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Title: Does anxiety affect working memory, and if so, what can be done about it


1
Does anxiety affect working memory, and if so,
what can be done about it?
  • Nathaniel Atkin, MS IV
  • University of Vermont College of Medicine
  • February, 2009

2
The Road Map
  • Review of clinical questions
  • Methods and search terms
  • Review selected papers
  • Discussion and implication for learning and
    education

3
Questions
  • What is Working Memory?
  • What is the effect of anxiety on working memory?
  • What is the evidence for interventions addressing
    the adverse effect of anxiety on working memory
    and test performance?

4
Methods and Search Terms
  • The Cochrane Library
  • exercise anxiety
  • performance anxiety
  • meditation anxiety
  • Google Scholar
  • reduce test performance anxiety
  • Medline (Ovid)
  • working memory anxiety (69)
  • yoga anxiety
  • PsychInfo
  • working memory anxiety
  • reduce (working memory)
  • PubMed
  • cortisol working memory (111)
  • fmri stress induced anxiety (10)

5
Literature Caveats
  • Working memory anxiety/stress interaction
    literature largely confined to adult population
  • Heavily weighted with studies of pathological
    anxiety disorder patient populations

6
Question 1
  • What is working memory?

7
A Capacity Theory of Comprehension Individual
Differences in Working Memory
  • Computational Theory
  • Basic commodity Activation
  • Limited Capacity
  • Storage, processing and maintenance functions
  • Processes occur in parallel
  • When tasks exceed available capacity, storage and
    computational functions are degraded
  • Capacity constrained comprehension
  • Elemental constructs represent words, phrases,
    propositions, grammatical structures, thematic
    structures, external objects

1. Just Carpenter, 1992
8
Question 2
  • What is the effect of anxiety on working memory?

9
Call it what you will
  • Poor attention
  • Distraction
  • Split attention
  • Wandering mind
  • Sustained focus
  • Boredom

Logically, anxiety will degrade your ability to
attend to a given task.
10
Stress effects on working memory, explicit
memory, and implicit memory for neutral and
emotional stimuli in healthy men
  • Papez Circuit elements w/ high density
    glucocorticoid receptors

2. Luethi et al., 2009
11
Papez Circuit
http//en.wikipedia.org/wiki/Papez_circuit
12
Stress effects on working memory, explicit
memory, and implicit memory for neutral and
emotional stimuli in healthy men
  • Papez Circuit elements w/ high density
    glucocorticoid receptors
  • Hippocampus prefrontal cortex-dependent memory
    follows inverted U-shaped response to stress
  • Assess stress and cortisol effect on memory
    systems (working, implicit, explicit)
  • WM assessed by reading span task
  • Stress environment resulted in negative impact by
    experimental measure
  • Suggest stress reduces efficiency of PFC and
    facilitates amygdala

2. Luethi et al., 2009
13
Perfusion functional MRI reveals cerebral blood
flow pattern under psychological stress
  • Arterial spin labeled perfusion measure of
    cerebral blood flow subtraction study low vs.
    high stress task
  • Serial verbal counting under stress vs. non
    stress
  • Positively correlated to subjective stress,
    anxiety difficulty scores and salivary cortisol
    levels
  • Persistent activation of ventral right prefrontal
    cortex, anterior cingulate cortex
  • Observed activation of left insula and putamen
  • Functional Imaging correlation to previously
    predicted data

3. Wang et al., 2005
14
Psychosocial stress induces working memory
impairments in an n-back paradigm
  • Evaluated effect of psychosocial stress on WM via
    hypothalamic-pituitary-adrenal axis (HPAA)
  • Compared salivary cortisol and alpha amalase to
    affect and WM performance measured by latency and
    accuracy, stress vs. control.
  • Cortisol increased in stress group which was
    correlated with negative impact on WM in initial
    trials
  • Propose initially performance limited by capacity
    with transition to automatic processing in later
    trials

4. Schoofs et al., 2008
15
Acute stress, memory, attention and cortisol
  • Investigation of real-world stressor on memory
    and attention
  • Compared perceived stress and salivary cortisol
    levels mid semester vs. examination period
  • Self reported stress significantly elevated
    during exam period
  • Paradoxically associated with decreased cortisol
    levels
  • Significant improvement in short-term memory
    tasks
  • Significant decrements in selective and divided
    attention
  • No significant effect on verbal working memory

5. Vedhara et al., 2000
16
Effects of Worry and Evaluation Stress on
Interhemispheric Interaction
  • More complex cogitative tasks benefit from
    recruitment of second hemisphere
  • Evaluated across hemispheric advantage (AHA) by
    stressful environment and scored level of worry

6. Compton Mintzer, 2001
17
  • Low cognitive demand task, cue and match group
    are physically identical (A and A).
  • High cognitive demand task, cue and match group
    are semantically identical (a and A).

6. Compton Mintzer, 2001
18
Effects of Worry and Evaluation Stress on
Interhemispheric Interaction
  • More complex cogitative tasks benefit from
    recruitment of second hemisphere
  • Evaluated across hemispheric advantage (AHA) by
    stressful environment and scored level of worry
  • Stressful environment required increased effort
    resulting in greater performance secondary to
    across hemispheric advantage (AHA).
  • In high anxiety cohorts, additional worry
    processing reduces coordination and integration
    (central executive component of WM) efficiency
    outweighing the benefits of division of labor.
  • Suggest high trait levels of worry reduce
    available cognitive resources as well as
    interfere with efficiency

6. Compton Mintzer, 2001
19
Question 3
  • What is the evidence for interventions
    addressing the adverse effect of anxiety on
    working memory and test performance?

20
Whats the general media have to say on the
subject?
21
According to NBC10 of Philadelphia
  • Tuesday Feb 24th broadcast
  • Just 10 minutes of Meditation a day
  • Make your brain function more organized
  • Re-wire your brain more efficiently
  • Increase your energy
  • Reduce your anxiety

22
Anecdotal techniques for reducing test anxiety
  • Being well prepared for the test is the best way
    to reduce test taking anxiety.
  • Space out your studying over a few days or weeks,
    and continually review class material, don't wait
    until the night before and try to learn
    everything the night before.
  • Try to maintain a positive attitude while
    preparing for the test and during the test.
  • Exercising for a few days before the test will
    help reduce stress.
  • Get a good night's sleep before the test.
  • Show up to class early so you won't have to worry
    about being late.
  • Stay relaxed, if you begin to get nervous take a
    few deep breaths slowly to relax yourself and
    then get back to work.
  • Read the directions slowly and carefully.
  • Skim through the test so that you have a good
    idea how to pace yourself.
  • Write down important formulas, facts, definitions
    and/or keywords in the margin first so you won't
    worry about forgetting them.
  • Do the simple questions first to help build up
    your confidence for the harder questions.
  • Don't worry about how fast other people finish
    their test just concentrate on your own test.
  • If you don't know a question skip it for the time
    being (come back to it later if you have time),
    and remember that you don't have to always get
    every question right to do well on the test.
  • Focus on the question at hand don't let your
    mind wander on other things.

Available for download as a PDF
http//www.testtakingtips.com/anxiety/index.htm
2009
23
Test Anxiety Interference, Defective Skills, and
Cognitive Capacity
  • Examins the high test anxiety students poor
    academic performance
  • Deficit model (two categories)
  • Poor study skills result in feeling of being ill
    prepared
  • Poor test taking skills cause in-test awareness
    of bad performance
  • Interference model
  • Cognitive Capacity theory suggests worry
    processing degrades attention resources and
    memory access
  • Test anxiety interferes with retrieval of learned
    material
  • Treatment should be aimed at individual
    weaknesses (Not mutually exclusive)
  • Study/test taking instruction for students w/
    deficit skills
  • Imagery, verbal elaboration strategies, anxiety
    reduction techniques for students with
    interference weaknesses

7. Tobias, 1985
24
Meditation therapy for anxiety disorders
  • Investigate effectiveness of meditation programs
    specifically designed to treat anxiety disorders
  • Anxiety Disorders long term worry, tension,
    nervousness, fidgeting and symptoms of autonomic
    hyperactivity
  • Inclusion randomized controlled trials, must
    include meditation in title and must be main
    intervention
  • Particpants Adults w/ primary Dx, clinical Dx
    criteria, or clinical descriptors
  • Results
  • Of 50 preliminary studies, only 2 studies
    included both of Moderate quality
  • Transcendental meditation, Muscle Biofeedback and
    Relaxation Training showed descriptive
    improvement.
  • Kundalini Yoga vs. Relaxation/Mindfulness
    meditation, primary measure showed no significant
    difference, secondary measure showed significant
    difference favoring Kundalini Yoga
  • Conclusions/Implications
  • Scarcity of research, no published trials from
    eastern countries
  • Marginal adherence to treatment protocols 50-60
    with high dropout rate
  • No studies/reports of adverse affects
  • Inadequate supporting evidence to permit
    conclusions

8. Kirsanaprakornkit et al., 2009
25
Group Anxiety Reduction with Sixth Grade Students
  • Cost/Time effective protocol for reducing test
    anxiety?
  • Active Control anxiety reduction protocol
  • Stretching, deep breathing, muscle
    tensing/relaxation, calming suggestions
  • Guided imagination of 8 learning/test-taking
    scenarios including interesting activities,
    material review, reward
  • Tense/relaxation instruction between each
    scenario
  • Showed significant reduction in test anxiety over
    controls
  • Significant increase in test scores within test
    group, and near significant increase over
    controls
  • Teacher Instruction for group instruction is a
    cost effective strategy

9. Miller et al., 2007
26
Reducing Student Stress Utilizing Thought
Stopping A Model
  • During anxious state, thought cycle interrupted
    by startle response
  • Resultant reduction in anxiety and stress
    reporting after brief training period
  • Training Model
  • Teacher Training
  • Conditioning
  • Self-Regulation Technique
  • Limitations
  • Not all student/situations apply

10. Tillinghast et al., 1987
27
Yoga for anxiety a systematic review of the
research evidence
  • Defines Yoga as encompassing stretching,
    breathing and meditation
  • Identified 8 controlled trials of which 6 were
    randomized
  • Generally of poor quality
  • Modest positive effects
  • Low participation and high attrition rates
  • 50 lost within 3 to 6 months
  • Causal effect unknown
  • Reductionist approaches may loose effectiveness

11. Kirkwood et al., 2005
28
Sudarshan Kriya Yogic Breathing in the Treatment
of Stress, Anxiety, and Depression
  • Part I Neurophysiologic Model
  • Part II Clinical Applications and Guidelines

Brown Gerbarg., 2005
29
Yogic Breathing Neurophysiologic Model
  • Ujjayi Slow breathing against restricted
    airway, 2-4 cycles per minute (cpm)
  • Increases parasympathetic vagal tone
  • Decreases chemoreflex sensitivity
  • Imporoves baroreflex response
  • Increases stress/exercise tolerance
  • Bhastrika forceful inhalation/exhalation at 30
    cpm
  • Mild sympathetic tone leading to increased
    capacity
  • Simulates chronic exposure and decreased
    sensitivity
  • Chanting Repetitive voicing Om
  • Mechanism unknown theorize modulation of
    para/sympathetic tone at thalamic level leading
    to physiologic indicators of relaxation
  • Sudarshan Kriya cyclic breathing at different
    rhythms
  • Stimulate vagal tone and suppression of reticular
    activating system termed edge of sleep state
  • Mild hypocapnia leads to increased cardiac output
    and renin-angiotensin system activation

12. Brown Gerbarg., 2005
30
Yogic Breathing Clinical Applications and
Guidelines
  • Successful instruction achieved in large groups
    over several days
  • Successful reduction of pre-examination anxiety
    in medical students
  • Overall reduction of anxiety in patients with
    mild anxiety disorders
  • May need preparatory guidance to avoid increased
    anxiety/panic during rapid cyclic breathing
  • Additional clinical trials warranted

13. Brown Gerbarg., 2005
31
Exercise in prevention and treatment of anxiety
and depression among children and young people
  • Do exercise interventions prevent/reduce anxiety
    or depression in children/young people relative
    to other/no treatment
  • If so what are the characteristics of the most
    beneficial treatment protocols?

14. Nordheim et al., 2009
32
Exercise in prevention and treatment of anxiety
and depression among children and young people
  • Criteria
  • Randomized control trials
  • Vigorous physical activity of specified
    amount/duration
  • Standardized outcome measures of anxiety or
    depression
  • Results (Anxiety)
  • Exercise vs. no Intervention
  • 5 low, 1 moderate quality mixed results with
    significant reduction demonstrated in moderate
    quality study
  • Exercise vs. low intensity/relaxation
  • 2 low, 1 moderate quality no significant result
  • Exercise vs. psychosocial intervention
  • 2 low quality no significant difference
  • Conclusions/Implications
  • Mostly low quality evidence with out
    demonstrating significant effect
  • The few moderate quality studies showed some
    reduction in anxiety symptoms
  • No evidence for superior exercise protocol, low
    vs. high intensity
  • Given health benefits associated with exercise,
    may be effective treatment

14. Nordheim et al., 2009
33
Summery
  • Large body of experimental and theoretical
    evidence to support the negative effect of
    anxiety on working memory.
  • Data consistent among anatomic, histological,
    imaging, pathologic, and physiologic studies.
  • Body evidence for exercise and meditation is
    small with some positive evidence
  • Behavioral techniques can be effectively taught
    in small groups with positive effect
  • Yoga as an intervention shows modest effect with
    low participation rates
  • Yogic breathing exercises show positive effect
    and can be learned quickly

34
Thanks for your hospitality!
35
References
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    comprehension individual differences in working
    memory. Psych Review. 1992, Vol. 99(1),
    122-149.
  • Luethi M, Meier B, Sandi C. Stress effects on
    working memory, explicit memory, and implicit
    memory for neutral and emotional stimuli in
    healthy men. Front Behav Neurosci. 200825.
    Epub 2009 Jan 15.
  • Wang J, Rao H, Wetmore GS, Furlan PM,
    Korczykowski M, Dinges DF, Detre JA. Perfusion
    functional MRI reveals cerebral blood flow
    pattern under psychological stress. Proc Natl
    Acad Sci U S A. 2005 Dec 6102(49)17804-9. Epub
    2005 Nov 23.
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    stress induces working memory impairments in an
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