Title: Does anxiety affect working memory, and if so, what can be done about it
1Does 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
2The Road Map
- Review of clinical questions
- Methods and search terms
- Review selected papers
- Discussion and implication for learning and
education
3Questions
- 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?
4Methods 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)
5Literature Caveats
- Working memory anxiety/stress interaction
literature largely confined to adult population - Heavily weighted with studies of pathological
anxiety disorder patient populations
6Question 1
7A 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
8Question 2
- What is the effect of anxiety on working memory?
9Call 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.
10Stress 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
11Papez Circuit
http//en.wikipedia.org/wiki/Papez_circuit
12Stress 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
13Perfusion 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
14Psychosocial 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
15Acute 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
16Effects 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
18Effects 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
19Question 3
- What is the evidence for interventions
addressing the adverse effect of anxiety on
working memory and test performance?
20Whats the general media have to say on the
subject?
21According 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
22Anecdotal 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
23Test 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
24Meditation 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
25Group 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
26Reducing 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
27Yoga 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
28Sudarshan Kriya Yogic Breathing in the Treatment
of Stress, Anxiety, and Depression
- Part I Neurophysiologic Model
- Part II Clinical Applications and Guidelines
Brown Gerbarg., 2005
29Yogic 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
30Yogic 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
31Exercise 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
32Exercise 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
33Summery
- 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
34Thanks for your hospitality!
35References
- Just M Carpenter P. A capacity theory of
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. - Schoofs D, Preuss D, Wolf OT. Psychosocial
stress induces working memory impairments in an
n-back paradigm. Psychoneuroendocrinology. 2008
Jun33(5)643-53. Epub 2008 Mar 21. - Vedhara K, et al. Acute stress, memory,
attention and cortisol, Psychoneuroendocrinology,
Volume 25, Issue 6, August 2000, Pages 535-549 - Compton R, Mintzer D. Effects of worry and
evaluation stress on interhemispheric
interaction. Neuropsychology. Vol 15(4), Oct
2001, 427-433. - Tobias S. Test anxiety interference, defective
skills, and cognitive capacity. Educational
Psychologist. 198520(3)135. - Krisanaprakornkit T, Sriraj W, Piyavhatkul N,
Laopaiboon M. Meditation therapy for anxiety
disorders. Cochrane Database of Systematic
Reviews, Issue 1, 2009. - DeLapp R Driscoll R. Group anxiety reduction
with sixth grade students. ERIC. 2007 ED498824. - Tillinghast R et al. Reducing student stress
utilizing thought stopping a model. J. Instr
Psych. Vol 14(4) 1985159-163. - Kirkwood G et al. Yoga for anxiety a systematic
review of the research evidence. British Journal
of Sports Medicine. 200539884-891. - Brown R, Gerbarg P. Sudarshan Kriya yogic
breathing in the treatment of stress, anxiety,
and depression part Ineurophysiologic model. J
Alternative Comp Med. 200511(1)189-201. - Brown R, Gerbarg P. Sudarshan Kriya yogic
breathing in the treatment of stress, anxiety,
and depression part IIclinical applications and
guidelines. J Alternative Comp Med.
200511(4)711-717. - Lillebeth Larun, Lena V. Nordheim, Eilin Ekeland,
Kåre Birger Hagen, Frode Heian. Exercise in
prevention and treatment of anxiety and
depression among children and young people.
Cochrane Database of Systematic Reviews, Issue 1,
2009.