Generalized anxiety disorder (GAD) is characterized by worry that feels difficult to control and that is often out of proportion to the situation. People with GAD frequently report difficulties concentrating; they find it hard to focus on the task at hand and become distracted by their worry. Difficulty concentrating is also common in other psychological disorders, like depression, which has led to debate about whether it is a useful and informative symptom, or criterion, to diagnose GAD. Dr. Lauren Hallion and colleagues argue that if the majority of individuals with GAD report difficulties with concentration, then it is a key feature of the disorder and therefore useful for diagnosis.

To test this, Hallion and colleagues conducted interviews to assess individuals’ difficulty with concentration and to assess for GAD and other diagnoses. They also administered questionnaires to measure individuals’ tendency to worry excessively and to experience anxiety. There were 175 American adults with GAD included in the study.

Of participants who met criteria for GAD, 89% had difficulty concentrating. This suggests that concentration difficulties are common in people with GAD. Notably, these difficulties concentrating were not explained by co-occurring disorders (such as depression and social anxiety disorder). Further, concentration problems predicted whether somebody would meet criteria for GAD, even after taking into account other common symptoms such as restlessness, muscle tension and sleep disturbances. Taken together, these findings suggest that difficulty concentrating is prominent in individuals with GAD. As such, it is a useful diagnostic criterion.

Difficulty concentrating was also found to be associated with the severity of GAD. Individuals who reported more severe concentration problems were also more likely to report more severe worry, higher levels of anxiety, and more severe depressive symptoms. Hallion and colleagues found that difficulty concentrating may, in part, explain the relationship between worry and GAD severity. They found that increases in worry lead to difficulty concentrating, which in turn increases GAD severity. These findings suggest that difficulty concentrating may contribute to making GAD more severe. The authors provided two potential explanations for the connections among worry, difficulty concentrating, and clinical severity.

The first explanation is that worry makes it difficult to concentrate, which may lead to interference in performing necessary daily tasks and maintaining relationships.

Consider these scenarios:

1) Mary and John are discussing a significant issue. Mid-conversation, John starts to worry about work and becomes distracted from the conversation. John’s inability to focus on the important discussion aggravates Mary, which leads to a conflict.

2) John’s poor concentration also interferes with his ability to successfully complete projects at work. As a result, he gets many negative performance reviews and is not considered a good candidate for a promotion. These concentration difficulties are impairing John’s work functioning.

The second explanation is that worry leads to difficulty concentrating, which leads to distress. A person might worry about the negative consequences of difficulty concentrating. Consider these scenarios:

1) John notices that he disengaged from his conversation with Mary. He becomes increasingly worried that if he cannot concentrate they will not resolve their issue, and their marriage will fall apart. John then becomes immensely distressed.

2) John is having difficulty completing a work project. His inability to concentrate on the project makes him worry that he will be fired. The more difficulty he has concentrating, the more worried he becomes.

In these examples, John’s difficulty concentrating is causing him distress, which increases the severity of his GAD.

These explanations are not mutually exclusive. Difficulty concentrating could interfere with the ability to perform required tasks, and also causes distress and anxiety. For example, if you aren’t able to focus at work, it makes sense that you might become anxious about work (distress), and that the quality of your work would suffer (interference). Notably, no definitive conclusions can be drawn about the direction of this relationship as the information was collected at only one time-point. Nevertheless, the authors provided two interesting potential explanations for the connections among worry, difficulty concentrating, and clinical severity.

These findings can be used to strengthen treatments for GAD. The authors suggest that in order to reduce the severity of GAD symptoms, interventions should target concentration. For example, research has shown that mindfulness meditation training can lead to increases in attention and decreases in concentration difficulties. For this reason, mindfulness meditation may be especially well suited to address the combination of chronic worry and concentration problems.