially for negative signals. GAD participants who worried, but not relaxed, were also significantly better than the norm at interpreting negative signals. These findings remained after controlling for gender, executive function, social anxiety, and depressive symptoms. For other ToM abilities, mean scores of persons with and without GAD who either worried or relaxed were normative. Limitations: The ToM reasoning measure lacked self-reference, and these preliminary findings warrant replication. Conclusions: Theoretical implications, such as the state worry-contingent nature of ToM in GAD, and clinical implications are discussed.