Marta Jorba and Carlota Serrahima
Affiliation: Universitat Pompeu Fabra & Universitat de València
Category: Philosophy
Keywords: Anxiety, Anxiety sensitivity, Inner speech, Worry, Emotional regulation
Date: Thursday 4th of September
Time: 15:00
Location: Room 154 (154)
View the full session: Thinking & Worrying
In anxiety disorders, subjects show features of excessive emotional response to what they perceive as threats. In different anxiety disorders, subjects perceive as threats different objects and situations (e.g., separation from attachment figures in separation anxiety disorder; social situations in social anxiety disorder; or enclosed spaces in agoraphobia). However, so-called anxiety sensitivity is present across most kinds of pathological anxiety (Olatunji and Wolitzky-Taylor, 2009). Anxiety sensitivity consists of the fear of anxiety-related bodily sensations due to the belief that the sensations themselves indicate danger for the organism, either physical, psychological, or social. For instance, anxious subjects can interpret accelerated heartbeat as cardiac disease; feelings of dizziness as a symptom that they are “going crazy”; or blushing as a cause of negative evaluation by others. Importantly, these beliefs contribute, in turn, to amplifying anxiety levels (ibid., 974): subjects are not just anxious about the external object or situation that triggers the anxiety, but also about their own bodily reactions to it. For instance, fear of social situations may make a subject with social phobia sweat in excess when in public. When anxiety sensitivity is present, this very fact will raise the subject’s concerns that she will be negatively evaluated by others. Importantly, just like anxiety, anxiety sensitivity is not only about situations where the subject is actually feeling threatened, but also about anticipation of these situations: our subject may feel anxious already when anticipating social situations, and the very possibility of showing anxiety symptoms in these potential situations may contribute to her anticipatory anxiety (cf. the definition of “Social Anxiety Disorder” in the DSM). Anxiety sensitivity contributes to the development of pathological anxiety, and it is a risk factor for panic attacks (Plehn and Peterson, 2002; McNally, 2022). At the conscious level, anxiety sensitivity manifests itself as intrusive, repetitive, negative thinking about the dangers implied by anxiety-related bodily sensations. Indeed, repetitive negative thinking has been identified as one transdiagnostic mechanism associated with both anxiety and depression (Ehring & Watkins, 2008). In particular, for anxiety disorders, this form of thinking is typically conceptualized as worry: repetitive, negative thoughts about potentially negative events in the future (Olatunji & Ciesielski, 2010). Although worry is to a certain degree a usual response to demanding or troublesome situations in the general population, it can become chronic and uncontrollable, as is the case, for instance, in Generalized Anxiety Disorder (GAD; DSM-5-R, APA, 2022). In this paper, we examine the relationship between, on the one hand, anxiety sensitivity, and on the other hand, inner speech, assuming that worry takes a verbal nature. Our interest is to investigate whether and how a certain profile of inner speech, i.e., that present in worry about one’s own bodily condition, can actually impact on bodily symptomatology and on the overall process of emotional distress. Indeed, a prominent feature of worry is its verbal articulation, that is, it is mainly carried verbally or in inner speech (Makovak et al., 2017). More generally, inner speech is the phenomenon known as “the little voice in the head” and has been characterized as keyed to natural language and often available to introspection (Gregory & Langland-Hassan, 2024). Numerous studies have shown the involvement of inner speech in the self-regulation of executive functions such as planning, reasoning, or task-switching (Petrolini et al., 2020; Verhaegen and Miravito, 2021; Kompa and Mueller, 2022). Similarly, it has been argued that inner speech serves functions of emotional self-regulation. Classical developmental theories of inner speech postulate that it is the result of a process of internalization of outer speech through the intermediate step of private speech (i.e., talking out lout) (Vygotsky, 1987) that, once internalized, helps children regulate their emotions via the ability to identify their feelings (Kopp, 1989). Evidence for this emotional self-regulation also comes from children with language impairment being less capable of regulating emotions (Fujiki et al., 2002), and teenagers with problems identifying emotions being more at risk of affective illnesses when exposed to stress (Nook et al., 2021). Similarly, research on affect labeling, i.e., the action of giving a name or label to an emotion, has shown that labeling emotions has an impact in emotion regulation (Lieberman et al., 2007). However, which specific inner speech profile serves the emotion self-regulation purpose is an open question that needs further examination, given that some studies call for a more nuanced conclusion regarding the supposed emotion regulation effect of labeling (Nook et al., 2021). Given that anxiety sensitivity has itself been characterized as a failure of emotional self-regulation (Aldao et al., 2010), the following question arises: What is the role of (the specific profile of) inner speech in episodes of anxiety with anxiety sensitivity? Does worry about one’s own bodily condition, as a verbal activity, specifically contribute to aggravating anxiety episodes? On the one hand, one could think that the presence of inner speech in anxiety sensitivity is responsible for some form of emotional dysregulation and distress. On the other hand, however, some authors have suggested that worry is actually a mechanism used by patients as an avoidance strategy aimed at controlling the physiological arousal caused by anxiety (Borkovec et al., 2004). We will adjudicate between these two hypotheses by, first, investigating further into the specific profile of inner speech involved both in emotion regulation and dysregulation strategies; and second, by analyzing the specific properties of worry —such as kind of content, or whether it is distant self-talk or not— in anxiety sensitivity.