See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/237145280

The Emotional Experience Associated with Worrying in Adolescents

Article  in  Journal of Psychopathology and Behavioral Assessment · March 2013

DOI: 10.1007/s10862-012-9316-3

CITATIONS READS

8 123

2 authors, including:

Marianna Szabo
The University of Sydney
38 PUBLICATIONS   580 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Development of the Youth version of the Depression Anxiety Stress Scales (DASS-Y) View project

All content following this page was uploaded by Marianna Szabo on 31 August 2015.

The user has requested enhancement of the downloaded file.

J Psychopathol Behav Assess (2013) 35:65–75
DOI 10.1007/s10862-012-9316-3

The Emotional Experience Associated with Worrying

in Adolescents
Samuel Fowler & Marianna Szabó

Published online: 25 August 2012

# Springer Science+Business Media, LLC 2012

Abstract Among adults, both normal and pathological proposed cognitive avoidance function of worrying may
worrying has been found to be associated with a unique be present by adolescence.
emotional syndrome involving irritability, restlessness, low
frustration tolerance and difficulty relaxing. This emotional Keywords Worry . DASS . Depression . Anxiety . Stress .
state is empirically distinguishable from anxiety and depres- Generalized anxiety disorder . GAD
sion, and is reliably assessed by the Stress scale of the
Depression Anxiety Stress Scales (DASS). The association
Worrying is a common experience in everyday life for most
between worry and ‘stress’ may have important implications
people. In its normal, everyday manifestation, it is described
for a better theoretical understanding of worrying in adults.
as an adaptive, problem-solving response to perceived fu-
Among youth, however, the emotional experience associat-
ture threat (Borkovec et al. 2004; Davey 1994; Mathews
ed with worrying has not yet been clearly described. The
1990; Wells 1999). However, excessive worrying is associ-
present study aimed to explore whether a distinct, adult-like
ated with a range of disorders, and it is the central diagnostic
‘stress’ syndrome can be assessed in adolescents via self-
feature of generalized anxiety disorder (GAD) in the Diag-
report, and whether, as in adults, stress has a specific asso-
nostic and Statistical Manual of Mental Disorders IV (DSM-
ciation with worrying. A simplified version of the DASS
IV-TR; American Psychiatric Association [APA], 2000).
was created to maximize its comprehension by adolescents.
GAD is known to have an early onset and a chronic and
A group of 340 12–18-year-olds completed the simplified
unremitting course, with many individuals reporting that
DASS and a self-report measure of worry. Factor analyses
they have been ‘worriers’ all their lives (APA 2000; Hol-
revealed a three-factor structure underlying the simplified
away et al. 2006). Yet, in spite of the importance of early
DASS, similar to the original adult version. Further analyses
intervention and prevention of pathological worrying, our
showed that worry had a unique association with Stress,
knowledge about worry in children and adolescents is espe-
over and above its association with Depression and Anxiety.
cially limited (Cartwright-Hatton 2006).
Adolescents who worry more excessively and uncontrolla-
Individuals receive a DSM-IV (APA 2000) diagnosis of
bly also reported higher levels of irritability, restlessness and
GAD if they report excessive and uncontrollable worrying
difficulty relaxing, while the autonomic arousal symptoms
about a range of outcomes. In adults, at least three of six
of anxiety had consistently low associations with worrying,
‘vigilance and tension’ symptoms associated with worrying
especially in older adolescents. Results indicate that the
are also required for a diagnosis, while in children only one
such symptom is needed. The six ‘Criterion C’ symptoms
This research was partly supported by a grant from the National Health include (1) restlessness or feeling keyed up or on edge; (2)
and Medical Research Council awarded to the second author.
irritability; (3) muscle tension; (4) sleep disturbance; (5)
S. Fowler : M. Szabó (*) difficulty concentrating; and (6) being easily fatigued. No-
School of Psychology, University of Sydney,
tably, GAD is the only DSM-IV anxiety disorder that does
Brennan MacCallum Bldg (A18),
Sydney, NSW 2006, Australia not include the classic autonomic arousal symptoms of
e-mail: marianna.szabo@sydney.edu.au anxiety (i.e., heart rate changes, sweating, or trembling)
S. Fowler amongst its central features. The emotional symptoms asso-
e-mail: samuel.fowler@sydney.edu.au ciated with worrying for a diagnosis of GAD have been
66
controversial since the inception of this diagnostic category.
The original definition of GAD in DSM-III-R (APA 1987)
included autonomic arousal, as well as vigilance and tension
symptoms. However, it was subsequently reported that au-
tonomic arousal was relatively less strongly associated with
excessive and uncontrollable worrying (Brown et al. 1995;
Freeston et al. 1996; Marten et al. 1993; Starcevic et al.
1994), and was therefore excluded from the DSM-IV defi-
nition of GAD (APA 2000). More recent reviews have
recommended reductions in the number of current vigilance
and tension symptoms as well. Andrews et al. (2010) argue
that only being ‘restless or feeling keyed up or on edge’ and
experiencing ‘muscle tension’ are specific to GAD. There-
fore, the authors recommend retaining only these two symp-
toms as diagnostic criteria in DSM-V, and requiring the
presence of only one of them for a diagnosis of GAD in
both adults and children.
Nevertheless, emerging evidence suggests that worrying,
both in its clinical and everyday manifestations, is associat-
ed with a unique emotional experience in adults. This dis-
tinct emotional syndrome has first been observed as a result
of factor analyses during the development of the Depression
Anxiety Stress Scales (DASS; Lovibond and Lovibond
1995), when a cluster of symptoms including irritability,
restlessness, nervous tension, agitation, difficulty relaxing,
and low frustration tolerance empirically emerged. This
factor was labeled ‘Stress’ or ‘tension/stress’ by the
researchers. Subsequent research provided further evidence
that DASS Stress reflects a unique, coherent, independent
emotional syndrome that is empirically distinguishable from
both anxiety and depression, and from general distress
(Henry and Crawford 2005; Lovibond 1998; Lovibond
and Lovibond 1995). The association between excessive
worrying and this emotional state of ‘stress’ was first
reported by Brown et al. (1997), who found that individuals
diagnosed with GAD obtained higher scores on the Stress
scale of the DASS, compared to individuals diagnosed with
other anxiety disorders who tended to score high on DASS
Anxiety. These findings were extended to non-clinical sam-
ples by Szabó (2011; Huang, Szabó, & Han, 2009), who
reported a strong unique relationship between DASS Stress
and scores on the Penn State Worry Questionnaire (PSWQ;
Meyer et al. 1990), a dimensional measure of excessive and
uncontrollable worrying. Similar strong associations were
found between DASS Stress and diary-based records of
worry frequency and uncontrollability. All associations be-
tween DASS Stress and worry remained strong and signif-
icant after controlling for DASS Anxiety and Depression in
hierarchical regression analyses. Finally, in more detailed
analyses, Szabó reported that the symptoms most strongly
associated with excessive worrying were indexed by such
items from the DASS Stress scale as a tendency for being
irritable, overreacting to situations, and difficulty relaxing or
J Psychopathol Behav Assess (2013) 35:65–75
‘winding down’. In contrast, the symptoms showing the
weakest associations with worrying were indexed primarily
by items reflecting autonomic arousal from the DASS Anx-
iety scale.
The reason for this pattern of associations is unclear.
Relatively few theoretical accounts of worrying consider
the nature of its associated emotional symptom profile. In
fact, only one such account, the cognitive avoidance theory
of worry (e.g., Borkovec et al. 2004), considers the emo-
tional experience associated with worrying to have central
theoretical importance. According to this theory, worrying,
both in its normal and pathological form, involves a pre-
dominantly verbal thinking process which serves to sup-
press threat-related imagery and the aversive autonomic
arousal symptoms (e.g., heart palpitations, sweating, and
trembling) associated with such imagery (Borkovec and
Hu 1990; Borkovec and Inz 1990; Freeston et al. 1996).
Recent expansions on the avoidance theory suggest that
individuals who worry excessively are motivated to avoid
not only anxiety but distressing internal experiences in
general, primarily as a result of broad difficulties with
emotion regulation (Aldao and Mennin 2012; Mennin et
al. 2005; Salters-Pedneault et al. 2006). In either case, it is
possible that the emotional experience that remains associ-
ated with worrying involves the symptoms of stress
reflected in the DASS (Lovibond and Lovibond 1995).
In comparison to current knowledge regarding worrying
in adults, there is relatively little research available to ex-
plain the nature and functions of worrying in youth. This
discrepancy is alarming given the high rates of worry en-
dorsed by both children and adolescents (e.g., Bell-Dolan et
al. 1990; Muris et al. 1998), and the many negative devel-
opmental outcomes known to be associated with excessive
worrying (Hale et al. 2008; Kim-Cohen et al. 2003). In the
absence of a developmentally appropriate understanding of
worrying, adult conceptualizations of this phenomenon are
often applied to children (Cartwright-Hatton 2006). Howev-
er, the age at which an adult-like worry process first emerges
is currently unknown. Although it has been initially sug-
gested that this process is already present as early as 7 or
8 years of age (Vasey 1993; Vasey et al. 1994), empirical
support for this proposition is limited. More recent data
indicate that the phenomenology of worrying in 7–12-
year-old children is different from the concept of worrying
held by adults, and it is more similar to adults’ concept of
fear (Szabó 2007, 2009). A more adult-like worry process is
thought to emerge during adolescence, and adult theories
aiming to explain worry may become applicable at this
developmental stage (Cartwright-Hatton 2006; Gosselin et
al. 2007; Laugesen et al. 2003).
Considering that an adult-like worry process is thought to
be present by the adolescent years, it is also possible that, as
in adults, worrying in adolescents is accompanied by
J Psychopathol Behav Assess (2013) 35:65–75 67

symptoms of irritability, restlessness, agitation and tension, Method

rather than with the autonomic arousal symptoms of anxiety.
Unfortunately, no research studies have so far documented Participants
the existence of such associations. The main reason for this
may be that no psychometrically sound instrument is cur- Participants were recruited from two independent high
rently available to assess the relevant symptoms in youth. schools. At the first school, all students from grades 7–12
The DASS (Lovibond and Lovibond 1995), the only instru- (approximately 1,000 students) were invited to participate in
ment currently available to assess the emotional state of the study. Of these students, 289 consented to participate,
stress, has been designed for use in adult samples. Its use indicating an approximate response rate of 29 %. This
in adolescents has not been supported by studies of its response rate is consistent with previous studies assessing
underlying factor structure. Importantly, while some studies worry in adolescents (e.g. Szabó 2009 [27 %]; Szabó and
suggested that a depression and an anxiety factor can be Lovibond 2006 [34 %]). At the second school, all students
observed in adolescent samples using the adult DASS, a in grades 9–12 (approximately 800) were invited to partic-
distinct adult-like ‘stress’ factor consistently failed to ipate, and 75 participants (9.4 %) returned signed parental
emerge (Duffy et al. 2005; Patrick et al. 2010; Szabó and participant consent. This relatively lower response rate
2010; Tully et al. 2009). It is possible, therefore, that stress was similar to the response rate of students from the upper
is not yet experienced as a unique, independent emotional grades in the other participating school. In total, 364 stu-
state during adolescence. dents participated. Data from 24 questionnaire booklets
Alternatively, results may have been affected by ad- were discarded due to incomplete attempts (i.e., where more
olescent respondents’ difficulties in comprehending than 10 % of data from any one questionnaire was missing).
some of the adult DASS items, especially those com- The remaining sample providing usable data consisted of
prising the Stress factor. This possibility is consistent 340 participants, 181 males and 159 females, with a mean
with missing values analyses reported by Szabó (2010), age of 14.45 years (SD01.41, Min011.67, Max018.03). Of
which revealed that items from the Stress Scale, such as these participants, 85 % (n0289) reported speaking only
those containing the words ‘intolerant’ and ‘agitated’, English at home, and the remaining 15 % (n051) reported
were the most often omitted by adolescents. So far, only also speaking a language other than English at home. Table 1
one study has attempted to overcome comprehension details the age and gender distribution of the sample,
difficulties by modifying the adult DASS items for use grouped by school year.
by young respondents. Szabó and Lovibond (2006) de-
veloped a large set of simplified items to explore Materials
whether anxiety, depression and stress, as defined by
the adult DASS, can be observed in 7–14-year-old The Modified Depression Anxiety Stress Scale for Adoles-
respondents. Results again suggested that stress was cents The modified DASS was developed to assess the
not observable as a unique factor separate from anxiety emotional states of depression, anxiety and stress, as defined
and depression. Nevertheless, the authors recommended by the original adult DASS (Lovibond and Lovibond 1995),
that further revision of the items and testing these in in young people aged 12–18 years. The adult DASS is a 42-
older adolescents may be a fruitful avenue for further item self-report measure of negative affect consisting of
research. No published research has yet attempted to use three 14-item scales indexing depression, anxiety, and
similar, simplified items in older adolescent samples to stress. Depression, as defined by the DASS, includes
date, however.
In the present study, therefore, we created simplified ver-
sions of the adult DASS items (Lovibond and Lovibond Table 1 Age and gender distribution in the total sample, and grouped
1995) to assess the three emotional states of depression, by school year
anxiety and stress in adolescents, and to explore their
Year n % of total N % males Mean age Age range
association with worrying. We expected that reducing
the comprehension difficulties associated with the use 7 74 21.80 74.30 12.68 11.67–13.51
of adult items in previous studies may enable adoles- 8 71 20.90 59.20 13.70 12.71–14.79
cents to self-report on a distinct emotional state of 9 118 34.70 48.30 14.72 13.89–15.69
stress. In light of suggestions that an adult-like worry 10 34 10.00 44.00 15.69 14.54–16.64
process is present by adolescence (e.g., Cartwright- 11 30 8.80 10.00 16.81 16.16–17.25
Hatton 2006), we also expected that, as in adults, stress 12 13 3.80 69.20 17.44 15.59–18.03
would have a unique association with worrying at this Total 340 100 53.20 14.45 11.67–18.03
age.
68
symptoms of hopelessness, devaluation of life, self-
deprecation, inertia, a lack of interest or involvement, anhe-
donia, and dysphoria. DASS Anxiety is defined by symp-
toms reflecting physiological arousal, skeletal musculature
effects, situational anxiety, and a subjective experience of
anxious affect. DASS Stress is a syndrome characterized by
difficulty relaxing, nervous tension, irritability, agitation and
impatience. The adult DASS has been shown to possess
excellent reliability and validity in normal and clinical sam-
ples (Antony et al. 1998; Brown et al. 1997; Crawford and
Henry 2003), and in several different languages and cultures
(e.g., Bayram and Bilgel 2010; Gong et al. 2010;
Norton 2007).
The modified DASS we developed for the purposes of
this study included 36 items, 12 items per scale. Item
selection was guided by the findings of previous pub-
lished literature (e.g. Szabó 2010; Szabó and Lovibond
2006) as well as of unpublished pilot studies of a large
initial pool of items developed by the second author.
Some of the original adult DASS items were judged to
be appropriate for adolescent participants and were left
unchanged (e.g., ‘I found it difficult to relax’). Other items
were simplified from the original adult DASS items. For
example, the adult DASS Stress item ‘I found myself
getting upset by quite trivial things’ was simplified to ‘I
felt upset about little things’. Finally, some original adult
DASS items were omitted from the adolescent version
because they were judged to be both too difficult to
understand by the younger respondents and not possible
to simplify without substantially changing their meaning
(e.g., ‘I was in a state of nervous tension’). We aimed to
include a minimum of one item to measure each subscale
of the three adult DASS scales. For example, to assess
Stress, we aimed to include at least one item to assess
each of the ‘Difficulty Relaxing’, ‘Nervous Arousal’,
‘Agitation’, ‘Irritability’ and ‘Impatience’ aspects of this
emotional syndrome, as defined by the DASS. The mod-
ified questionnaire was pilot tested on a small sample of
young adolescents, who were asked to provide feedback
concerning their understanding of the items. On the basis
of such feedback, some items were modified further. For
example, the item ‘I had difficulty swallowing’, initially
unchanged from the adult version, was modified to read
‘It felt like there was a lump in my throat’. This was
modified to counter the apparent confusion regarding
whether ‘difficulty swallowing’ was related to difficulties
in food consumption or, as intended, was a symptom of
anxiety. Similar to the response format of the adult DASS,
participants were asked to rate on a 4-point Likert scale
the extent to which each statement applied to them over
the past week. However, the response options were sim-
plified to 00 not at all true of you, 10 a little true of you,
20 quite true of you, and 30 very true of you.
J Psychopathol Behav Assess (2013) 35:65–75
The Penn State Worry Questionnaire for Children (PSWQ-
C) The PSWQ-C (Chorpita et al. 1997) is a 14-item self-
report measure assessing young people’s tendency to worry
excessively and uncontrollably. This scale was modified by
Chorpita et al. from its original adult version (PSWQ;
Meyer et al. 1990) to be appropriate for 6–18 year-old
respondents. The PSWQ-C includes such items as ‘I find it
easy to stop worrying when I want’ (reworded from the adult
item ‘I find it easy to dismiss worrisome thoughts’) and ‘My
worries really bother me’. Respondents report how much
each statement is true of them, where 00 Never true, 10
Sometimes True, 20 Often True, and 30 Always True. Chor-
pita et al. reported high internal consistency (Cronbach’s
alpha 0.89), a one-week test-retest reliability coefficient of
.92, good convergent and discriminant validity, and a stable
unitary factor structure for the PSWQ-C. In the present
study, the scale evidenced excellent internal consistency
(Cronbach’s alpha 0.93).
Procedure
The study procedure was approved by the relevant institu-
tional ethics committees. Only students who returned a
signed parental and participant consent form by the day of
testing took part in the study. Each participant completed a
booklet that included a demographic information question-
naire, the modified DASS for Adolescents and the PSWQ-
C, in that order. Booklets were filled out in groups of about
20 participants in school.
Results
The first aim of this study was to explore whether it is
possible to assess a construct similar to the DASS Stress
syndrome observed in adults, via self-report in adolescents.
As no previous study examined this question using simpli-
fied DASS items, exploratory factor analyses were con-
ducted to test whether the simplified items can be
summarized in three interpretable underlying factors, and
whether the items that define these factors are similar to the
Depression, Anxiety and Stress scales comprising the adult
DASS (Lovibond and Lovibond 1995). For exploratory
factor analyses, the use of maximum likelihood extraction
is recommended for data sets with multivariate normality
(Fabrigar et al. 1999). In this study, the highest skewness
value was 2.38, with only four items having skewness
statistics greater than two and no items having kurtosis
values greater than seven. Therefore, maximum likelihood
extraction was judged to be appropriate. The data was
further examined for missing values, following the initial
listwise deletion of data from 24 participants as described in
J Psychopathol Behav Assess (2013) 35:65–75 69

the Participants section above. Of the remaining sample, 2 Table 2 Factor loadings from exploratory factor analysis
participants had 3 missing values from the modified DASS, Simplified DASS items 1 2 3
4 participants had 2 values missing, and 39 participants had
1 missing value. Prior to the factor analyses, these missing Easily irritated 0.78
values were replaced using Maximum Likelihood proce- Annoyed by interruptions 0.74 0.14
dures in SPSS-20. Upset about little things 0.68 −0.19
The first factor analysis was fully exploratory and Easily annoyed 0.68
allowed all factors with Eigenvalues greater than one Over-react to situations 0.63
to be extracted. A direct Oblimin rotation was employed Easily upset 0.48 −0.35
to allow all underlying factors to correlate with each Not feel like doing anything 0.44 −0.26
other, as in the original adult DASS. This initial analy- Hated stopping what I was doing 0.44
sis produced a seven-factor solution, accounting for Difficult to relax 0.43 −0.23 0.17
64.50 % of the total variance. This solution included a Could not stop thinking about things 0.40 0.21
complex and uninterpretable pattern of factor loadings, Couldn’t calm down 0.38 −0.29 0.2
inconsistent with previous research concerning the struc- Hard to get started 0.35
ture of negative affect. A review of the scree plot Sweating a lot 0.24 0.16
indicated a relatively marked decrease in explained var- Life was terrible −0.88
iance after the first three factors. The first factor Hated life −0.88
accounted for 42.90 % of variance, the second 4.84 % Hated self −0.85
and the third 4.53 %, before a drop to the fourth factor, Felt like I was no good −0.68 0.22
which accounted for only 3.43 % of total variance. Nothing would work out 0.32 −0.53
Hence, in the second analysis, a three-factor solution No excitement 0.24 −0.47 0.15
was forced. The resulting three correlated factors togeth- No fun 0.26 −0.46 0.11
er explained 52.28 % percent of total variance. Sad and unhappy 0.41 −0.46
An examination of the pattern matrix for the three-factor
Nothing to look forward to 0.35 −0.45
solution revealed a clear and interpretable pattern of factor
Really scared −0.42 0.41
loadings (defined as values greater than .35). The pattern of
Could not enjoy anything 0.31 −0.39
these loadings was largely consistent with the factor struc-
Afraid 0.16 −0.32 0.32
ture of the adult DASS. Only one item (‘I never felt like
Trouble breathing 0.74
doing anything’) had a cross-loading. This item was
Shaky hands 0.72
designed to index the ‘Inertia’ aspect of Depression, but
About to panic −0.24 0.65
had an unexpected loading of .44 on the Stress factor.
Felt dizzy 0.11 0.56
Interestingly, the other item originally designed to index a
Heart beating fast 0.11 −0.18 0.48
similar aspect of Depression (‘It was hard to get started to
Lump in throat 0.14 0.45
do things’) also loaded on Stress, albeit only marginally.
Situations made me scared −0.30 0.37
Two items ‘I felt sad and unhappy’, and ‘Some things I had
Dry mouth 0.21 0.33
to do really scared me’, had substantial double loadings, and
Hard to wait patiently 0.29 −0.11 0.30
a further seven of the original 36 modified DASS items had
weak or non-discriminating loadings (e.g. 0.35 or lower on Scared by new things 0.19 −0.18 0.24
several factors). These nine items were omitted from further Felt restless 0.22 −0.15 0.23
analyses. The 11 items with substantial loadings on the Values lower than .11 are omitted for clarity. Items retained to calculate
Stress factor, nine items with substantial and clear loadings total scores are in bold. The table contains abbreviated versions of the
on the Depression factor, and seven items with substantial items. The full questionnaire is available from the second author upon
loadings on the Anxiety factor were retained for further request
analyses. The retained items are printed bold in Table 2.
Scores on these items were summed to index ‘depression’, The main aim of the study was to investigate whether the
‘anxiety’ and ‘stress’ in our study. Descriptive statistics for emotional experience associated with worrying is similar in
these scales are presented in Table 3, which shows that each adolescents to that previously reported in adults (Szabó
of the three scales had high internal consistency estimates. 2011). Worrying was assessed via the PSWQ-C. The aver-
Comparisons between the genders revealed that total scores age score obtained by the sample on this measure was 17.46
were greater for females than males on all three subscales (SD09.92), with females (M021.10, SD09.82) obtaining
(Depression: t03.53, p<.001, Anxiety: t05.32, p<.001, Stress: higher scores compared to males (M013.91, SD08.69; t0
t04.48, p<.001.) 6.86, p < .001). As the simple correlations presented in
70 J Psychopathol Behav Assess (2013) 35:65–75

Table 3 Descriptive statistics for the simplified depression, anxiety age. At the last step involving all predictors, the interactions
and stress scales
between either depression and age or stress and age were not
Total (N0340) Females (n0159) Males (n0181) statistically significant. However, there was a statistically
significant interaction between anxiety and age, suggesting
α Mean SD Mean SD Mean SD that as age increases, the strength of the relationship be-
tween worry and anxiety decreases.
Depression .94 04.59 6.43 05.91 7.33 03.44 5.29
To illustrate this interaction, we established a ‘young
Anxiety .83 03.08 4.00 04.29 4.70 02.02 2.88
adolescent’ group that included 99 participants with a mean
Stress .91 10.68 7.84 12.69 8.35 08.90 6.91
age of 12.82 years (SD0.44, Min011.67, Max013.50 years)
and an ‘older adolescent’ group including 102 participants,
Table 4 show, scores on the PSWQ-C were positively relat-
ed to each of the three simplified DASS scales, which were Table 5 A moderated hierarchical regression analysis assessing the
positively related to each other. Age had a low but statisti- role of each simplified DASS scale in explaining variance in worry
scores
cally significant relationship with all other variables.
To control for such interrelationships and document the R2 R2 change β
unique emotional experience associated with worrying in
adolescents, a hierarchical multiple regression analysis was STEP 1 .04*** .04***
carried out, with PSWQ-C scores as the criterion variable. Age .20***
Considering the wide age range of the sample in this study, STEP2 .41*** .37***
we also aimed to explore whether the emotional experience Age .12**
associated with worrying varied as a function of age. To that Depression .61***
aim, Depression, Anxiety and Stress scores were entered as STEP 3 .46*** .05***
predictor variables into a moderated hierarchical multiple Age .09*
regression analysis, with age as the moderating variable. All Depression .40***
variables were mean-centered to reduce multicollinearity Anxiety .31***
(Keith 2006). Age was entered as a predictor at the first STEP 4 .56*** .10***
step, Depression, Anxiety and Stress scores were entered as Age .08
predictor variables in the next three steps, and the interaction Depression .08
terms between age and the three DASS scales were individ- Anxiety .15**
ually entered at the remaining steps. The significant R2 Stress .55***
change values presented in Table 5 show that when all three STEP 5 .56*** .00
DASS scales were entered into the equation at Step 4, Stress Age .08
explained a substantial amount of variance in PSWQ-C Depression .09
scores, over and above the variance already explained by Anxiety .16**
Depression and Anxiety. Beta values also indicated that, Stress .55***
relative to Depression and Anxiety, Stress provided the Age x Depression −.06
greatest contribution to the explanation of variance in worry. STEP 6 .57*** .01**
Finally, the interaction terms entered at the last steps in the Age .08*
moderated multiple regression analysis indicated that the Depression .07
relationship between worry and anxiety varies according to Anxiety .20**
Stress .54***
Table 4 Correlations between the simplified DASS scales, the Age x Depression .02
PSWQ-C and age Age x Anxiety −.14**
STEP 7 .57*** .00
1 2 3 4 5
Age .08*
1. Depression – Depression .07
2. Anxiety 0.68*** – Anxiety .20**
3. Stress 0.79*** 0.70*** – Stress .54***
4. PSWQ-C 0.63*** 0.61*** 0.73*** – Age x Depression .03
5. Age 0.13* 0.19** 0.16** 0.20** – Age x Anxiety −.13*
Age x Stress −.02
PSWQ-C Penn State Worry Questionnaire for Children
*p<.05 **p<.01 ***p<.005 *p<.05 **p<.01 ***p<.005
J Psychopathol Behav Assess (2013) 35:65–75 71

with a mean age of 16.15 years (SD 0.86, Min 015.00, Table 6 Pearson correlation coefficients estimating the associations
between total PSWQ-C scores and each simplified DASS item
Max018.00 years). To assess the extent to which the stress
and anxiety syndromes accompany excessive worrying in Simplified DASS items r
younger and older adolescents, hierarchical multiple regres-
sion analyses were carried out separately in the two age Upset about little things .63***
groups. Regarding Stress, the results were highly similar in About to panic .60***
the two groups. At the last step of the analysis, Stress Easily upset .60***
accounted for the highest proportion of variance in PSWQ- Nothing would work out .59***
C scores in both younger (Depression β0.11, t01.12, p Could not stop thinking about things .58***
>.05; Anxiety β 0.28, t02.73, p<.01; Stress β0.46, t0 Easily annoyed .58***
4.31, p<.001) and in older adolescents (Depression β0.16, Felt like I was no good .57***
t01.23, p>.05; Anxiety β0.11, t0.92, p>.05; Stress β0.42, Couldn’t calm down .57***
t03.02, p<.005). However, as implicated by the moderated Difficult to relax .56***
MRA above, Anxiety had a relatively stronger association Over-react to situations .56***
with worrying in the young adolescent group, while this Hated self .56***
relationship was not statistically significant in the older Life was terrible .54***
age group. Not fun .50***
Finally, following the more detailed analytical strategy Hated life .50***
previously carried out in an adult sample (Szabó 2011), we No excitement .49***
also aimed to explore the associations between excessive Not feel like doing anything .49***
worrying and specific emotional symptoms in adolescents. Easily irritated .49***
A series of Pearson correlation analyses were conducted to Heart beating fast .49***
explore the strength of the relationships between total scores Situations made me scared .48***
on the PSWQ-C and each of the 27 simplified DASS items Could not enjoy anything .45***
we retained for further analyses on the basis of their factor Nothing to look forward to .42***
loadings. The coefficients presented in Table 6 show that Annoyed by interruptions .40***
adolescents who worry more also experience more symp- Shaky hands .39***
toms of tension, irritability and difficulty relaxing. On the Hated stopping what I was doing .38***
other hand, such symptoms of autonomic arousal as trouble Trouble breathing .35***
breathing or feeling shaky had the lowest associations with Lump in throat .32**
excessive worrying. Felt dizzy .32**

Items were only included if they loaded significantly in the previous

Discussion
A central aim of this study was to explore whether the emo-
tional experience associated with worrying in adolescents is
similar to that previously identified in adults. In adults, wor-
rying has been shown to be associated with symptoms of
irritability, tension, agitation, restlessness, and difficulty relax-
ing (Brown et al. 1997; Huang et al. 2009; Szabó 2011).
Moreover, there is strong evidence that these symptoms form
a unique, independent emotional syndrome, as indexed by the
Stress scale of the DASS (Lovibond and Lovibond 1995). The
DASS was originally designed for adults, and no
corresponding measure appropriate for use in adolescent pop-
ulations exists. Therefore, to enable an initial assessment of
the emotional experience associated with worrying in youth,
the present study first explored whether it is possible to assess
stress as a coherent syndrome, distinguishable from both
depression and anxiety, in 12–18-year-old adolescents. To that
aim, we developed a simplified version of the DASS to
increase comprehension by adolescent respondents. Guided
factor analyses. Stress items are presented in bold, Anxiety items in
italics. The table contains abbreviated versions of the items. The full
questionnaire is available from the second author upon request
*p<.05 **p<.01 ***p<.005
by the findings of previous studies (e.g., Szabó 2010), we
retained some of the original adult DASS items unchanged,
simplified other items to retain their meaning but increase
their comprehensibility by adolescents, and deleted items that
have been judged to lack simpler alternative expressions.
Adolescents’ responses to these items were subjected to ex-
ploratory factor analyses, which revealed an interpretable
three-factor solution to the data.
The first factor was primarily defined by items developed
to assess Stress in adolescents. The highest loading items on
this factor reflected irritability, difficulty tolerating interrup-
tions, and being easily upset. Only two of the 12 items
developed to assess Stress failed to load clearly on this
factor. These two items (‘I felt restless’ and ‘I found it hard
to wait patiently for anything [e.g. waiting for a lift]’) may
72
not be age-appropriate expressions of the restlessness and
impatience associated with Stress and were excluded from
our analyses. Interestingly, however, one item (‘I never felt
like doing anything’) originally designed to assess the ‘In-
ertia’ or ‘Lack of Interest’ aspect of depression loaded on
the Stress factor. Similarly, the other item originally
designed to assess depressive Inertia (‘It was hard to get
started to do things’), also had a marginal association with
Stress, rather than with Depression. One likely explanation
of the association of these items with the underlying Stress
factor may be that they in fact reflect avoidant behaviours
associated with worrying (i.e., did not feel like doing any-
thing because of expected threatening outcomes), rather
than the lack of motivation, interest or energy characteristic
of depression. Future studies may be able to answer this
question by further refining the wording of these items. In
the meantime, for the purposes of our study, all 11 items that
loaded on the Stress factor were retained to form the Stress
scale to be used in our main analyses.
So far, results suggest that previous difficulties in identi-
fying Stress as a unique, independent emotional syndrome
using the adult DASS in adolescents (Duffy et al. 2005;
Patrick et al. 2010; Szabó 2010; Tully et al. 2009) may have
been largely attributable to comprehension problems.
Importantly, Szabó (2010) reported that missing values anal-
yses indicated a tendency for adolescents to leave blank
items indexing the ‘easily upset/agitated’ and ‘impatient’
aspects of Stress when responding to the adult version of
the DASS. In the present study, such words as ‘intolerant’ or
‘agitated’ were omitted or replaced, and an examination of
missing values revealed no clear pattern. In addition to
exploring whether simplified versions of the adult DASS
Stress items form a coherent factor, we also sought to
determine whether this factor is distinguishable from those
thought to index Depression and Anxiety. Therefore, it is
important to consider the nature of the other two factors that
emerged in the exploratory analyses. These two factors were
positively correlated with but clearly distinguishable from
the Stress factor, and their item structure was consistent with
that of the adult DASS.
The second factor to emerge was defined primarily by
simplified versions of adult DASS items developed to assess
Depression. As discussed above, two items intended to
index Inertia had weak loadings on this factor. These find-
ings are consistent with previous studies examining the
adult version of the DASS in adolescents (Szabó 2010) as
well as in adults (Antony, et al. 1998; Crawford and Henry
2003; Lovibond and Lovibond 1995), and contribute to
emerging evidence that Inertia is a relatively weak indicator
of depression. One further item, ‘I felt sad and unhappy’,
had a double loading on both the depression and the stress
factors in the present study. The reason for this is unclear,
but it is interesting to note that a similar item (‘I feel
J Psychopathol Behav Assess (2013) 35:65–75
unhappy’) also had weak loading on the ‘depression’ factor
in a previous study concerning negative affect in children
and young adolescents (Szabó and Lovibond 2006). It is
possible that the words ‘sad’ and ‘unhappy’ have a broader
meaning, indicating general negative affect in young people.
Therefore, this item may need to be revised if it is to be
included in self-report measures of youth depression in
future. In general, however, the second factor appeared
consistent with the item definition of Depression in the adult
DASS (Lovibond and Lovibond 1995).
Finally, the third factor to emerge in these analyses com-
prised of seven items indexing autonomic arousal, skeletal
musculature effects, situational anxiety and a subjective
experience of anxious affect. Although it had a clear simi-
larity to the Anxiety scale of the adult DASS, this factor was
relatively less well defined. Four of the items originally
intended to assess Anxiety failed to have a substantial load-
ing on any factor, and one item (‘Some things I had to do
really scared me’) double-loaded on Depression. Further
refinement of the non-discriminating items may result in a
more comprehensive assessment of Anxiety in adolescents
in future research. For the purposes of our study, however,
the seven items with substantial loadings were taken as
adequate initial indicators of Anxiety in adolescents.
The simplified Stress, Depression and Anxiety scales
defined by these items were found to have excellent internal
consistency estimates, comparable to those previously
reported for the adult DASS (Lovibond and Lovibond
1995). Overall, the findings are consistent with the idea that
the modification of items to maximise comprehension while
retaining item specificity (Szabó and Lovibond 2006), may
allow the identification of the three adult-like emotional
syndromes of Depression, Anxiety and Stress in adoles-
cents. It is important to acknowledge, however, that the
items developed in our study are not exhaustive. Future
work is especially needed to achieve a more comprehensive
assessment of depression and anxiety in adolescents. Future
studies are needed to refine the items developed for the
present study, and to provide further evidence of the reli-
ability and validity of the resulting scales in adolescent
samples. Such evidence would necessarily involve further
tests of the items using Confirmatory Factor Analyses. As
the present study involved a non-clinical sample, it would
also be important to examine the psychometric properties of
the resulting scales in clinical samples. Studies involving
clinical samples would allow the identification of cut-off
points for pathological manifestations of negative emotional
states, in addition to providing a comparison against the
current findings.
The main aim of the present study, however, was to
explore whether an emotional state similar to stress in adults
also accompanies worrying in adolescents. To that aim, both
detailed item-level correlational analyses and more
J Psychopathol Behav Assess (2013) 35:65–75
controlled multiple regression analyses were carried out.
Item-level analyses showed that adolescents who worry
more excessively and uncontrollably also experience more
symptoms of tension, irritability and difficulty relaxing. On
the other hand, such symptoms of autonomic arousal as
trouble breathing, feeling faint or feeling shaky had the
lowest associations with excessive worrying in our sample.
These results are consistent with the deletion of autonomic
arousal symptoms from the DSM-IV (APA 2000) definition
of GAD for both adults and adolescents. Importantly, how-
ever, the results also suggest that the scope of ‘vigilance and
tension’ symptoms for GAD could be expanded upon to
incorporate symptoms reflected in the DASS Stress scale.
These interpretations, of course, require further evidence
from studies carried out in clinically anxious adolescent
samples.
A series of multiple regression analyses were carried out
to assess the extent to which worry has a unique relationship
with depression, anxiety, and stress, and whether these rela-
tionships vary with age. Each of the analyses showed that
stress explained the largest proportion of variance in worry,
above and beyond that accounted for by anxiety and depres-
sion. Moreover, moderated regression analyses indicated
that the relationship between stress and worry does not vary
with age, but that anxiety becomes less strongly associated
with worry as adolescents mature. Indeed, our follow-up
analyses of this interaction effect showed that stress had
the strongest unique association with worrying both in the
youngest (aged 11.67–13.50 years) and the oldest (aged 15–
18 years) adolescent age groups. A notable difference be-
tween the two age groups was that an association between
worry and anxiety was found in young adolescents only.
This relationship was weak and not statistically significant
in older adolescents.
Overall, the pattern of results is consistent with adult data
(Szabó 2011) and with theories suggesting that worrying is a
cognitive avoidance process designed to reduce the aversive
autonomic arousal symptoms of anxiety (e.g., Borkovec et
al. 2004). Interestingly, the findings regarding the decreas-
ing association between worry and DASS Anxiety are con-
sistent with earlier suggestions that in younger adolescents
and especially in children, worrying may be similar to the
adult concept of fear (Szabó 2007, 2009). It is possible that
the cognitive avoidance function of worry has not yet fully
developed in younger adolescents, and that an association
between worry and autonomic arousal in the younger ado-
lescent age group reflects a fear-like phenomenology of
worry that is not yet fully identical to the adult experience.
Given that the youngest participants in the present study
were 11.67 years of age, future research exploring the struc-
ture of negative emotional states and the emotional experi-
ence associated with worry are now needed to test these
suggestions in children.
73
In summary, the present study sought to initiate an explo-
ration of the emotional experience associated with worrying in
youth. To that aim, we first investigated whether stress can be
observed as a unique emotional state in adolescents, distin-
guishable both from anxiety and depression. Unlike previous
studies using the original adult DASS items (Duffy et al. 2005;
Patrick et al. 2010; Szabó 2010; Tully et al. 2009), we used
simplified versions to improve comprehension by adolescent
respondents. This strategy lead to the identification of three
correlated but clearly differentiated factors that were highly
similar in item content to the Depression, Anxiety and Stress
scales comprising the adult DASS (Lovibond and Lovibond
1995). It needs to be acknowledged that the use of these items
as valid indicators of the emotional states of depression,
anxiety, and stress in adolescents requires future verification.
In the meantime, however, our results are the first to provide
an initial indication of the emotional experience of worrying
in youth, showing that worrying in 12–18-year-olds is asso-
ciated with a unique emotional syndrome involving irritabil-
ity, being easily upset, difficulty relaxing, and difficulty
tolerating interruptions. On the other hand, symptoms of
autonomic arousal had only weak associations with worry in
this sample. Future studies are now needed to further develop
our ability to reliably assess the emotional syndrome of stress
in young people, to clearly delineate the nature of this con-
struct, to identify the age at which it first emerges, and to
explicate the reasons for its specific association with
worrying.
Acknowledgments The authors would like to thank all participants
and school personnel for their invaluable support, without which this
project would not have been possible.
References
Aldao, A., & Mennin, D. (2012). Paradoxical cardiovascular effects of
implementing adaptive emotion regulation strategies in general-
ized anxiety disorder. Behaviour Research & Therapy, 50, 122–
130.
American Psychiatric Association. (1987). Diagnostic and statistical
manual of mental disorders (3rd ed.). Washington: American
Psychiatric Association.
American Psychiatric Association. (2000). Diagnostic and statistical
manual of mental disorders IV-Text Revised (DSM-IV-TR). Wash-
ington: American Psychiatric Association.
Andrews, G., Hobbs, M. J., Borkovec, T. D., et al. (2010). Generalized
worry disorder: a review of DSM-IV generalized anxiety disorder
and options for DSM-V. Depression and Anxiety, 27, 134–147.
Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R.
P. (1998). Psychometric properties of the 42-item and 21-item
versions of the Depression Anxiety Stress Scales in clinical
groups and a community sample. Psychological Assessment, 10,
176–181.
Bayram, N., & Bilgel, N. (2010). Turkish version of the Depression
Anxiety Stress Scale (DASS-42): Psychometric properties.
Archives of Neuropsychiatry, 47, 118–126.
74
Bell-Dolan, D. J., Last, C. G., & Strauss, C. C. (1990). Symptoms of
anxiety disorders in normal children. Journal of the American
Academy of Child & Adolescent Psychiatry, 29, 759–765.
Borkovec, T. D., & Hu, S. (1990). The effect of worry on cardiovas-
cular response to phobic imagery. Behaviour Research and Ther-
apy, 28, 69–73.
Borkovec, T. D., & Inz, J. (1990). The nature of worry in generalized
anxiety disorder: a predominance of thought activity. Behaviour
Research and Therapy, 28, 153–158.
Borkovec, T. D., Alcaine, O. M., & Behar, E. (2004). Avoidance theory
of worry and generalized anxiety disorder. In R. G. Heimberg, C.
L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder:
advances in research and practice (pp. 77–108). New York:
Guilford Press.
Brown, T. A., Marten, P. A., & Barlow, D. A. (1995). Discriminant
validity of the symptoms constituting the DSM-III-R and DSM-
IV associated symptom criterion of generalized anxiety disorder.
Journal of Anxiety Disorders, 9, 317–328.
Brown, T. A., Chorpita, B. F., Korotitsch, W., & Barlow, D. H. (1997).
Psychometric properties of the Depression Anxiety Stress Scale
(DASS) in clinical samples. Behavior Research and Therapy, 35,
79–89.
Cartwright-Hatton, S. (2006). Worry in childhood and adolescence. In
G. Davey & A. Wells (Eds.), Worry and its psychological disor-
ders: theory, assessment and treatment (pp. 81–97). Chichester:
Wiley.
Chorpita, B. F., Tracey, S. A., Brown, T. A., Collica, T. J., & Barlow,
D. H. (1997). Assessment of worry in children and adolescents:
an adaptation of the Penn State Worry Questionnaire. Behaviour
Research and Therapy, 35, 569–581.
Crawford, J. R., & Henry, J. D. (2003). The depression anxiety stress
scales (DASS): normative data and latent structure in a large non-
clinical sample. British Journal of Clinical Psychology, 42, 111–
131.
Davey, G. C. L. (1994). Pathological worrying as exacerbated
problem-solving. In G. C. L. Davey & F. Tallis (Eds.), Worrying:
perspectives on theory, assessment and treatment (pp. 35–61).
Chichester: Wileys.
Duffy, C. J., Cunningham, E. G., & Moore, S. M. (2005). Brief report:
the factor structure of mood states in an early adolescent sample.
Journal of Adolescence, 28, 677–680.
Fabrigar, L. R., Wegener, D. T., MacCallum, R. C., & Strahan, E. J.
(1999). Evaluating the use of exploratory factor analysis in psy-
chological research. Psychological Methods, 4, 272–299.
Freeston, M. H., Dugas, M. J., & Ladouceur, R. (1996). Thoughts,
images, worry, and anxiety. Cognitive Therapy and Research, 20,
265–273.
Freeston, M. H., Dugas, M. J., Letarte, H., & Rheaume, J. (1996).
Physical symptoms associated with worry in a non-clinical pop-
ulation. Journal of Anxiety Disorders, 10, 365–377.
Gong, X., Xie, X., Xu, R., & Luo, Y. (2010). Psychometric properties
of the Chinese version of the DASS-21 in Chinese college stu-
dents. Chinese Journal of Clinical Psychology, 18, 443–446.
Gosselin, P., Langlois, F., Freeston, M. H., et al. (2007). Cognitive
variables related to worry among adolescents: avoidance strate-
gies and faulty beliefs about worry. Behaviour Research and
Therapy, 45, 225–233.
Hale, W. W., III, Raaijmakers, Q., Muris, P., Van Hoof, A., & Meeus,
W. (2008). Developmental trajectories of adolescent anxiety dis-
order symptoms: a 5-year prospective community study. Journal
of the American Academy of Child and Adolescent Psychiatry, 47,
556–564.
Henry, J. D., & Crawford, J. R. (2005). The short-form version of the
depression anxiety stress scales (DASS-21): construct validity and
normative data in a large non-clinical sample. British Journal of
Clinical Psychology, 44, 227–239.
J Psychopathol Behav Assess (2013) 35:65–75
Holaway, R. M., Rodebaugh, T. L., & Heimberg, R. G. (2006). The
epidemiology of worry and generalized anxiety disorder. In G. L.
C. Davey & A. Wells (Eds.), Worry and its psychological disor-
ders: theory, assessment and treatment (pp. 3–21). Chichester:
Wiley. Ch 1.
Huang, K., Szabó, M., & Han, J. (2009). The relationship of low
distress tolerance to excessive worrying and cognitive avoidance.
Behaviour Change, 26, 223–234.
Keith, T. Z. (2006). Multiple regression and beyond. Boston: Pearson.
Kim-Cohen, J., Caspi, A., Moffitt, T. E., et al. (2003). Prior juvenile
diagnoses in adults with mental disorder: developmental follow-
back of a prospective-longitudinal cohort. Archives of General
Psychiatry, 60, 709–717.
Laugesen, N., Dugas, M. J., & Bukowski, W. M. (2003). Understand-
ing adolescent worry: the applicability of a cognitive model.
Journal of Abnormal Child Psychology, 31, 55–64.
Lovibond, P. F. (1998). Long-term stability of depression, anxiety, and
stress syndromes. Journal of Abnormal Psychology, 107, 520–
526.
Lovibond, P. F., & Lovibond, S. H. (1995a). The structure of negative
emotional states: comparison of the depression anxiety stress
scales (DASS) with the beck depression and anxiety inventories.
Behavior Research and Therapy, 33, 335–343.
Lovibond, S. H., & Lovibond, P. F. (1995b). Manual for the depression
anxiety stress scales. Sydney: Psychology Foundation
Monograph.
Marten, P. A., Brown, T. A., Barlow, D. H., et al. (1993). Evaluation of
the ratings comprising the associated symptom criterion of DSM-
III-R generalized anxiety disorder. Journal of Nervous and Mental
Disease, 81, 676–682.
Mathews, A. (1990). Why worry? The cognitive function of anxiety.
Behaviour Research and Therapy, 28, 455–468.
Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2005).
Preliminary evidence for an emotion dysregulation model of
generalized anxiety disorder. Behaviour Research and Therapy,
43, 1281–1310.
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990).
Development and validation of the Penn State Worry Question-
naire. Behaviour Research and Therapy, 28, 487–495.
Muris, P., Meesters, C., Merckelbach, H., Sermon, A., & Zwa-
khalen, S. (1998). Worry in normal children. Journal of the
American Academy of Child & Adolescent Psychiatry, 37,
703–710.
Norton, P. J. (2007). Depression anxiety and stress scales (DASS-21):
psychometric analysis across four racial groups. Anxiety, Stress &
Coping, 20, 253–265.
Patrick, J., Dyck, M., & Bramston, P. (2010). Depression anxiety stress
scale: is it valid for children and adolescents? Journal of Clinical
Psychology, 66, 1–12.
Salters-Pedneault, K., Roemer, L., Tull, M. T., Rucker, L., & Mennin,
D. S. (2006). Evidence of broad deficits in emotion regulation
associated with chronic worry and generalized anxiety disorder.
Cognitive Therapy and Research, 30, 469–480.
Starcevic, V., Fallon, S., & Uhlenhuth, E. H. (1994). The frequency
and severity of generalized anxiety disorder symptoms. Toward a
less cumbersome conceptualisation. Journal of Nervous and Men-
tal Disease, 182, 80–84.
Szabó, M. (2007). Do children differentiate worry from fear? Behav-
iour Change, 24, 195–204.
Szabó, M. (2009). Worry in adults and children: developmental
differences in the importance of probability and cost judg-
ments. Journal of Psychopathology and Behavioral Assess-
ment, 31, 235–245.
Szabó, M. (2010). The short version of the depression anxiety stress
scales (DASS-21): factor structure in a young adolescent sample.
Journal of Adolescence, 33, 1–8.
J Psychopathol Behav Assess (2013) 35:65–75
Szabó, M. (2011). The emotional experience associated with worrying:
anxiety, depression or stress? Anxiety. Stress and Coping, 24(1), 1–15.
Szabó, M., & Lovibond, P. F. (2006). Anxiety, depression, and tension/
stress in children. Journal of Psychopathology and Behavioural
Assessment, 28, 195–204.
Tully, P. J., Zajac, I. T., & Venning, A. J. (2009). The structure of
anxiety and depression in a normative sample of younger and
older Australian adolescents. Journal of Abnormal Child Psychol-
ogy, 37, 717–726.
View publication stats
75
Vasey, M. W. (1993). Development and cognition in childhood anxi-
ety: The example of worry. In T. H. Ollendick & R. J. Prinz
(Eds.), Advances in clinical child psychology (pp, Vol. 15, pp.
1–39). New York: Plenum.
Vasey, M. W., Crnic, K. A., & Carter, W. G. (1994). Worry in child-
hood: a developmental perspective. Cognitive Therapy and Re-
search, 18, 529–549.
Wells, A. (1999). A cognitive model of generalized anxiety disorder.
Behaviour Modification, 23, 526–555.