The Effects of Worry in Daily Life: An Ecological Momentary Assessment Study Supporting the Tenets of the Contrast Avoidance Model

Ecological momentary assessment of the unique effects of trait worry on daily negative emotionality: does arousal matter?

Worry proneness is a transdiagnostic trait that predicts increased negative affect (NA), potentially in the service of preventing negative emotional contrasts. Although discrete types of NA vary along the dimension of arousal, the extent to which trait worry predicts high vs. low arousal forms of NA in daily life is unclear. This distinction has important implications for conceptualising how worry may perturb adaptive emotionality in various disorders. The present study (not pre-registered) aimed to isolate the effects of trait worry on high (N = 88) and low (N = 122) arousal NA in daily life using ecological momentary assessment while controlling for potential physical and psychological confounds. Participants were assessed for trait worry and depressive symptoms at baseline then reported their affect, heart rate, and exercise three times per day for one week. Multilevel models revealed that trait worry predicted both increased high and low arousal NA after controlling for momentary heart rate, daily exercise, and depression. In contrast, baseline depressive symptoms only predicted low arousal NA in daily life. Findings support the contrast avoidance model of worry and suggest that worry is linked to increased state NA in daily life, independent of arousal.

Stress, repetitive negative thinking, and mental health in Chilean university students: an ecological momentary assessment study

Background

Mental disorders in university students are a growing attention problem in the international community due to their high prevalence and serious consequences. One possible reason is university students' difficulties in coping with stress. Repetitive negative thinking (RNT) is a transdiagnostic process that, when combined with stress, can lead to the development of various disorders. We aim to determine the effect of stress and RNT on predicting various mental health syndromes in university students across 7 days.

Method

Prospective observational study using Momentary Ecological Assessment (EMA) with the OURMIND Mobile App. On day one, 238 university students responded to the SCL-90R questionnaire for symptoms of depression, anxiety, hostility, obsession, psychoticism, paranoia, somatization, and interpersonal sensitivity; RNT styles questionnaires, RRS for rumination and negative reflection, PSWQ for worry; SISCO-II for term academic stress, and sociodemographic. EMA consisted of five assessments a day for 6 days; each time, the students answered items about academic and non-academic stress (EMA-stress), reactive RNT duration and intrusiveness (EMA-RNT process), and reactive RNT rumination, reflection, and worry (EMA-RNT content). On day eight, symptoms were re-assessed. Seven hierarchical stepwise linear regression models were used to test the predictive power of the study variables in the development of SCL-90R symptoms.

Results

When comparing models, adding baseline symptoms increased the models' predictive power in all symptom groups. In most cases, including EMA-stress generated greater predictive power, except for paranoia and interpersonal sensitivity. Adding the EMA-RNT process increased the prediction of paranoia and obsessive symptoms; for hostility symptoms, RNT styles increased predictive power. For the final regression models, considering the initial symptoms, the EMA-RNT process predicted the progression of symptoms in six out of eight groups, while EMA-non-academic stress predicted the remaining two. Additionally, living with other relatives or friends was a predictor of depressive symptoms.

Discussion

The stress of university life impacts the development of psychiatric symptoms in university students. These results provide evidence of RNT as a transdiagnostic process in several syndromic groups. Universal preventive programs should consider the impact of academic and non-academic stress on university students' mental health. Targeting RNT would also benefit selective preventive interventions.

Is a brief mindfulness ecological momentary intervention more efficacious than a self-monitoring app for social anxiety disorder? A randomized controlled trial

Despite their proliferation, limited knowledge exists regarding possible benefits of brief mindfulness ecological momentary interventions (MEMIs) for social anxiety disorder (SAD). Propositions that MEMIs could alleviate SAD symptoms and related clinical outcomes remain untested. This trial evaluated a 14-day MEMI for SAD. Participants with self-reported SAD were randomized to MEMI (n = 96) or self-monitoring app (SM; n = 95). Whereas MEMI instructed mindfulness exercises, SM prompted only self-monitoring five times daily for 14 days. Participants completed state-level self-reports of depression, anxiety, and mindfulness pre-post-mindfulness practice and SAD symptoms, worry, depression severity, repetitive negative thinking, and trait mindfulness at pre-randomization, post-intervention, and 1-month follow-up (1MFU). Hierarchical linear modeling was conducted. The MEMI yielded statistically significantly larger improvements in momentary depression, anxiety, and mindfulness (Cohen's d = -0.10-0.11). Although no between-group effects emerged in alleviating SAD fear and avoidance, excessive worry, depression severity, repetitive negative thinking, and trait mindfulness (-0.13-0.15), within-group effects were significantly small-to-large from pre-post and pre-1MFU (-4.62-0.67). A significant reduction in depression severity occurred in MEMI (-0.63--0.60) but not SM (-0.31--0.29). Brief MEMI and SM yielded nondifferent sustained effects on SAD, comorbid symptoms, and risk factors, highlighting its potential value within stepped-care delivery settings.

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.

Treatment condition as a moderator and change in trait mindfulness as a mediator of a brief mindfulness ecological momentary intervention for generalized anxiety disorder

BACKGROUND

Theories propose that judgment of and reactivity to inner experiences are mediators of the effect of mindfulness-based interventions on generalized anxiety disorder (GAD). However, no study has tested such theories using brief, mindfulness ecological momentary intervention (MEMI). We thus tested these theories using a 14-day MEMI versus self-monitoring app (SM) control for GAD.

METHODS

Participants (N = 110) completed self-reports of trait mindfulness (Five Facet Mindfulness Questionnaire), GAD severity (GAD-Questionnaire-IV), and trait perseverative cognitions (Perseverative Cognitions Questionnaire) at prerandomization, posttreatment, and 1-month follow-up (1MFU). Counterfactual mediation analyses with temporal precedence were conducted.

RESULTS

Improvement in pre-post mindfulness domains (acceptance of emotions, describing feelings accurately, acting with awareness, judgment of inner experience, and reactivity to inner experience) predicted pre-1MFU reduction in GAD severity and pre-1MFU reduction in trait perseverative cognitions from MEMI but not SM. MEMI reduced pre-post reactivity to inner experiences (but not other mindfulness domains) significantly more than SM. Only reduced pre-post reactivity significantly mediated stronger efficacy of MEMI over SM on pre-1MFU reductions in GAD severity (indirect effect: β = -2.970 [-5.034, -0.904], p = .008; b path: β = -3.313 [-6.350, -0.276], p = .033; percentage mediated: 30.5%) and trait perseverative cognitions (indirect effect: β = -0.153 [-0.254, -0.044], p = .008; b path: β = -0.145 [-0.260, -0.030], p = .014; percentage mediated: 42.7%). Other trait mindfulness domains were non-significant mediators.

CONCLUSIONS

Reactivity to inner experience might be a mindfulness-based intervention change mechanism and should be targeted to optimize brief MEMIs for GAD.

An initial test of the contrast avoidance model in bipolar spectrum disorders

The Contrast Avoidance Model suggests that individuals sensitive to negative emotional shifts use prior increases in negative affect to prevent further escalation in response to adverse situations, while the heightened negative affect amplifies positive emotional contrasts when encountering unexpected positive events. Individuals with bipolar spectrum disorders (BSDs), characterized by shifts between (hypo)manic and depressive episodes, may undergo more salient emotional contrasts. Drawing from the Contrast Avoidance Model, the shifts from depression to (hypo)mania can be conceptualized as positive emotional contrasts, potentially heightening the perceived pleasure during (hypo)manic episodes. On the other hand, the shifts from (hypo)manic to depressive episodes can be viewed as negative emotional contrasts, contributing to the challenges associated with depressive states. Despite the intriguing potential of this interplay, the link between the Contrast Avoidance Model and BSDs has never been empirically tested. Our study addressed this gap by examining group differences in contrast avoidance traits between individuals with BSDs, unipolar depression, and healthy controls in a large cohort study (N = 536). Results indicated that individuals with BSDs exhibited significantly higher scores in the total, and Discomfort with Negative Emotional Shifts and Avoidance of Negative Emotional Contrasts/Enhancement of Positive Emotional Contrasts factors, as well as separate item scores on the Contrast Avoidance Questionnaire-General Emotion (CAQ-GE), compared to those with unipolar depression and healthy controls. Although marginal, the BD II subtype demonstrated a stronger inclination to avoid negative emotional contrasts compared to BD I. These findings suggest that contrast avoidance may be a psychological mechanism implicated in BSDs.

Intolerance of Uncertainty and Worry Prospectively Predict COVID-19 Anxiety and Distress: A 4-Year Longitudinal Study

The COVID-19 pandemic precipitated an uptick in poor mental health outcomes, including coronavirus-related anxiety and distress. Preliminary research has shown that intolerance of uncertainty (IU) and worry proneness, two transdiagnostic risk factors for anxiety and related disorders, are associated cross-sectionally with pandemic-related fear and distress. However, the extent to which IU and worry proneness prospectively predict coronavirus-related anxiety and distress is unclear. Whether IU and worry may also interact in prospectively predicting coronavirus-related anxiety and distress is also unknown. To address this knowledge gap, the present study examined IU and trait worry as prospective predictors of the level and trajectory of coronavirus anxiety and COVID stress syndrome over time, as well as the extent to which worry moderated the relation between IU and pandemic-related outcomes. Participants (n = 310) who completed self-report measures of IU and trait worry in 2016 were contacted following the onset of COVID-19 in 2020 and completed biweekly measures of coronavirus anxiety and COVID stress syndrome for 30 weeks. Multilevel models revealed that IU assessed in 2016 significantly predicted the severity of both coronavirus anxiety and COVID stress syndrome throughout the study period in 2020. Worry also moderated the link between IU and coronavirus anxiety, such that individuals with high levels of trait worry and high IU in 2016 experienced the most coronavirus anxiety in 2020. Results suggest that IU and worry functioned as independent and interactive vulnerability factors for subsequent adverse psychological reactions to COVID-19. Clinical implications and future directions are discussed.

Introduction to a special issue on the contrast avoidance model

The current paper introduces the special issue on the Contrast Avoidance Model. The Contrast Avoidance Mmodel theorizes that chronic worriers are afraid of a sharp increase in negative emotion and/or sharp reduction in positive emotion (labeled negative emotional contrasts; NECs). They thus use perseverative thought as means to create and sustain negative emotion to prevent NECs if they were to experience negative events. Further, these individuals are uncomfortable with sustained positive emotion because it leaves them vulnerable to NECs. At the same time, worry increases the probability of positive emotional contrasts (PECs), or sharp increases in positive emotion or decreases in negative emotion when things turn out better than expected or positive events are experienced. Therefore, these individuals generate negative emotion via perseverative thought as a way to avoid NECs and increase the likelihood of PECs. The current special issue provides novel research on the model.

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.

Negative affect variability differs between anxiety and depression on social media

OBJECTIVE

Negative affect variability is associated with increased symptoms of internalizing psychopathology (i.e., depression, anxiety). The Contrast Avoidance Model (CAM) suggests that individuals with anxiety avoid negative emotional shifts by maintaining pathological worry. Recent evidence also suggests that the CAM can be applied to major depression and social phobia, both characterized by negative affect changes. Here, we compare negative affect variability between individuals with a variety of anxiety and depression diagnoses by measuring the levels and degree of change in the sentiment of their online communications.

METHOD

Participants were 1,853 individuals on Twitter who reported that they had been clinically diagnosed with an anxiety disorder (A cohort, n = 896) or a depressive disorder (D cohort, n = 957). Mean negative affect (NA) and negative affect variability were calculated using the Valence Aware Dictionary for Sentiment Reasoning (VADER), an accurate sentiment analysis tool that scores text in terms of its negative affect content.

RESULTS

Findings showed differences in negative affect variability between the D and A cohort, with higher levels of NA variability in the D cohort than the A cohort, U = 367210, p < .001, r = 0.14, d = 0.25. Furthermore, we found that A and D cohorts had different average NA, with the D cohort showing higher NA overall, U = 377368, p < .001, r = 0.12, d = 0.21.

LIMITATIONS

Our sample is limited to individuals who disclosed their diagnoses online, which may involve bias due to self-selection and stigma. Our sentiment analysis of online text may not completely capture all nuances of individual affect.

CONCLUSIONS

Individuals with depression diagnoses showed a higher degree of negative affect variability compared to individuals with anxiety disorders. Our findings support the idea that negative affect variability can be measured using computational approaches on large-scale social media data and that social media data can be used to study naturally occurring mental health effects at scale.

Ready for the worst? Negative affect in anticipation of a stressor does not protect against affective reactivity

INTRODUCTION

Lay wisdom suggests feeling negative while awaiting an upcoming stressor-anticipatory negative affect-shields against the blow of the subsequent stressor. However, evidence is mixed, with different lines of research and theory indirectly suggesting that anticipatory negative affect is helpful, harmful, or has no effect on emotional outcomes. In two studies, we aimed to reconcile these competing views by examining the affective trajectory across hours, days, and months, separating affective reactivity and recovery.

METHODS

In Study 1, first-year students (N = 101) completed 9 days of experience sampling (10 surveys/day) as they received their first-semester exam grades, and a follow-up survey 5 months later. In Study 2, participants (N = 73) completed 2 days of experience sampling (60 surveys/day) before and after a Trier Social Stress Test. We investigated the association between anticipatory negative affect and the subsequent affective trajectory, investigating (1) reactivity immediately after the stressor, (2) recovery across hours (Study 2) and days (Study 1), and (3) recovery after 5 months (Study 1).

RESULTS

Across the two studies, feeling more negative in anticipation of a stressor was either associated with increased negative affective reactivity, or unassociated with affective outcomes.

CONCLUSION

These results run counter to the idea that being affectively ready for the worst has psychological benefits, suggesting that instead, anticipatory negative affect can come with affective costs.

Fear learning and extinction predicts anxiety in daily life: a study of Pavlovian conditioning and ecological momentary assessment

BACKGROUND

The association between anxious mood and aberrant fear learning mechanisms has not been fully elucidated. Studying how fear conditioning and extinction constructs relate to anxiety symptoms and reactivity to stressful and benign moments in everyday life provides a powerful addition to experimental paradigms.

METHOD

Fifty-one young adults completed laboratory-based differential conditioning and extinction tasks with (CS + ) and without (CS-) an aversive unconditional stimulus (US). Electrodermal skin conductance responses were measured during each phase, followed by ecological momentary assessment (EMA) tapping anxiety and stressors six times daily for seven days (2, 142 moments).

RESULTS

Conditioned electrodermal reactivity to the CS + and overgeneralisation to the CS- were associated with greater change in anxiety (measured via EMA), across non-stressful situations, remaining the same across stressful situations. Likewise, during extinction when the CS + is now safe, more electrodermal reactivity to the CS + was associated with more anxiety change across non-stressful situations and remained the same across stressful situations. Also, during extinction when threat is absent, more electrodermal reactivity at the late stage of the CS- was associated with less momentary anxiety change in response to stressful situations; more electrodermal activity at the late stage of the CS + was associated with more anxiety change across non-stressful situations and remained the same across stressful situations.

CONCLUSIONS

Sampling 'in vivo' emotion and stress experiences, study findings revealed links between conditioned electrodermal reactivity and overgeneralisation to safe stimuli and heightened anxious reactivity during non-stressful (i.e. safe) moments in daily life, coupled with less change in response to actual stressors.

A cross-lagged prospective network analysis of depression and anxiety and cognitive functioning components in midlife community adult women

BACKGROUND

Scar theory proposes that heightened depression and anxiety precede and predict worse cognitive functioning outcomes, whereas the vulnerability theory posits the opposite pathway. However, most investigations on this topic have been cross-sectional, precluding causal inferences. Thus, we used cross-lagged prospective network analyses to facilitate causal inferences in understanding the relations between psychopathology and cognitive functioning components.

METHODS

Racially-diverse midlife women (n = 1816) participated in the Study of Women's Health Across the Nation at two time-points, spanning one year apart. Five psychopathology (anxiety severity, depressed mood, somatic symptoms, positive affect, interpersonal problems) and four cognitive functioning nodes (working memory (WM), processing speed (PS), facial recognition (FCR), and verbal memory (VRM)) were assessed. All analyses adjusted for age, menopausal status, estradiol, and follicle-stimulating hormones.

RESULTS

Contemporaneous networks yielded notable inverse between-node relations (edges) between interpersonal problems and reduced FCR and PS, and between depressed mood and lower FCR, VRM, or PS. Nodes that had the highest likelihood to bridge other constructs were positive affect, anxiety severity, WM, and VRM. Temporal networks produced edges consistent with the scar (v. vulnerability) hypotheses. Higher somatic symptoms were related to reduced PS and WM, and greater depressed mood was correlated with lower future PS and WM. Also, higher anxiety severity coincided with decreased future PS and WM. Greater positive affect was associated with stronger future PS, FCR, and WM. Also, positive affect had the strongest relations with other nodes.

CONCLUSIONS

Findings suggest the importance of targeting symptoms and cognitive functioning simultaneously.

Savoring, worry, and positive emotion duration in generalized anxiety disorder: Assessment and interventional experiment

BACKGROUND

Intentional attempts to savor positive emotions may be infrequent in Generalized Anxiety Disorder (GAD) due to avoidance of emotional contrasts. Yet purposeful enjoyment may help reduce worry and increase wellbeing in GAD. We sought to explore 1) the frequency, intensity, and duration of positive emotions from savoring in GAD and 2) its effect on pre-existing worry.

METHOD

The same 139 participants participated in two studies. They first took baseline measures. After, they were explicitly taught about savoring practices. In study 1, all participants were instructed to savor a photograph and video, timing and rating their emotion. Then in study 2, participants underwent a worry induction followed by an interventional experiment. In a savoring condition, participants were instructed to savor a personally-chosen enjoyable video. In a control condition, participants watched an emotionally neutral video.

RESULTS

Participants who met DSM-5 criteria for GAD had significantly lower scores on naturalistic savoring via self-report than those without GAD. Yet when explicitly taught and directed to savor in study 1, there were no differences between those with and without GAD in positive emotion duration and intensity. In study 2, longitudinal linear mixed models demonstrated that savoring after a worry induction significantly decreased worry, decreased anxiety, and increased positive emotions to greater degrees than the control task. These changes did not differ between diagnostic groups. All analyses controlled for depression symptoms.

CONCLUSION

Although persons with GAD tend to savor less in daily life than those without GAD, intentional savoring may decrease worry and increase positive emotion for both groups.

The transdiagnostic use of worry and rumination to avoid negative emotional contrasts following negative events: A momentary assessment study

The contrast avoidance model (CAM) suggests that individuals with generalized anxiety disorder (GAD) are sensitive to a sharp increase in negative and/or decrease in positive affect. They thus worry to increase negative emotion to avoid negative emotional contrasts (NECs). However, no prior naturalistic study has examined reactivity to negative events, or ongoing sensitivity to NECs, or the application of CAM to rumination. We used ecological momentary assessment to examine effects of worry and rumination on negative and positive emotion before and after negative events and intentional use of repetitive thinking to avoid NECs. Individuals with major depressive disorder (MDD) and/or GAD (N = 36) or without psychopathology (N = 27) received 8 prompts/day for 8 days and rated items on negative events, emotions, and repetitive thoughts. Regardless of group, higher worry/rumination before negative events was associated with less increased anxiety and sadness, and less decreased happiness from before to after the events. Participants with MDD/GAD (vs. controls) reported higher ratings on focusing on the negative to avoid NECs and greater vulnerability to NECs when feeling positive. Results support the transdiagnostic ecological validity for CAM extending to rumination and intentional engagement in repetitive thinking to avoid NECs among individuals with MDD/GAD.

Incremental validity of the contrast avoidance model: A comparison with intolerance of uncertainty and negative problem orientation

BACKGROUND

This study examined the incremental validity of the Contrast Avoidance Model (CAM) in predicting generalized anxiety disorder (GAD) symptoms when compared against well-established constructs in the GAD literature: intolerance of uncertainty (IU) and negative problem orientation (NPO).

METHOD

In this study, 185 students (108 of whom endorsed clinical levels of GAD symptoms) completed questionnaires to assess for all constructs. GAD symptoms were regressed on measures of contrast avoidance (CA; Contrast Avoidance-General Emotion and Contrast Avoidance-Worry Questionnaires; Llera & Newman, 2017) tendencies in addition to measures of IU and NPO in separate analyses. Commonality analyses explored the unique versus overlapping contributions of each factor in explaining GAD symptoms.

RESULTS

In all models, CA was a significant predictor after controlling for demographic variables (age, gender, race, and ethnicity) and both IU and NPO. This was also true when excluding CA items referencing worry. All variables contributed unique explanatory power in the prediction of GAD.

CONCLUSION

Results provide evidence of the incremental validity of the CAM as a model of GAD.

Psychometric evaluation of a Visual Interpersonal Analog Scale

Interpersonal theory organizes social behavior along dominant (vs. submissive) and warm (vs. cold) dimensions. There is a growing interest in assessing these behaviors in naturalistic settings to maximize ecological validity and to study dynamic social processes. Studies that have assessed interpersonal behavior in daily life have primarily relied on behavioral checklists. Although checklists have advantages, they are discrepant with techniques used to capture constructs typically assessed alongside warmth and dominance, such as affect, which typically rely on adjective descriptors. Further, these checklists are distinct from the methodologies used at the dispositional level, such as personality inventories, which rarely rely on behavioral checklists. The present study evaluates the psychometric performance of interpersonal adjectives presented on a visual analog scale in five different samples. Validity of the Visual Interpersonal Analog scale (VIAS) approach to momentary assessment was evaluated by comparing its performance with an interpersonal behavior checklist and by examining associations among the VIAS Warmth and Dominance scales and other momentary and dispositional constructs. Results were generally consistent with an existing interpersonal behavior checklist at the within-person level but diverged somewhat at the dispositional level. Across the five samples, the VIAS generally performed as hypothesized at both the within- and between-person levels. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Contrast avoidance predicts and mediates the effect of trait worry on problem-solving impairment

This study examined the relationship between the Contrast Avoidance Model (CAM; Newman & Llera, 2011) and impairment in the problem-solving process using an in-vivo laboratory-based problem-solving task. We also explored whether general emotional CA tendencies explained the relationship between trait worry and problem-solving outcomes. In this study, 185 participants (42 of whom met diagnostic criteria for generalized anxiety disorder) engaged in a problem-solving task, and reported outcomes related to ability to generate solutions, confidence in solutions, intention to implement solutions, and state anxiety levels. According to results, higher general emotional CA tendencies predicted significantly more difficulties on most problem-solving outcomes. Further, CA tendencies mediated between trait worry and some, but not all, problem solving outcomes. Overall, CA appears to be linked to problem-solving deficits, and may help to explain some of the association between trait worry and negative problem-solving outcomes.

Examining the Factor Structure and Incremental Utility of the Contrast Avoidance Questionnaires via Bifactor Analysis

The negative emotional contrast avoidance model posits that pathological worry is maintained by the avoidance of negative emotional shifts. The Contrast Avoidance Questionnaires (CAQ-Worry and CAQ-General Emotion) aim to assess contrast avoidance beliefs and behaviors. Questions remain around the factor structures of the CAQs, whether such structures replicate in nonundergraduate samples, and whether their domain-specific factors are valid for independent use. This study used bifactor analysis in a large community sample (N = 827) to address these gaps in the literature. Results supported bifactor models of both measures. Complementary analyses supported the multidimensionality of the CAQ-Worry, including its strong general factor and independent use of two domain-specific factors, rather than the original three domain-specific factors. The CAQ-General Emotion's general factor was strong, but the merits of the Discomfort domain-specific factor require more exploration, and use of the Avoidance domain-specific factor is discouraged.

Worry and rumination enhance a positive emotional contrast based on the framework of the Contrast Avoidance Model

The Contrast Avoidance Model (CAM) suggests that worry increases negative affect and decreases positive affect. CAM also suggests that in response to a positive event, higher worry enhances the probability of experiencing greater decreased negative affect and increased positive affect (positive emotional contrasts; PECs). Consequently, worrying may be reinforced by repeated PECs. However, no study has tested whether rumination enhances PECs. Also, emotional specificity in these processes has not been considered. Therefore, we tested whether both rumination and worry enhanced PECs related to specific emotions. After resting baseline, participants with pure generalized anxiety disorder (GAD group, n = 91), pure depression symptoms (depression group, n = 91), and non-GAD and non-depressed healthy controls (HCs, n = 93) engaged with randomly assigned induction tasks (either worry, rumination, or relaxation), and then watched an amusement video. Regardless of group, both worry and rumination increased sadness and fear and decreased amusement more than relaxation from baseline. However, worry increased fear more than rumination, and rumination increased sadness more than worry. Although all inductions led to PECs during the video, worry enhanced fear PECs more than rumination, and rumination enhanced sadnessPECs more than worry. The GAD group who worried experienced the most salient PEC of amusement relative to other groups.

Interpersonal contrast avoidance as a mechanism for the maintenance of worry

Despite consistent links between interpersonal problems and worry, mechanisms explaining this relationship remain unknown. The Contrast Avoidance Model (CAM; Newman & Llera, 2011) posits that individuals at risk for chronic worry and generalized anxiety disorder (GAD) fear sudden negative mood shifts, using worry to perpetuate negative moods and avoid these negative emotional contrasts. We propose interpersonal (IP) contrast avoidance (e.g., acting friendly to prevent others from causing mood shifts) as a novel explanation for interpersonal dysfunction in worriers. This study investigated IP contrast avoidance and worry in two samples. A nonclinical sample ranging in GAD symptoms (Study 1; N = 92) reported IP problems at baseline then IP contrast avoidance and worry over eight weeks (637 diaries). As expected, baseline IP problems prospectively predicted worry indirectly through chronic IP contrast avoidance. Affiliative, submissive, cold, and total IP contrast avoidance strategies predicted same-week and lagged next-week worry increases; affiliative, submissive, and total strategies also predicted maintenance of worry over eight weeks in growth models. Lastly, Study 2 showed the relevance of IP contrast avoidance strategies in a treatment-seeking clinical sample (N = 40), correlating with interpersonal problems and worry. Overall, results provide proof-of-concept for extending the CAM to the interpersonal domain.

Contrast avoidance prospectively mediates effects of fear of emotional responding, negative problem orientation, and sensitivity to low perceived control on generalized anxiety disorder symptoms

The Contrast Avoidance Model (CAM; Newman & Llera, 2011) has been well established in the literature on the etiology and maintenance of generalized anxiety disorder (GAD). Research has investigated other factors that may also characterize GAD, such as fear of emotional responding, negative problem orientation (NPO), and negative beliefs about control; however, these have yet to be explored within the context of the CAM regarding maintenance of GAD symptoms. The purpose of this study was to explore the predictive relationship between the above-mentioned factors and GAD symptoms, mediated by contrast avoidance. Participants (N = 99, 49.5% of whom scored in the upper range on GAD symptoms) completed a series of questionnaires across three time points, each one week apart. Results indicated that fear of emotional responding, NPO, and sensitivity to low perceived control predicted CA tendencies a week later. CA tendencies then mediated the relationship between each predictor and GAD symptoms in the following week. Findings suggested that known vulnerabilities for GAD predict coping with distressing internal responses via sustained negative emotionality (such as through chronic worry) as a way to avoid negative emotional contrasts. However, this coping mechanism itself may maintain GAD symptoms over time.

A randomized controlled trial of a 14-day mindfulness ecological momentary intervention (MEMI) for generalized anxiety disorder

BACKGROUND

Little is known about whether brief mindfulness ecological momentary interventions (MEMIs) yield clinically beneficial effects. This gap exists despite the rapid growth of smartphone mindfulness applications. Specifically, no prior brief MEMI has targeted generalized anxiety disorder (GAD). Moreover, although theories propose that MEMIs can boost executive functioning (EF), they have largely gone untested. Thus, this randomized controlled trial (RCT) aimed to address these gaps by assessing the efficacy of a 14-day smartphone MEMI (versus self-monitoring placebo [SMP]).

METHOD

Participants with GAD were randomly assigned to either condition (68 MEMI and 42 SMP). MEMI participants exercised multiple core mindfulness strategies and were instructed to practice mindfulness continually. Comparatively, SMP participants were prompted to practice self-monitoring and were not taught any mindfulness strategies. All prompts occurred five times a day for 14 consecutive days. Participants completed self-reports and neuropsychological assessments at baseline, posttreatment, and 1-month follow-up (1MFU). Piecewise hierarchical linear modeling analyses were conducted.

RESULTS

MEMI (versus SMP) produced greater pre-1MFU reductions in GAD severity and perseverative cognitions (between-group d = 0.393-0.394) and stronger improvements in trait mindfulness and performance-based inhibition (d = 0.280-0.303). Further, MEMI (versus SMP) led to more considerable pre- to posttreatment reduction in state-level depression and anxiety and more mindfulness gains (d = 0.50-1.13). Overall, between-treatment effects were stronger at pre-1MFU than pre- to posttreatment for trait-level than state-level treatment outcome measures.

CONCLUSIONS

Preliminary findings suggest that the beneficial effect of an unguided brief MEMI to target pathological worry, trait mindfulness, and EF is modest yet potentially meaningful. Other theoretical and clinical implications were discussed.

A transdiagnostic evaluation of contrast avoidance across generalized anxiety disorder, major depressive disorder, and social anxiety disorder

BACKGROUND

The contrast avoidance model (CAM) proposes that persons with generalized anxiety disorder (GAD) are sensitive to sharp increases in negative emotion or decreases in positive emotion (i.e., negative emotional contrasts; NEC) and use worry to avoid NEC. Sensitivity to and avoidance of NEC could also be a shared feature of major depressive disorder (MDD) and social anxiety disorder (SAD).

METHODS

In a large college sample (N = 1409), we used receiver operating characteristics analysis to examine the accuracy of a measure of emotional contrast avoidance in detecting probable GAD, MDD, and SAD.

RESULTS

Participants with probable GAD, MDD, and SAD all reported higher levels of contrast avoidance than participants without the disorder (Cohen's d = 1.32, 1.62 and 1.53, respectively). Area under the curve, a measure of predictive accuracy, was 0.81, 0.87, and 0.83 for predicting probable GAD, MDD, and SAD, respectively. A cutoff score of 48.5 optimized predictive accuracy for probable GAD and SAD, and 50.5 optimized accuracy for probable MDD.

CONCLUSION

A measure of emotional contrast avoidance demonstrated excellent ability to predict probable GAD, MDD, and SAD. Sensitivity to and avoidance of NEC appears to be a transdiagnostic feature of these 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.

The naturalistic reinforcement of worry from positive and negative emotional contrasts: Results from a momentary assessment study within social interactions

BACKGROUND

The Contrast Avoidance Model (Newman & Llera, 2011) proposes that worry is reinforced by avoiding a negative contrast and increasing the likelihood of a positive contrast.

OBJECTIVE

To determine if reinforcement of worry occurs naturalistically via contrasts in both negative and positive emotion.

METHOD

Using event-contingent momentary assessment we assessed social interactions, pre-interaction state worry and pre-post interaction positive and negative emotion. Participants with generalized anxiety disorder (GAD; N = 83) completed an online questionnaire after social interactions lasting at least 1 min for 8 days. Three-level multilevel models were conducted.

RESULTS

Higher worry was concurrently associated with increased negative emotion and decreased positive emotion. Regardless of pre-interaction worry level, negative emotion decreased, and positive emotion increased from before to after interactions, suggesting that most interactions were benign or positive. At lower levels of pre-interaction worry, participants experienced increased negative emotion and decreased positive emotion from before to after interactions. At higher levels of pre-interaction worry, participants experienced decreased negative emotion and increased positive emotion from before to after interactions.

CONCLUSION

Among persons with GAD, worrying before social interactions may be both negatively and positively reinforced; furthermore, not worrying before social interactions may be both negatively and positively punished.

Stratification of individuals with lifetime depression and low wellbeing in the UK Biobank

BACKGROUND

Previous studies stratified patients with major depressive disorder (MDD) based on their clinical characteristics. This study used this approach in individuals with lifetime MDD who reported low wellbeing, a group of high clinical relevance.

METHODS

We selected participants in the UK Biobank (UKB) with lifetime MDD and a wellbeing score in the lowest 25 %. A wellbeing score was previously created considering happiness, belief that own life is meaningful, health satisfaction and functioning in relevant areas. In the selected group, we applied latent class analysis using mood-spectrum symptoms and personality traits as input variables, then we compared the clinical-demographic and genetic (polygenic risk scores, PRSs) characteristics of the identified classes.

RESULTS

A total of 13,896 individuals were included and a model with five classes showed the best performance. The most common class (31.25 %) was characterised by periods of irritable mood and trait irritability with high neuroticism. A rarer class (16.49 %) showed depressive-manic mood fluctuations and risk-taking personality, higher percentage of males, atypical depressive symptoms, lower socio-economic status, higher PRS for attention-deficit hyperactivity disorder and lower PRS for education. The second most common class (29.79 %) showed worry as main personality trait with low risk of manic/irritable manifestations. The remaining classes showed an anxious-irritable personality profile and a purely depressive profile (4.92 % and 17.55 %, respectively).

LIMITATIONS

Our results may reflect the characteristics of UKB participants.

CONCLUSIONS

Subthreshold manic/irritable mood fluctuations and personality traits irritability and neuroticism may distinguish the most common groups with poor wellbeing in lifetime MDD.

Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts

INTRODUCTION

Generalized anxiety disorder (GAD) is common and disabling. Different versions of cognitive behavioral therapy (CBT) have been tested, but no treatment works for everyone. Therefore, researchers have attempted approaches to enhance CBT.

AREAS COVERED

The current narrative review examines meta-analyses and individual trials of CBT-based treatments for GAD. We focus on CBT and its cognitive and behavioral components as well as efforts to enhance CBT and its dissemination and generalizability. Enhancement efforts included interpersonal and emotional processing therapy, mindfulness-based CBT, emotion regulation therapy, intolerance of uncertainty therapy, the unified protocol, metacognitive therapy, motivational interviewing, and contrast avoidance targeted treatment. Emerging strategies to enhance dissemination have focused on technologically based treatments. Attempts at generalizability have included examination of efficacy within diverse racial and ethnic groups.

EXPERT OPINION

We conclude that CBT is efficacious, and a number of enhancement efforts have shown some promise in improving upon CBT in single trials. However, more research is needed, particularly efforts to determine which enhancements work best for which individuals and what are the mechanisms of change. Furthermore, few technological interventions have been compared to active treatments. Finally, much more attention needs to be paid to ethnic and racial diversity in randomized controlled trials.

Associations Between Repetitive Negative Thinking and Habituation of Defensive Responding Within and Between Sessions

Repetitive negative thinking (RNT) is a transdiagnostic risk factor for internalizing psychopathology, and theoretical models suggest that RNT may maintain symptoms by interfering with psychophysiological habituation. The present study therefore examined associations between RNT and habituation within and between study sessions. Community members (N=86) completed a habituation task involving exposure to acoustic probes at up to five sessions spaced 7 days apart on average. Eyeblink startle response was measured using the electromyography startle magnitude. Self-reported anxiety was assessed before and after the habituation task at each session. Multilevel growth curve modeling indicated that RNT was associated with a higher "floor" (i.e., asymptote) of startle responding as evidenced by reduced within-session startle habituation at later sessions. Results suggest that RNT may disrupt startle habituation and are consistent with theoretical models proposing that RNT sustains physiological activation to support avoidance of negative emotional contrasts or perceived future threats.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-022-00121-w.

Neural indices of performance monitoring are associated with daily emotional functioning in youth with anxiety disorders: An ERP and EMA study

Excessive monitoring of one's performance is a characteristic of anxiety disorders that has been linked to alterations in implicit emotion regulation (ER), including elevations in neural measures of performance monitoring (i.e., error- and correct-related negativity; ERN and CRN). Elevations in ERN and CRN amplitudes have been reported consistently in anxiety disorders, suggesting that an overactive performance monitoring system is linked to ER difficulties in anxiety. Yet, the relevance of these lab-based neural measures for day-to-day emotional functioning remains poorly understood. This study examined the degree to which ERN and CRN amplitudes are associated with measures of daily ER difficulties in youth with anxiety disorders. Youth (N = 100, Mage = 11.14, SDage = 1.46) completed a computerized flanker task assessing the ERN and CRN. They then completed a 5-day ecological momentary assessment (EMA) protocol assessing their daily ER (i.e., intensity of momentary and peak negative affect, intensity of worry, reliance on maladaptive ER strategies). Results showed that more negative mean CRN amplitudes were associated with higher levels of negative emotional reactivity and more intense worries. There were no significant associations between ERN amplitude and EMA measures. Furthermore, elevations in CRN were linked to more frequent use of maladaptive ER strategies (i.e., rumination, physiological reactivity, avoidance). Together, results indicate that among youth with anxiety, individual differences in CRN, but not ERN, amplitudes are related to daily ER difficulties. Findings highlight the clinical utility of a lab-based neural measure of ER, suggesting that the CRN, rather than the ERN, reflects individual ER differences in the context of daily life among youth with pediatric anxiety disorders. As such, the CRN might serve as an important dimensional index of a treatment target that can be tracked with a validated, multi-method measure.

The effects of worry proneness on diurnal anxiety: An ecological momentary assessment approach

Existing theoretical models and empirical evidence suggest that worry proneness is associated with anxious responding. However, it is unknown how worry proneness may influence the experience of anxiety throughout the day. The present study addresses this gap in the literature by employing an ecological momentary assessment design to examine the impact of worry proneness on diurnal changes in anxiety reported in the morning, afternoon, and evening for one week in a sample of unselected adults (N = 136). Results indicated a significant reduction in anxiety from morning to evening. Further, this effect was moderated by worry proneness, such that a diurnal decline in anxiety was detectable among those with low and moderate levels of worry proneness, whereas those high in worry proneness reported increased momentary anxiety which was sustained throughout the day. These results replicate previous studies indicating anxiety is highest in the morning and lowest in the evening. Further, these findings suggest that worry proneness may override normative diurnal changes in anxiety and thereby maintain anxiety at elevated and consistent levels. The implications of these findings for the development and treatment of disorders characterized by excessive worry are discussed.

Avoidance of negative emotional contrast from worry and rumination: An application of the Contrast Avoidance Model

According to the Contrast Avoidance model (CAM), worry causes increased and sustained negative affect and such negative affect enables avoidance of a future sharp increase in negative emotion. However, only pathological worriers (vs. controls) view worry as a positive coping strategy to avoid a negative emotional contrast (NEC). We examined if rumination, which is another type of repetitive negative thought, would function similarly. Individuals with self-reported symptoms of pure generalized anxiety disorder (GAD; n = 90), pure depression (MDD; n = 85), and non-anxious/non-depressed controls (HC; n = 93) were randomly assigned to conditions where they were asked to worry, ruminate, or relax. Emotional and physiological changes were measured during worry and subsequent exposure to fearful and sad videos. We also assessed participant group differences in preference for worry or rumination as a strategy to cope with negative affect during the negative emotional video exposures. Consistent with CAM, regardless of the group, both worry and rumination enabled avoidance of NEC. Whereas worry led to greater avoidance of a fear contrast, rumination led to greater avoidance of a sadness contrast. On the other hand, relaxation enhanced NEC. Skin conductance also indicated patterns in line with CAM. In the subjectively perceived preference, the GAD group reported a greater preference for worry in coping with a fear contrast than HC. However, such a salient pattern was not found for the MDD group. Treatment implications of these findings are discussed.

Digital biomarkers of anxiety disorder symptom changes: Personalized deep learning models using smartphone sensors accurately predict anxiety symptoms from ecological momentary assessments

Smartphones are capable of passively capturing persons' social interactions, movement patterns, physiological activation, and physical environment. Nevertheless, little research has examined whether momentary anxiety symptoms can be accurately assessed using these methodologies. In this research, we utilize smartphone sensors and personalized deep learning models to predict future anxiety symptoms among a sample reporting clinical anxiety disorder symptoms. Participants (N = 32) with generalized anxiety disorder and/or social anxiety disorder (based on self-report) installed a smartphone application and completed ecological momentary assessment symptoms assessing their anxiety and avoidance symptoms hourly for the course of one week (T = 2007 assessments). During the same period, the smartphone app collected information about physiological activation (heart rate and heart rate variability), exposure to light, social contact, and GPS location. GPS locations were coded to reveal the type of location and the weather information. Personalized deep learning models using the smartphone sensor data were capable of predicting the majority of total variation in anxiety symptoms (R² = 0.748) and predicting a large proportion of within-person variation at the hour-by-hour level (mean R² = 0.385). These results suggest that personalized deep learning models using smartphone sensor data are capable of accurately predicting future anxiety disorder symptom changes.

Excessive Worrying as a Central Feature of Anxiety during the First COVID-19 Lockdown-Phase in Belgium: Insights from a Network Approach

Since the WHO declared the COVID-19 pandemic on March 11, 2020, the novel coronavirus, SARS-CoV-2, has profoundly impacted public health and the economy worldwide. But there are not the only ones to be hit. The COVID-19 pandemic has also substantially altered mental health, with anxiety symptoms being one of the most frequently reported problems. Especially, the number of people reporting anxiety symptoms increased significantly during the first lockdown-phase compared to similar data collected before the pandemic. Yet, most of these studies relied on a unitary approach to anxiety, wherein its different constitutive features (i.e., symptoms) were tallied into one sum-score, thus ignoring any possibility of interactions between them. Therefore, in this study, we seek to map the associations between the core features of anxiety during the first weeks of the first Belgian COVID-19 lockdown-phase (n = 2,829). To do so, we implemented, in a preregistered fashion, two distinct computational network approaches: a Gaussian graphical model and a Bayesian network modelling approach to estimate a directed acyclic graph. Despite their varying assumptions, constraints, and computational methods to determine nodes (i.e., the variables) and edges (i.e., the relations between them), both approaches pointed to excessive worrying as a node playing an especially influential role in the network system of the anxiety features. Altogether, our findings offer novel data-driven clues for the ongoing field's larger quest to examine, and eventually alleviate, the mental health consequences of the COVID-19 pandemic.

An experience sampling investigation of emotion and worry in people with generalized anxiety disorder

Emotion-oriented theories (e.g., emotion dysregulation model, Mennin et al., 2005; contrast avoidance model; Newman & Llera, 2011) posit that people with Generalized Anxiety Disorder (GAD) have disturbances in emotion, experience negative emotion as aversive and in turn use maladaptive strategies, including worry, to regulate their distress. Much of what is known about emotion in the context of GAD is based on studies employing static methodologies. It is proposed that constructs and methodologies from the literature on emotion dynamics offer a complementary perspective. The principal aims of the study were to identify an emotion profile for people with GAD and to examine the direct effect of worry on subsequent negative and positive emotions via the experience sampling method. Participants included people with GAD (GAD group; n = 39) and people without GAD (nonclinical control [NCC] group; n = 41). Relative to the NCC group, the GAD group exhibited an emotion profile characterized by elevated mean intensity, greater instability and greater inertia of negative emotions and lower mean intensity, greater instability of positive emotions, but did not differ on inertia of positive emotions. People with GAD were found to have greater worry inertia and worry was also found to be associated with a subsequent increase in negative emotion, and this was more pronounced for the GAD group relative to the NCC group. The findings inform emotion-oriented models, provide unique insights into the dynamic emotional experiences of those with GAD and reinforce the benefits of the experience sampling methodology to study GAD-relevant processes.

Worry and Positive Episodes in the Daily Lives of Individuals With Generalized Anxiety Disorder: An Ecological Momentary Assessment Study

Worry is a central feature of generalized anxiety disorder (GAD). Although worry is related to anxiety and maintained by beliefs that worry is uncontrollable, there is scarce research on how individuals with GAD react to worry episodes in their daily life and how their positive experiences might impact reactions to worry episodes. The current study examined the level and variability of anxiety and controllability during high worry periods and positive experiences in GAD. Moreover, it investigated the influence of worry and positive experiences on later anxiety and perceived controllability within-persons. Finally, it examined change in anxiety level from previous to current episodes depending on previous episodes type. In the current study, 49 individuals with GAD (514 observations) registered their worry and positive episodes (i.e., episodes in which they had positive experiences) and reported on several variables during these episodes (i.e., anxiety and controllability of episodes and episode duration) using smartphone-based ecological momentary assessment for 7days. Results show anxiety and controllability differed by episode type (higher anxiety, lower controllability in worry episodes, and the opposite in positive episodes), and notable within-person variability in anxiety and controllability in both episode types. The time-lagged multilevel models showed episode type did not predict later anxiety during either episode type, although previous anxiety predicted current anxiety in worry episodes (but not positive episodes). Moreover, worry episodes did predict later controllability in worry episodes (but not positive episodes) and previous controllability predicted current controllability in both episode types. Furthermore, we obtained the increase in anxiety from t₀₋₁ to t₀ in a current worry episode to be significantly smaller when preceded by a worry (vs. positive) episode. Likewise, the reduction in anxiety from t₀₋₁ to t₀ in a current positive episode was significantly larger when preceded by a worry (vs. positive) episode. The novel findings in the current study that perceptions of controllability and anxiety vary within individuals with GAD, that greater controllability is experienced in positive episodes than worry episodes, and that worry may confer a sense of controllability at a later time could be seen as important contributions to the GAD literature.

Psychometric Properties and Prospective Predictive Utility of the Contrast Avoidance Questionnaires

Abstract. Recent theoretical research posits that a key factor in the development and maintenance of pathological worry is the avoidance of sudden emotional shifts. Recently two self-report instruments were developed to index this phenomenon (Contrast Avoidance Questionnaire – Worry [CAQ-W] and Contrast Avoidance Questionnaire – General Emotion [CAQ-GE]). This work employed a multi-study design to provide an independent evaluation of the latent structure of these measures; additionally, the validity and longitudinal predictive ability of the measures was examined. Findings of the factor analytic work support a two-factor solution for each of the questionnaires. These were defined as the following subscales: CAQ-W: Emotional Contrast; Negative Affect, and for the CAQ-GE: Avoidance; Discomfort. Test-retest reliability of the measure was strong and the identified subscales demonstrated differential predictive ability regarding future worry and depression. Results indicate that subscales related to the experience of negative affect rather than avoidance, display predictive utility of future symptoms. These findings are somewhat discrepant with extant literature on ecological momentary assessment (EMA) assessment of contrast avoidance indicating the need for refinement in the self-report measurement of this construct.

Patterns of Associations Between Maternal Symptoms and Child Problem Behaviors: The Mediating Role of Mentalization, Negative Intentionality, and Unsupportive Emotion Socialization

We examined how maternal depression, anxiety, hostility, mentalization, negative intentionality (NI), and unsupportive emotion socialization (UES) predict child internalizing and externalizing problem behaviors (CIEPB). Mothers (N = 537) of toddlers (M_age = 23.26 months, Range 10-44 months) completed the Brief Symptom Inventory, the Parental Reflective Functioning Questionnaire, the Infant Intentionality Questionnaire, the Coping with Children's Negative Emotions Scale, and the Child Behavior Checklist. All maternal symptoms negatively predicted mentalization and positively predicted NI, UES, and CIEPB. NI and UES mediated the relationship between maternal symptoms and CIEPB. Negative intentionality mediated the link between maternal hostility and internalizing behaviors, indicating a possible intervention area. Mentalization had an effect on externalizing behaviors only for high-SES, anxious mothers, underscoring the role of SES. Thus, the relationship between maternal symptoms, cognitive and behavioral parenting characteristics and CIEPB supports the multifinality principle for early childhood psychopathology development and shows the importance of screening for maternal symptoms and CIEPB.

Rumination, worry and negative and positive affect in prolonged grief: A daily diary study

After bereavement, a significant minority experiences severe, persistent, and disabling grief, termed prolonged grief or complicated grief. Prolonged grief treatments may be enhanced by improving understanding of malleable risk factors in post‐loss psychological adaptation. Repetitive negative thought (e.g., rumination, worry) constitutes such a risk factor. Rumination and worry are both theorized to be maladaptive through interrelations with affect, yet this assumption has not been systematically investigated in the bereaved. We aimed to fill this gap in knowledge with a baseline survey and 10‐day daily diary investigation among a bereaved sample. Survey between‐subject analyses (N = 113) demonstrated that trait rumination and worry, trait negative affect and prolonged grief symptoms are positively related to each other and negatively related with trait positive affect. Within‐subject multilevel analyses of diaries (N = 62) demonstrated that trait rumination and trait worry relate positively to daily negative affect and negatively to daily positive affect. Daily rumination and worry showed similar relationships with daily negative and positive affect. A stronger relationship emerged between daily rumination and daily negative affect in people with higher prolonged grief symptom levels. Findings consistently support interrelations between repetitive negative thought, affect, and prolonged grief symptoms. Rumination appears particularly detrimental in people with severe grief reactions. Results align with research demonstrating the effectiveness of targeting repetitive negative thought in prolonged grief treatments. Additionally, our study demonstrates the potential feasibility and usefulness of using daily diaries to study behaviours of relevance to post‐loss adaptation in everyday life.

Emotion network density is a potential clinical marker for anxiety and depression: Comparison of ecological momentary assessment and daily diary

OBJECTIVES

Using two intensive longitudinal data sets with different timescales (90 minutes, daily), we examined emotion network density, a metric of emotional inflexibility, as a predictor of clinical-level anxiety and depression.

DESIGN

Mobile-based intensive longitudinal assessments.

METHODS

119 participants (61 anxious and depressed, 58 healthy controls) completed ecological momentary assessment (EMA) to rate a variety of negative (NE) and positive emotions (PE) 9 times per day for 8 days using a mobile phone application. 169 participants (97 anxious and depressed and 72 healthy controls) completed an online daily diary on their NE and PE for 50 days. Multilevel vector autoregressive models were run to compute NE and PE network densities in each data set.

RESULTS

In the EMA data set, both NE and PE network densities significantly predicted participants' diagnostic status above and beyond demographics and the mean and standard deviation of NE and PE. Greater NE network density and lower PE network density were associated with anxiety and depression diagnoses. In the daily diary data set, NE and PE network densities did not significantly predict the diagnostic status.

CONCLUSIONS

Greater inflexibility of NE and lower inflexibility of PE, indexed by emotion network density, are potential clinical markers of anxiety and depressive disorders when assessed at intra-daily levels as opposed to daily levels. Considering emotion network density, as well as the mean level and variability of emotions in daily life, may contribute to diagnostic prediction of anxiety and depressive disorders.

PRACTITIONER POINTS

Emotion network density, or the degree to which prior emotions predict and influence current emotions, indicates an inflexible or change-resistant emotion system. Emotional inflexibility or change resistance over a few hours, but not daily, may characterize anxiety and depressive disorders. Inflexible negative emotion systems are associated with anxiety and depressive disorders, whereas inflexible positive emotion systems may indicate psychological health. Considering emotional inflexibility within days may provide additional information beyond demographics and mean level and variability of emotions in daily life for detecting anxiety and depressive disorders. ​.

Reduced positive affect on days with stress exposure predicts depression, anxiety disorders, and low trait positive affect 7 years later

Positive emotions serve important functions for mental health. Susceptibility to reduced positive emotions in the context of stress may increase risk for poor mental health outcomes, including anxiety and depressive disorders and low overall levels of positive emotion. In an 8-day daily diary study within a larger panel study (N = 1,517), we tested whether degree of reduction in time spent experiencing positive affect on days of stress exposure predicted lower levels of positive affect and elevated risk for major depressive and anxiety disorders (generalized anxiety disorder or panic disorder) 7 years later. Bayesian multilevel structural equation modeling controlling for overall levels of affect, stress exposure, leisure time, sex, age, and past year diagnoses of depression and anxiety disorders was conducted. Participants, on average, reported less time experiencing positive affect on days with stressors compared to days without stressors. In addition, participants varied in the extent to which their time spent experiencing positive affect differed across days with and without stressors. Those who reported an especially reduced proportion of the day experiencing positive affect on days with stressors also experienced lower positive affect and greater risk for major depressive disorder and anxiety disorders 7 years later. These prospective associations suggest that between-person differences in the within-person association between stress and positive emotions have implications for mental health years later. The efficacy of preventive interventions could be improved by fostering resilience of positive emotions during common stressful events. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Worry impairs the problem-solving process: Results from an experimental study

INTRODUCTION

Many individuals believe that worry helps solve real-life problems. Some researchers also purport that nonpathological worry can aid problem solving. However, this is in contrast to evidence that worry impairs cognitive functioning.

OBJECTIVE

This was the first study to empirically test the effects of a laboratory-based worry induction on problem-solving abilities.

PROCEDURE

Both high (n = 96) and low (n = 89) trait worriers described a current problem in their lives. They were then randomly assigned to contemplate their problem in a worrisome (n = 60) or objective (n = 63) manner or to engage in a diaphragmatic breathing task (n = 62). All participants subsequently generated solutions and then selected their most effective solution. Next, they rated their confidence in the solution's effectiveness, their likelihood to implement the solution, and their current anxiety/worry. Experimenters uninformed of condition also rated solution effectiveness.

RESULTS

The worry induction led to lower reported confidence in solutions for high trait worry participants, and lower experimenter-rated effectiveness of solutions for all participants, relative to objective thinking. Further, state worry predicted less reported intention to implement solutions, while controlling for trait worry. Finally, worrying about the problem led to more elevated worry and anxiety after solving the problem compared to the other two conditions.

CONCLUSIONS

Overall, the worry induction impaired problem solving on multiple levels, and this was true for both high and low trait worriers.

Worry as a mediator between psychosocial stressors and emotional sequelae: Moderation by contrast avoidance

BACKGROUND

Worry is the core feature of generalized anxiety disorder (GAD), which is prevalent among emerging adults. The contrast avoidance model proposes that individuals with GAD use worry to avoid negative emotional contrasts by maintaining a state of negative affect. Research suggests worry in response to stressors increases anxiety, but more research is needed to examine depression as an outcome and the predictions of contrast avoidance in the context of multiple stressor subtypes. The current study examined whether worry may be associated with increased symptoms of anxiety and depression, regardless of stressors, due to the use of worry as an avoidance strategy, moderating these associations.

METHODS

367 undergraduate college students from a medium-sized, public university completed self-report questionnaires online.

RESULTS

Worry significantly mediated the associations from academic stressors and social stressors to symptoms of anxiety and depression. Contrast avoidance significantly moderated associations between academic stressors and worry as well as worry and anxiety. For those high in contrast avoidance, worry was relatively high regardless of academic stressors; for those low in contrast avoidance, students with fewer academic stressors reported less worry.

LIMITATIONS

The present study relied on self-report. In addition, the cross-sectional design limits the ability to draw conclusions about temporal relations.

CONCLUSIONS

Contrast avoidance elevated worry regardless of academic stressors, and strengthened the association between worry and anxiety but not worry and depression. Individuals who experience high levels of contrast avoidance may benefit from cognitive interventions focusing on reducing beliefs about the perceived benefits of worry.

Daily Worry in Trauma-Exposed Afghan Refugees: Relationship with Affect and Sleep in a Study Using Ecological Momentary Assessment

Background

Repetitive negative thinking—and worry as a common variant—have been suggested to be transdiagnostic maintaining factors of psychopathology in refugees. Using an ecological momentary assessment (EMA) approach, this study tested the feasibility of EMA and the hypothesis of a self-reinforcing relationship (a) between worry and affect and (b) between worry and sleep in refugees. Additionally, we examined whether worry interacts with postmigration stress to impact on affect and sleep.

Methods

For 1 week, 45 trauma-exposed Afghan refugees received five prompts per day asking them to report on momentary levels of worrying and negative as well as positive affect. In addition, sleep quality was assessed in the morning and the occurrence of postmigration stress at night.

Results

Our findings did not indicate a bidirectional relationships (a) between worry and affective experiences and (b) between worry and poor sleep quality. However, worry experienced on a given day predicted increased negative affect on the next day; in turn, positive affect predicted decreased worrying on the next day. Hypotheses on the interaction between worry and stress in predicting affect and sleep were not supported.

Conclusion

These preliminary findings suggest unidirectional effects of daily worry on negative affect and positive affect on daily worry. However, the low compliance rate and the small sample size precludes drawing firm conclusions. Implications for further EMA research among refugees are discussed.

Cognitive-Behavioral Therapy in the Digital Age: Presidential Address

Our field has come a long way in establishing cognitive-behavioral therapy as the empirically supported treatment of choice for a wide range of mental and behavioral health problems. Nevertheless, most individuals with mental disorders do not receive any care at all, and those who do often have difficulty accessing care that is consistently high in quality. Addressing these issues is complex and costly and thus progress has been slow. We are entering an exciting stage in which emerging technologies might offer novel solutions to the treatment gap. This paper discusses a number of technology-enabled solutions to our field's challenges, including Internet-based and smartphone-based cognitive-behavioral therapy. Nevertheless, we must remain attentive to potential pitfalls of these emerging technologies. The paper incorporates suggestions for how the field may approach these potential pitfalls and provides a vision for how we might develop powerful, scalable, precisely timed, personalized interventions to enhance global mental health.

The impact of uncontrollability beliefs and thought-related distress on ecological momentary interventions for generalized anxiety disorder: A moderated mediation model

This study was a secondary analysis of LaFreniere and Newman (2016), a randomized controlled trial comparing two ecological momentary interventions (EMIs) for generalized anxiety disorder (GAD): The worry outcome journal (WOJ) and thought log (TL). We predicted that higher thought-related distress would be a mediator by which higher uncontrollability beliefs (UB) would hinder the efficacy of the WOJ, but not the TL. Fifty-one undergraduates who met GAD criteria underwent one of the EMIs for 10 days. WOJ users tracked worries, associated distress, interference, expected outcome probabilities, and whether their worries came true four times/day. TL users tracked general thoughts, associated distress, and interference four times/day. Bootstrapping path analysis was used to analyze moderated mediation models. Higher UB predicted higher thought-related distress for both EMIs. Higher UB also predicted reduced efficacy of the WOJ at post-trial and of both EMIs at 30-day follow-up. However, for WOJ users, when higher initial UB levels predicted higher thought-related distress early in treatment, participants reported greater levels of worry at post-trial and follow-up. In contrast, UB's effect on the TL group at post-trial and follow-up was not mediated by early distress. Thought-related distress appears to be a mechanism by which UB impedes the WOJ intervention.