Correlates of Dampening and Savoring in Generalized Anxiety Disorder

Savoring changes novel positive mindset targets of GAD treatment: Optimism, prioritizing positivity, kill-joy thinking, and worry mediation

This study analyzed effects of savoring on unstudied positive mindset targets of generalized anxiety disorder (GAD) treatment (ClinicalTrials.gov: NCT05040061). 85 students with GAD were randomly assigned to one of two ecological momentary interventions (EMIs) on smartphone for seven days. The SkillJoy EMI promoted practices for savoring positive emotions. An active control EMI mirrored SkillJoy, yet did not include savoring or positive emotion. Optimism, worry, kill-joy thinking (lessening positive emotion with cognition), and prioritization of positive emotion activities and goals were assessed at pre-trial, eighth-day, post-trial, and 30th-day follow-up. Savoring was assessed pre-trial and fifth-day mid-trial. Longitudinal linear mixed models and simple slope analyses examined change between and within conditions. Bias-corrected bootstrapping path analysis examined mediation of worry change by increased savoring. SkillJoy led to significantly greater increases in both optimism and prioritizing positivity than the control from pre-trial to post-trial and pre-trial to follow-up. Both interventions significantly reduced kill-joy thinking at both timepoints with Skilljoy leading to marginally greater change at post-trial. Pre- to mid-trial increases in savoring mediated the relationships between treatment condition and reductions in worry at both post-trial and follow-up.

The Contrast Avoidance Model: Conclusion and synthesis of new research in the special issue

In this special series, new research on the Contrast Avoidance Model (CAM) was presented, including studies on the role of CAM in the maintenance of chronic worry, the incremental validity of CAM, CAM as a mediator of the association between generalized anxiety disorder (GAD) and other variables, CAM as transdiagnostic, and interpersonal behaviors as a means to avoid negative emotional contrasts (NECs). Furthermore, the role of perseverative thought in relation to positive emotional contrasts (PECs) was explored. Studies indicated that higher worry was positively and negatively reinforced, a factor that is likely to contribute to the maintenance of GAD. Further, research demonstrated that CAM contributed unique variance to understanding GAD above and beyond other variables associated with GAD, such as intolerance of uncertainty and negative problem orientation. Additional research revealed the transdiagnostic nature of contrast avoidance, as well as the association between contrast avoidance and problem-solving deficits. In addition, both worry and rumination increased the likelihood of PECs. Further, data suggested that anxious individuals may use interpersonal strategies to avoid NECs. Finally, savoring positive emotions was found to reduce contrast avoidance, providing a novel intervention strategy to address contrast avoidance in individuals with GAD.

Intolerance of uncertainty heightens negative emotional states and dampens positive emotional states

Individuals high in self-reported Intolerance of Uncertainty (IU) tend to view uncertainty as unbearable and stressful. Notably, IU is transdiagnostic, and high levels of IU are observed across many different emotional disorders (e.g., anxiety, depression). Research has primarily focused on how IU evokes and modulates emotional states such as fear and anxiety. However, recent research suggests that IU may have relevance for a broader range of emotional states. Here, an online survey was conducted to examine whether IU evokes and modulates a range of negative (e.g., fear/anxiety, sadness/upset, anger/frustration, disgust) and positive (e.g., happiness/joy, excitement/enthusiasm, surprise/interest) emotional states. Findings within a community sample (n = 231) revealed that individuals with higher levels of IU report: (1) that uncertainty in general and uncertainty under ambiguity are more likely to evoke negative emotional states and less likely to evoke positive emotional states, (2) that uncertainty under risk is less likely to evoke positive emotional states, and (3) that uncertainty heightens existing negative emotional states and dampens existing positive emotional states. Importantly, these IU-related findings remained when controlling for current experiences of general distress, anxious arousal, and anhedonic depression. Taken together, these findings suggest that IU is involved in evoking and modulating a wide array of emotional phenomena, which likely has relevance for transdiagnostic models and treatment plans for emotional disorders.

Reducing contrast avoidance in GAD by savoring positive emotions: Outcome and mediation in a randomized controlled trial

This secondary analysis of a randomized controlled trial (RCT) examined whether contrast avoidance (CA) in Generalized Anxiety Disorder (GAD) could be reduced through savoring-purposeful engagement with positive emotions. 85 participants were diagnosed with GAD by both questionnaire and clinical interview. They were then randomly assigned to one of two seven-day smartphone-delivered ecological momentary interventions (EMIs). The SkillJoy EMI facilitated in-the-moment practice of savoring positive emotions in participants' daily lives. The active self-monitoring control (ASM) was nearly identical to SkillJoy in ratings, activities, and language, yet omitted specific attention to positive emotion and savoring. CA was assessed by questionnaire at pre-trial and post-trial. Savoring was assessed by questionnaire at pre-trial and fifth-day mid-trial. Longitudinal linear mixed models and simple slope analyses examined CA change between and within conditions. Bias-corrected boot strapping path analysis examined mediation by savoring using individuals' CA slopes extracted from a multilevel model as outcome. Results showed that SkillJoy led to significant reductions in CA, whereas the ASM control did not. The relation between treatment condition and reduction in CA was mediated by increases in savoring from pre- to mid-trial. It may be possible for treatment to meaningfully reduce CA in GAD, specifically through savoring practices.