(PS2-B29) Anxiety, Worry, and Subjective Difficulty Concentrating: Examining Concurrent and Prospective Symptom Relationships in the Context of the COVID-19 Pandemic

Background: Difficulty concentrating is an understudied cognitive phenomenon, despite its status as a diagnostic criterion for generalized anxiety disorder and contributor to clinically significant distress and impairment. Existing theoretical accounts of the observed relationship between worry and subjective difficulty concentrating rely on a deficit model, in which impairments in trait attentional control render anxious individuals vulnerable to pathological worry. However, worse attentional task performance is not reliably associated with subjective difficulty concentrating in daily life. Alternatively, anxiety could be framed as a source of attentional interference via its primary cognitive manifestation, worry, along two potential pathways. Within-person variability in worry (e.g., short-term elevations relative to individual baselines) may interfere concurrently with attentional performance. Between-person differences in average worry severity may prospectively interfere with attention through increased attentional bias to threat. The present study examined concurrent and prospective relationships between anxiety, worry, and difficulty concentrating over time in an adult sample spanning the full range of anxiety symptoms.

Methods: The current study examined the associations between anxiety (Depression Anxiety Stress Scales-21), worry (Penn State Worry Questionnaire), and subjective difficulty concentrating (Attentional Control Scale) in an adult sample (N = 723, 70.86% female) aged 19-81 years (M = 34, SD = 14.70). Data were drawn from a larger study of psychopathology during the COVID-19 pandemic. Online surveys were administered at three timepoints: April/May 2020, July/August 2020, and September/October 2020. Two linear mixed-effects models were constructed to examine within- and between-person effects of anxiety on worry, and worry on difficulty concentrating, while controlling for clustering within individuals over time.

Results: Worry at each timepoint was significantly predicted by between-person differences in average anxiety (b = 0.92, SE = 0.03, p < .001) as well as within-person variation in anxiety (b = -0.83, SE = 0.02, p < .001). This model had a significantly better fit than a model with only between-person anxiety as a predictor (c2 = 1138.60, p < .001). Difficulty concentrating at each timepoint was significantly predicted by between-person differences in average worry (b = 0.27, SE = 0.02, p < .001) as well as within-person variation in worry (b = -0.15, SE = 0.02, p < .001). This model had a significantly better fit than a model with only between-person worry as a predictor (c2 = 88.56, p < .001).

Discussion: Between- and within-person variability in worry severity were significant predictors of subjective difficulty concentrating in a naturalistic longitudinal dataset. These preliminary findings support theoretical accounts of worry as a cognitive mechanism linking anxiety with subjective attentional problems. Future research should continue to examine mechanistic pathways by which worry may interfere with attention, with the goal of developing more effective interventions for anxiety-related difficulty concentrating and associated functional impairment.