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Int J Psychophysiol. 2014 Sep;93(3):349-55. doi: 10.1016/j.ijpsycho.2014.05.010. Epub 2014 May 27.

Worry as an adaptive avoidance strategy in healthy controls but not in pathological worriers.

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IRCCS Santa Lucia Foundation, Rome, Italy.
Department of Psychology, University of Bologna, Bologna, Italy.
Studi Cognitivi, Post Graduate Cognitive Psychotherapy School, Milano, Modena and San Benedetto del Tronto, Italy.
Studi Cognitivi, Post Graduate Cognitive Psychotherapy School, Milano, Modena and San Benedetto del Tronto, Italy; Azienda Sanitaria di Bolzano, Italy.
Psicoterapia Cognitiva e Ricerca, Post Graduate Cognitive Psychotherapy School, Milano and Bolzano, Italy. Electronic address:


The cognitive avoidance model of worry assumes that worry has the adaptive function to keep under control the physiological arousal associated with anxiety. This study aimed to test this model by the use of a fear induction paradigm in both pathological and healthy individuals. Thirty-one pathological worriers and 36 healthy controls accepted to be exposed to a fear induction paradigm (white noise) during three experimental conditions: worry, distraction, and reappraisal. Skin conductance (SCR) and heart rate variability (HRV) were measured as indices of sympathetic and parasympathetic nervous system functioning. Worriers showed increased sympathetic and decreased parasympathetic activation during the worry condition compared to non-worriers. There were no differences between groups for the distraction and reappraisal conditions. SCRs to the white noises during worry were higher in worriers versus controls throughout the entire worry period. Intolerance of uncertainty - but not metacognitive beliefs about worry - was a significant moderator of the relationship between worry and LF/HF-HRV in pathological worriers. Results support the cognitive avoidance model in healthy controls, suggesting that worry is no longer a functional attitude when it becomes the default/automatic and pathological response.


Cognitive avoidance model; Heart rate variability; Skin conductance response; White noise; Worry

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