A novel theory of experiential avoidance in generalized anxiety disorder: a review and synthesis of research supporting a contrast avoidance model of worry

The association between intolerance of uncertainty and depressive symptoms during COVID-19 in New York, USA

BACKGROUND

Coronavirus Disease 2019 (COVID-19), a highly contagious respiratory illnesses, has globally impacted mental health. This study aims to investigate the association between intolerance of uncertainty and depressive symptoms during the pandemic in New York, USA, considering COVID-19-related worries as modifiers and mediators.

METHOD

1227 participants from three ongoing cohort studies, originally centered on trauma-exposed children and adolescents, provided data via questionnaires and telephone interviews across three waves. We used multivariable logistic and linear regression models to investigate the intolerance of uncertainty-depressive symptoms relationship, while adjusting for potential confounders and assessing the modification and mediation effects of Covid-19 related worries.

RESULTS

Depressive symptoms prevalence was 18 %, 12 %, and 9 % at waves 0, 1, and 2 respectively. Strong positive associations were observed between intolerance of uncertainty above the median and depressive symptoms which remained significant after adjusting for potential confounders. Odds ratios were 2.14 (95 % CI: 1.54-2.99) and 4.50 (95 % CI: 2.67-7.93) for intolerance of uncertainty-depressive symptoms association at wave 0 and 1 respectively, and 3.22 (95 % CI: 1.68-6.63) for intolerance of uncertainty at wave 1 and depressive symptoms at wave 2. There was evidence of partial mediation by worries (12-37 %), but no evidence of a moderating effect.

LIMITATION

It includes study's methodology, including self-report measures, remote data collection, and uncontrolled variables like anxiety and COVID-19 perspectives.

CONCLUSION

The findings emphasize the importance of evidence-based strategies for tackling intolerance of uncertainty during pandemics, particularly in managing long COVID. Collaborative efforts between policymakers and clinicians are essential in this endeavor.

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 role of expectancies and selective interrogation of information in trait anxiety-linked affect when approaching potentially stressful future events

The present study examined cognitive mechanisms underpinning the increased tendency of individuals with high trait anxiety to experience inflation of negative affect when approaching potential stressors. Specifically, the roles of (1) disproportionately negative relative to positive expectancies (i.e., negative expectancy bias) and (2) disproportionately interrogating negative relative to positive information (i.e., negative interrogation bias), each concerning the potential stressor, were examined. High and low trait anxiety participants (N = 286) completed the experimental session, in which they were informed they may view a potentially stressful film. As participants approached the putative film viewing, participants' negative and positive affect, as well as their negative and positive expectancies were assessed. Additionally, negative interrogation bias was assessed by providing participants the opportunity to selectively interrogate information from a larger pool of negative and positive information concerning the putative film viewing. Our findings provide evidence indirect associations between trait anxiety and inflation of negative affect is serially mediated via negative interrogation bias and, in turn, negative expectancy bias. Findings are discussed with regards to limitations and potential implications for public health campaigns, and cognitive interventions for anxiety, highlighting the utility of further examining negative interrogation bias as an avenue for improving the efficacy of each.

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.

Risk estimation in relation to anxiety and depression for low probability negative events

Foundational cognitive models propose that people with anxiety and depression show risk estimation bias, but most literature does not compute true risk estimation bias by comparing people's subjective risk estimates to their individualized reality (i.e., person-level objective risk). In a diverse community sample (N = 319), we calculated risk estimation bias by comparing people's subjective risk estimates for contracting COVID-19 to their individualized objective risk. Person-level objective risk was consistently low and did not differ across symptom levels, suggesting that for low probability negative events, people with greater symptoms show risk estimation bias that is driven by subjective risk estimates. Greater levels of anxiety, depression, and COVID-specific perseverative cognition separately predicted higher subjective risk estimates. In a model including COVID-specific perseverative cognition alongside anxiety and depression scores, the only significant predictor of subjective risk estimates was COVID-specific perseverative cognition, indicating that symptoms more closely tied to feared outcomes may more strongly influence risk estimation. Finally, subjective risk estimates predicted information-seeking behavior and eating when anxious, but did not significantly predict alcohol or marijuana use, drinking to cope, or information avoidance. Implications for clinical practitioners and future research are discussed.

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.

Not just emotion regulation, but cognition: An experience sampling study testing the relations of ecological interpretation biases and use of emotion regulation strategies with momentary affective states during daily life functioning

BACKGROUND

Current research is moving from studying cognitive biases and maladaptive emotion regulation (ER) as relatively stable phenomena contributing to affective disturbances, adopting ecological methodologies, such as Experience Sampling Methods (ESM). However, there is still limited ESM evidence on the interactions between stress and ER strategies' use, and negative interpretation biases, regarding their relations with momentary affective states. In this study, we used a new ESM design to disentangle the contextual, regulatory and cognitive processes implicated in daily affective experiences.

METHOD

A sample of 103 participants completed an ESM study (3 times a day for 10 days) that included self-reports of momentary affect, stress intensity, ER strategies' use and a cognitive task measuring momentary negative interpretation biases.

RESULTS

Multilevel analyses supported significant interactions of both rumination and worry with stress intensity, to account for momentary higher negative and lower positive affect levels. Furthermore, higher state negative interpretation bias levels uniquely predicted both higher negative and lower positive momentary affect levels.

CONCLUSION

This study implemented a novel online cognitive task within an ESM procedure, which helped to disentangle how contextual ER strategies' use and momentary cognitive biases uniquely relate to affective experiences in daily life.

Grey matter alterations in generalized anxiety disorder: A voxel-wise meta-analysis of voxel-based morphometry studies

OBJECTIVE

Grey matter, a crucial component of the brain, has been found altered in generalized anxiety disorder (GAD) of several voxel-based morphometry studies. The conclusive and consistent grey matter alterations in GAD have not been confirmed.

METHOD

Eleven voxel-based morphometry studies of GAD patients were included in the current systematic review and meta-analysis. The linear model of anxiety severity scores was applied to explore the relationship of grey matter alterations and anxiety severity. The subgroup analysis of adult GAD and adolescent GAD was also performed.

RESULTS

Significantly modest grey matter alterations in the left superior temporal gyrus of patients with GAD were found. The anxiety severity score was significantly correlated with grey matter alterations in the right insula, lenticular nucleus, putamen and striatum. The subgroup analysis of adult GAD and adolescent GAD all failed to show significant grey matter alterations. However, in the adult GAD subgroup, anxiety severity score was significantly correlated with grey matter alterations in the right insula.

CONCLUSION

GAD might have the modest grey matter alterations in the left superior temporal gyrus. Anxiety severity might be related to the grey matter alterations in the limbic regions, such as the right insula, lenticular nucleus, putamen and striatum. This kind of correlation might be related to the effects of adult GAD. Future studies with adequate sample sizes and sophisticated GAD categories will be needed.

Positive reappraisal coping mediates the relationship between parental abuse and lack of affection on adulthood generalized anxiety severity

Exposure to parental abuse and lack of parental affection during childhood are risk factors for adulthood psychopathology. Tendency to engage in positive reappraisal may be a plausible mechanism underlying this relationship. The current study examined if positive reappraisal coping mediated the relationship between maternal/paternal abuse/affection and adulthood generalized anxiety disorder (GAD) symptoms. Participant data (N = 3294) from the Midlife Development in the United States study was collected in three waves, spaced nine years apart. Longitudinal structural equation mediation modeling examined whether positive reappraisal coping at Time 2 mediated the relationship between maternal/paternal abuse/affection at Time 1 and GAD symptoms at Time 3, controlling for GAD symptoms at Time 1. Positive reappraisal coping mediated maternal/paternal childhood abuse - GAD symptom severity and maternal/paternal childhood affection - GAD severity relations. Maternal and paternal abuse was associated with lower positive reappraisal tendencies, predicting increased GAD symptom severity. Conversely, higher maternal/paternal affection was associated with increased positive reappraisal, predicting lower GAD severity. Incremental prediction revealed that childhood abuse to GAD severity via positive reappraisal path was significant for maternal but not paternal abuse, whereas affection from both parents remained significant. Positive reappraisal coping may be a possible mechanism linking childhood experiences to adulthood GAD severity.

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.

Daily Associations Between Sleep and Affect in Youth at Risk for Psychopathology: The Moderating Role of Externalizing Symptoms

Problems with sleep, emotion regulation, and externalizing psychopathology are interrelated, but little is known about their day-to-day associations in youth. We examined self-reported daily sleep quality as a bidirectional predictor of next-day positive and negative affect (PA/NA), with externalizing symptoms as a moderator. Data were drawn from an ecological momentary assessment (EMA) study involving 82 youths (ages 9-13; 50% female; 44% White, 37% Black/African American) at high (n = 41) or low (n = 41) familial risk for psychopathology. Parents rated youths' externalizing symptoms at baseline. Youths then completed a 9-day EMA protocol, reporting sleep quality 1x/day and affect 4-8x/day. Daily means, peaks, and variability in PA and NA were computed. Multilevel models examined bidirectional associations between sleep and affect (between- and within-person), testing externalizing symptoms as a moderator and controlling for age and sex. In models of sleep predicting affect: Within-person, poorer-than-usual sleep quality predicted greater variability and higher peaks in next-day NA, but only for youth with higher levels of externalizing symptoms. Between-person, poor sleep quality and higher levels of externalizing symptoms predicted lower mean and peak PA. In models of affect predicting sleep: Within-person, lower-than-usual mean PA predicted poorer subsequent sleep quality, but only for youth with higher levels of externalizing symptoms. Between-person, youths with higher mean and peak PA had better sleep quality. These findings suggest that affective functioning is bidirectionally linked to daily self-reported sleep quality among high- and low-risk youth. Specific disturbances in daily sleep-affect cycles may be distinctly associated with externalizing psychopathology.

The relationship between purpose in life and depression and anxiety: A meta-analysis

Purpose in life consists of having a sense of meaning and purpose regarding one's activities as well as an overall sense that life is meaningful. This study reports a comprehensive assessment of the relationship of purpose in life with depression and anxiety. A meta-analysis (total n = 66,468, total k = 99) investigated the association of purpose in life with depression and anxiety. Across samples, greater purpose in life was significantly associated with lower levels of depression and anxiety. The mean weighted effect size between purpose in life and depression was r = -0.49, [95% confidence intervals, CIs: -0.52, -0.45], p < 0.001. For the purpose in life and anxiety the mean weighted effect size was r = -0.36, [95% CIs: -0.40, -0.32], p < 0.001. The association of purpose in life with mental health was stronger for clinical populations, especially with regard to the relationship with anxiety. Both approach deficits and avoidance motivation are argued to play a role in the relationship between purpose and psychopathology, with greater purpose potentially limiting avoidance tendencies and reducing the effects of depression and anxiety. Understanding the role that purpose in life may play in depression and anxiety could help to inform current conceptualizations of these disorders and improve treatment outcomes.

Subjective dry eye symptoms and associated factors among the national general population in China during the COVID-19 pandemic: A network analysis

Background

The coronavirus disease 2019 (COVID-19) pandemic has presented numerous challenges to public health, including the emergence of subjective dry eye symptoms among individuals. However, there is currently a dearth of comprehensive knowledge regarding the associated factors with subjective dry eye symptoms in the general population.

Methods

A nationwide survey in China was carried out from 20 June to 31 August 2022, involving 21 916 participants. Subjective dry eye symptoms were assessed using the Ocular Surface Disease Index-6. We employed random forest classification to select potential associated factors based on the socioecological model. We also conducted univariate and multivariable logistic regression analyses to explore the factors associated with subjective dry eye symptoms. Network analyses were employed to explore the network structure of subjective dry eye symptoms and associated factors.

Results

The item "watching TV (or similar task)" displayed the highest node strength and exhibited the highest predictability within the network. The results of the multivariate logistic regression analysis demonstrated significant associations between subjective dry eye symptoms and several factors, including loneliness (odds ratio (OR) = 1.29; 95% confidence interval (CI) = 1.26 to 1.32), problematic Internet use (OR = 1.08; 95% CI = 1.08 to 1.09), family communication (OR = 1.01; 95% CI = 1.00 to 1.01), the presence of depression (OR = 1.53; 95% CI = 1.39 to 1.68) and anxiety (OR = 1.31; 95% CI = 1.17 to 1.47) symptoms, older age (OR = 1.01; 95% CI = 1.01 to 1.01), self-rated health status (OR = 0.99; 95% CI = 0.98 to 0.99), family health (OR = 0.97; 95% CI = 0.96 to 0.97), health literacy (OR = 0.98; 95% CI = 0.97 to 0.99) and the agreeableness personality trait (OR = 0.97; 95% CI = 0.95 to 0.99).

Conclusions

These findings have important implications for public health interventions targeting the prevention and management of subjective dry eye symptoms in the general population. Strategies addressing individual risk factors and supporting psychological well-being may prove beneficial in mitigating the burden associated with subjective dry eye symptoms.

The relationship between tolerance for uncertainty and academic adjustment: the mediating role of students' psychological flexibility during COVID-19

Introduction

University students are among the groups most adversely affected by COVID-19 in terms of their psychological and academic wellbeing, particularly given the pandemic's uncertainty. However, little is known about their psychological flexibility to deal with this uncertain nature of pandemic. This study aimed to examine the mediating role of psychological flexibility (PF) in the relationship between university students' intolerance of uncertainty (IU) and their academic adjustment to the online learning process during COVID-19.

Methods

Data was collected from 388 university students from Türkiye (18-34 (Mage = 21.43, SD = 2.04) who completed five questionnaires - Intolerance of Uncertainty Scale, Acceptance and Action Questionnaire II, Academic Self Efficacy Scale, Educational Stress Scale, and Online Self-Regulatory Learning Scale. Additionally, as indicators of students' academic adjustment, perceived academic performance - ranging 1 to 10, and their last academic grade point average before and during the pandemic were also collected.

Results

The results indicated that PF and IU had a significant effect on the academic adjustment of students during the pandemic. PF had a complete mediating role between the IU and academic adjustment. Results also revealed that online self-regulation, a sub-dimension of academic adjustment, did not show a significant relationship with any other variable in the model.

Discussion

Research findings showed that psychological flexibility is a very important strength for university students to maintain their academic adjustment in stressful times. The results were discussed in light of the relevant research, and recommendations for further research and implications were provided.

Psychometric Properties of the Iranian Version of Contrast Avoidance Questionnaires: Could Contrast Avoidance Be a New Transdiagnostic Construct?

The contrast avoidance model (CAM) hypothesizes that individuals with chronic worry recruit worry to create and maintain a negative emotional state to avoid sudden increases in negative emotions. Preliminary evidence using the contrast avoidance questionnaires (CAQs) suggests that there might be a similar mechanism across mood and other anxiety disorders. To continue to assess the CAQs, they should be adapted for other languages and evaluated across multiple symptom domains. The present study aimed to develop the Persian versions of the CAQs and examine the transdiagnostic nature of CAM across two studies. A large Persian-speaking college student sample (Total n = 1438) was used to evaluate the factor structure of the CAQs (Study 1) and the psychometric properties of CAQs (Study 2). Results supported the two-factor structure of the CAQ-W (worry) and CAQ-GE (general emotion). Results showed that CAQ-W was a significant predictor of anxiety-related measures. However, CAQ-GE and IUS-12 significantly predicted depressive and other symptoms over the CAQ-W. Results demonstrated excellent psychometric properties. They indicate that contrast avoidance, measured via CAQ-GE, could be a transdiagnostic construct, and CAQ-W may be more sensitive to anxiety-specific contrast avoidance among Persian speaking and/or Iranian individuals.

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.

Reactivity toward daily events: Intraindividual variability and change in recurrent depression - A measurement burst study

In Major Depressive Disorder, first evidence shows heightened mood-reactivity toward daily events. Related longitudinal studies in remitted patients with recurrent major depression are lacking. Long-term changes in such short-term within-person associations can be analysed via measurement burst designs. Two bursts, separated by approximately 4.4 years, consisted of a baseline session and an Ambulatory Assessment (burst-1: 3 days, burst-2: 5 days). Via smartphone, 54 initially remitted patients with recurrent major depression indicated their negative and positive affect, rumination, self-acceptance, and the occurrence of negative and positive daily events ten times and collected saliva cortisol samples five times per day. In bursts with higher depression levels, patients showed blunted negative affect- and cortisol-reactivity and stronger decreases in positive affect and self-acceptance toward negative daily events, as well as stronger increases in self-acceptance following positive daily events. However, patients with higher depression levels demonstrated stronger ruminative stress-reactivity within bursts. Furthermore, patients with higher depression levels showed an increase of affective stress-reactivity over bursts, such that negative affect more strongly increased and positive affect more strongly decreased following negative daily events over bursts. Following positive daily events, patients with higher depression levels showed stronger decreases in negative affect within bursts and a decrease of self-acceptance-reactivity over bursts. To conclude, measurement burst designs enable to examine intraindividual variability and change of micro-level processes, and possible moderators thereof, potentially providing prognostic information for the course of recurrent major depression.

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.

Symptom severity in daily life, early response and posttreatment changes in anxiety and depressive symptoms in generalized anxiety disorder

BACKGROUND

Meta-analytic research shows early response to psychotherapy to predict depression and anxiety outcomes posttreatment. However, little is known about which variables explain differences in early response. Moreover, for patients with generalized anxiety disorder (GAD), there is limited research on whether early response predicts longer-term changes in symptoms. In this study, we used anxiety and controllability beliefs assessed in daily life at intake to predict early response to treatment (until session 5), and we further examined if early response predicts longer-term changes in symptoms (until posttreatment, when adjusting for intake symptom severity) in patients with GAD.

METHODS

Forty-nine individuals with GAD reported their anxiety and controllability beliefs using event-based (participant-initiated) ecological momentary assessment (EMA) for 7 days at intake. Symptoms were measured at pretreatment, session 5, session 10, and posttreatment.

RESULTS

Results show anxiety levels reported during EMA to be associated with a higher reduction in both anxiety and depressive symptoms early in treatment. Moreover, higher controllability beliefs during EMA were associated with less early response. When predicting change in symptoms until posttreatment, results showed an early change to significantly predict change in symptoms until posttreatment.

CONCLUSIONS

Given that we found early response to psychotherapy in patients with GAD to be a prognostic factor for long-term response, it is recommended to monitor response early in treatment and pay special attention to those patients showing less early response.

Change in interpersonal problems and metacognitive beliefs as predictors of improvement in patients with generalized anxiety disorder

INTRODUCTION

Generalized anxiety disorder (GAD) is characterized by persistent worry and anxiety, often with a chronic course. We tested the role of two suggested underlying factors in GAD, interpersonal problems and negative metacognitive beliefs, as predictors of trait-worry and trait-anxiety.

METHODS

The sample consisted of 56 patients with a primary diagnosis of GAD from a randomized controlled trial. We first estimated the proportion of variance lying between the higher level of the data structure to account for potential therapists' effects. Two hierarchical regression analyses were conducted testing change in interpersonal problems and negative metacognitive beliefs as predictors of change in trait-worry and trait-anxiety following treatment. Change in depression and anxiety symptoms was controlled.

RESULTS

Change in negative metacognitive beliefs was the strongest predictor of improvement of both trait-worry and trait-anxiety. Change in interpersonal problems was not a unique predictor of change in trait-worry but did make a significant and unique contribution to trait-anxiety.

CONCLUSIONS

Negative metacognitive beliefs may be important targets to improve trait-worry and trait-anxiety in GAD. Interpersonal problems may be relevant for trait-anxiety but could also be a surface marker of higher order vulnerability factors. Implications for treatment are discussed.

Intolerance of Uncertainty, Negative Reinforcement Alcohol Use Motives, and Hazardous Drinking in College Students with Clinically Elevated Worry

Background: Hazardous drinking has remained high for college students in recent years, and individuals who endorse drinking to cope with emotional distress or to conform socially report higher levels of alcohol use. Intolerance of uncertainty, a core process underlying generalized anxiety disorder, has been linked to negative reinforcement drinking motives; however, no research, to date, has examined the role of intolerance of uncertainty in terms of alcohol use motives and hazardous drinking among individuals with generalized anxiety disorder. Objective: The current study was designed to examine the relationships between intolerance of uncertainty, coping and conformity alcohol use motives, and hazardous drinking in an analogue generalized anxiety disorder sample. Methods: Participants were 323 college students (M_age = 19.25, SD = 2.23, Range = 18-40) who endorsed past-year alcohol use and clinically elevated levels of worry. Self-report measures were completed online for course credit. Results: Partially consistent with our hypotheses, uncertainty paralysis predicted greater levels of coping motives, but not conformity motives. Desire for predictability did not predict either drinking motive. Mediation analyses revealed that there was a significant indirect effect of uncertainty paralysis on more hazardous drinking through greater coping motives. Conclusion: Overall, these findings highlight the potential utility of targeting behavioral inhibition due to uncertainty to reduce unhealthy coping via alcohol use and subsequent hazardous alcohol use.

A randomized clinical trial of behavioral activation and exposure-based therapy for adults with generalized anxiety disorder

Objective

Exposure-based therapy (EXP) and behavioral activation (BA) are empirically-supported behavioral intervention techniques that target avoidance and approach behavior to alleviate symptoms. Although EXP is an established treatment for generalized anxiety disorder (GAD), the effectiveness of BA for GAD has not been directly tested or compared with that of EXP. This study examined the efficacy of EXP and BA for adults with GAD.

Method

In a randomized clinical trial (clinicaltrials.gov: NCT02807480) with partial blinding in Tulsa, OK, 102 adults with GAD were allocated to manualized, 10-session EXP or BA between April 2016-April 2021. Primary analyses were intention-to-treat and included the 94 (46 EXP, 48 BA) participants who started treatment. The GAD-7 self-report scale was the primary outcome measure.

Results

Similar GAD-7 declines were observed at post-treatment for EXP (d=-0.97 [95% CI -1.40 to -0.53]) and BA (d=-1.14 [95% CI -1.57 to -0.70]), and were maintained through 6-month follow-up (EXP: d=-2.13, BA: d=-1.98). Compared to EXP, BA yielded more rapid declines in anxiety and depression scores during therapy (d=0.75-0.77), as well as lower anxiety and depression scores (d=0.13-0.14) and greater participant-rated improvement (d=0.64) at post-treatment. Bayesian analyses indicated 74-99% probability of greater change in BA than EXP at post-treatment.

Conclusions

BA and EXP are both effective in treating GAD, and BA may confer greater benefit during treatment. Future research is warranted to inform personalized treatment approaches.

Upregulating positive emotion in generalized anxiety disorder: A randomized controlled trial of the SkillJoy ecological momentary intervention

OBJECTIVE

This study sought to determine if upregulating positive emotion both reduces symptoms and increases well-being for those with generalized anxiety disorder (GAD).

METHOD

Eighty-five 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). SkillJoy, a savoring ecological momentary intervention, prompted participants to attend to positive aspects of the present moment, engage in and savor planned enjoyable activities, record and reflect on recent positive experiences, note events that turned out well, and look forward to positive events. The active self-monitoring control (ASM) mirrored SkillJoy's activities and wording, yet omitted savoring. It included attending to current thoughts and feelings, planning everyday activities, remembering and recording daily events, and anticipating important events. Participants were assessed at pre- and posttreatment with a 30th day follow-up. Linear mixed models and simple slope analyses with multiple imputation examined outcome change between and within conditions.

RESULTS

Pretrial to posttrial, SkillJoy (vs. ASM) led to significantly greater reductions in worry and increases in positive emotions and savoring. Depression symptoms significantly decreased for both EMIs. Pretrial to follow-up, SkillJoy (vs. ASM) users showed significantly greater increases in savoring. Both SkillJoy and ASM significantly decreased worry (d = -1.02 vs. -0.51) and depression (d = -1.09 vs. -0.63) pre-to-follow-up, yet SkillJoy had greater effect sizes. SkillJoy significantly increased positive emotions and savoring pre-to-follow-up, yet ASM did not.

CONCLUSION

SkillJoy may strengthen positive emotions and skills for enhancing them, while also reducing worry. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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.

Predictors of Psychological Strain and Allostatic Load in Teachers: Examining the Long-Term Effects of Biopsychosocial Risk and Protective Factors Using a LASSO Regression Approach

Teacher stress significantly challenges teachers' health, teaching quality, and students' motivation and achievement. Thus, it is crucial to identify factors that effectively prevent it. Using a LASSO regression approach, we examined which factors predict teachers' psychological strain and allostatic load over two years. The study included 42 teachers (28 female, Mage = 39.66, SD = 11.99) and three measurement time points: At baseline, we assessed teachers' (a) self-reports (i.e., on personality, coping styles, and psychological strain), (b) behavioral data (i.e., videotaped lessons), and (c) allostatic load (i.e., body mass index, blood pressure, and hair cortisol concentration). At 1- and 2-year follow-ups, psychological strain and allostatic load biomarkers were reassessed. Neuroticism and perceived student disruptions at baseline emerged as the most significant risk factors regarding teachers' psychological strain two years later, while a positive core self-evaluation was the most important protective factor. Perceived support from other teachers and the school administration as well as adaptive coping styles were protective factors against allostatic load after two years. The findings suggest that teachers' psychological strain and allostatic load do not primarily originate from objective classroom conditions but are attributable to teachers' idiosyncratic perception of this environment through the lens of personality and coping strategies.

‘It just doesn't feel right’ and other reasons why some people fear and avoid positive emotions

The need to further our understanding of positive affect dysregulation in depression has been widely acknowledged. Two related relevant concepts in this realm, are Avoidance Of Positivity (AOP; referring to avoidance behaviour towards positivity) and Fear Of Positivity (FOP; referring to anxious or unpleasant feelings related to positivity). However, traditionally manifestations of AOP and FOP are considered in isolation, and self-report scales used to measure both concepts show considerable content overlap. Therefore, the first study aim was to examine how AOP and FOP relate to one another, depressive symptomatology and anhedonia, through new clearly delineated scales. For exploratory purposes, general and state-specific versions were developed. The second aim was to uncover beliefs that underlie the tendency towards AOP/FOP. An adult community sample (n = 197) completed online measures of AOP, FOP, depressive symptoms and anhedonia, and answered open-ended questions about reasons for AOP and FOP. Cross-sectionally, preliminary evidence was found for AOP and FOP being positively associated with one another, depressive symptomatology and anhedonia. Even after controlling for depressive symptomatology, anhedonia remained positively associated with AOP and FOP. So, AOP and FOP may be viable candidate mechanisms maintaining anhedonia that are worth further investigation and may be appropriate to target during treatment. Answers to the open-ended questions (n = 77) reflected various beliefs underlying AOP/FOP, which were broader than simply anticipating negative consequences of feeling positive and also touched on themes of unworthiness and social inappropriateness of feeling positive. Some theoretical and clinical implications of different beliefs underlying AOP/FOP are discussed.

Combining transcranial direct current stimulation with group cognitive behavioral therapy developed to treat rumination: a clinical pilot study

Background

As part of repetitive negative thinking (RNT), rumination is a maladaptive cognitive response style to stress or negative mood which can increase the risk of depression and may prohibit complete recovery. Cognitive behavioral therapy (CBT) and transcranial direct current stimulation (tDCS) both proved to be effective in decreasing rumination. However, the combined effects of tDCS and CBT interventions on rumination have not yet been explored. The first aim of this pilot study is to investigate whether the combination of tDCS and CBT has an accumulating positive effect on modulating state rumination. The second aim is to assess the feasibility and safety profile of the proposed combined approach.

Method

Seventeen adults aged 32-60 years, suffering from RNT, were referred by their primary care professional to participate in an 8-week group intervention for RNT ("Drop It") comprising 8 sessions of CBT. Before each CBT session, patients underwent one double-blinded prefrontal active (2 mA for 20 min) or sham tDCS (anode over F3, cathode over the right supraorbital region) combined with an internal cognitive attention task focused on individual RNT, i.e., online tDCS priming. During each session, the Brief State Rumination Inventory was used to assess state rumination.

Results

A mixed effects model analysis revealed no significant differences between the stimulation conditions, weekly sessions, or their interaction in terms of state rumination scores.

Conclusion

Overall, the combination of online tDCS priming followed by group CBT was found to be safe and feasible. On the other hand, no significant additional effects of this combined approach on state rumination were established. Although our pilot study may have been too small to find significant clinical effects, future larger RCT studies on combined tDCS-CBT treatment protocols may reevaluate the selection of internal cognitive attention tasks and more objective neurophysiological measurements, consider the optimal timing of the combination (concurrently or sequentially), or may add additional tDCS sessions when following CBT.

Lay perspectives on emotion: past, present, and future research directions

Empirical research has demonstrated that individuals vary widely in how they view their emotions. We call the viewpoints that individuals have towards their emotions emotion perspectives. While many subdisciplines of psychology, such as social psychology and clinical psychology, have studied this topic, research thus far can be siloed, despite overlap in terms and constructs. The goal of the current special issue and this introduction is to describe the state of research on emotion perspectives, highlight common themes in streams of emotion perspective research, and present future directions for investigation. The first portion of this introduction to the special issue provides a basic review of emotion perspective research, spotlighting topics such as emotion beliefs, emotion mindsets, lay theories of emotion, and attitudes toward emotion. The second portion of the introduction presents themes that cut across papers in the special issue, with a discussion of future research directions throughout. The goal of this introduction and special issue is to serve as a guide for greater integration in emotion perspective research and to provide a roadmap for emotion perspective research moving forward.

Teachers' perception of aggressive student behavior through the lens of chronic worry and resignation, and its association with psychophysiological stress: An observational study

Aggressive student behavior is considered a leading risk factor for teacher stress. However, teachers' coping styles may affect how they perceive and respond to aggressive student behavior. This study tests whether teachers' perceptions of aggressive student behavior mainly mirror objectively observed aggression in presence of the teacher (as coded by external observers) or whether teachers' perception of aggressive student behavior primarily reflects teachers' avoidant coping styles, such as chronic worry and resignation. Finally, we examine whether observed and teacher-perceived aggression relates to increased vital exhaustion and psychophysiological stress among teachers (i.e., higher hair cortisol concentration). In an ambulatory assessment study, we administered self-reports to 42 Swiss teachers to assess perceived student aggression, chronic worry, resignation, and vital exhaustion. Additionally, four consecutive lessons per teacher were filmed, and aggressive student behavior in presence of the teacher was coded by four trained external observers. The concentration of cortisol was assessed in hair samples. Results showed that teacher-perceived and observed aggression were moderately associated. Observed aggression was related to teacher perceptions to a much lesser extent than teachers' avoidant coping styles, that is, chronic worry and resignation. While teacher-perceived student aggression was associated with teachers' self-reported vital exhaustion, we did not find any significant association with hair-cortisol concentration. Our findings suggest that teachers perceive student aggression through the lens of their coping styles. Teachers' dysfunctional coping styles are associated with an overestimation of student aggression. Teachers' overestimation of student aggression relates to higher levels of vital exhaustion. Therefore, it is crucial to identify and change teachers' dysfunctional coping styles to prevent a vicious cycle of dysfunctional teacher-student interactions.

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.

Transdiagnostic Cognitive Behavioral Psychotherapy: Unified Protocol as an Example

The fact that there are many limitations of the current classification systems led to the emergence of transdiagnostic approaches (TA) that focus on the common psychopathological processes underlying disorders rather than categorical diagnoses. TA focuses on the underlying common psychopathological processes in the emergence and persistence of mental disorders. Thus, even if the disorders are categorically diagnosed differently, it can be determined how they overlap or separate with each other. TA aims to treat mental disorders using these aspects. TA has a flexible and modular structure that can be easily integrated into cognitive behavioral therapies. The rest of this review will focus on the Unified Protocol (UP), one of the most popular TA examples. The main purpose of the UP is to enable patients to recognize their feelings and give more adaptive reactions to their negative emotions. Accordingly, UP consists of eight modules. The modules can usually be completed in a total of 11 - 17 weeks. Each 50 to 60-minute individual session is held once a week. If necessary, changes can be made to the number or the frequency of sessions allocated to modules. The goals of each module of the UP and the treatment approaches towards these goals allow a very clearly defined approach. For this reason, there is a need for a detailed evaluation, conceptualization and treatment plan before the UP is put into practice. We hope that mental health professionals from Turkey will contribute to the developments in the UP.

The mediating effect of stress reactivity in the 18-year bidirectional relationship between generalized anxiety and depression severity

BACKGROUND

Generalized anxiety disorder (GAD) and major depressive disorder (MDD) often precede and predict one another. Heightened stress reactivity may be a mediation mechanism underlying the long-term connections between GAD and MDD. However, cross-sectional studies on this topic have hindered directional inferences.

METHOD

The present study examined stress reactivity as a potential mediator of the sequential associations between GAD and MDD symptoms in a sample of 3,294 community-dwelling adults (M age = 45.6, range = 20-74). Participants completed three waves of measurement (T1, T2, and T3) spaced nine years apart. GAD and MDD symptom severity were assessed at T1, T2, and T3 (Composite International Diagnostic Interview-Short Form). Stress reactivity (Multidimensional Personality Questionnaire) was measured at T2.

RESULTS

Structural equation mediation modeling demonstrated that higher T1 GAD symptoms positively predicted more severe T3 MDD symptoms via T2 stress reactivity, controlling for T1 MDD (d = 0.45-0.50). However, T2 stress reactivity was not a significant mediator in the relationship between T1 MDD severity and T3 GAD symptoms after controlling for T1 GAD. Direct effects indicated that T1 GAD positively predicted T3 MDD 18 years later and vice versa (d = 1.29-1.65).

LIMITATIONS

Stress reactivity was assessed using a self-report measure, limiting conclusions to perceived (vs. physiologically indexed) stress reactivity.

CONCLUSIONS

These findings indicate that stress reactivity may be one mechanism through which GAD leads to later MDD over prolonged durations. Overall, results suggest that targeting stress reactivity in treatments for GAD may reduce the risk of developing subsequent MDD.

High-trait anxious individuals show positive relationship between HRV and threat vigilance

Selectively attending to threat-related stimuli in the environment, known as threat bias (TB), is a prominent feature of anxiety. Individuals with high anxiety also tend to show lower heart rate variability (HRV), a reflection of reduced parasympathetic cardiac control. Previous investigations have established associations between low HRV and various attentional processes that facilitate attention to threat, though these have primarily been conducted among non-anxious individuals. The current analysis, derived from a larger TB modification study, examined the relationship between TB and HRV among a young, nonclinical sample of individuals with either high or low trait anxiety (HTA, LTA, respectively; M_age  = 25.8, SD = 13.2, 61.3% female). Consistent with expectations, HTA (β = -.18, p = .087) trended toward an association with higher threat vigilance. A significant moderation effect showed the relationship between HRV and threat vigilance was influenced by TA (β = .42, p = .004). Simple slopes analysis revealed that for the LTA group, lower HRV trended toward higher threat vigilance (p = .123), consistent with expectations. However, this relationship was unexpectedly reversed for the HTA group, for whom higher HRV was a significant predictor of higher threat vigilance (p = .015). These results are interpreted within a cognitive control framework, in which regulatory ability, as assessed via HRV, may influence which cognitive strategy is employed when encountering threatening stimuli. Results suggest that HTA individuals with greater regulatory ability may employ a contrast avoidance mechanism, while those with reduced regulatory ability engage in cognitive avoidance.

Reciprocal Prospective Effects of Momentary Cognitions and Affect in Daily Life and Mood Reactivity Toward Daily Events in Remitted Recurrent Depression

Major depressive disorder is a recurrent condition. Potential risk factors for future episodes are maladaptive cognitions, such as rumination and unfavorable reactivity toward negative daily events. Positive thoughts and positive daily events, in contrast, could act as a buffer against mood deterioration. The aim of the present study is to (a) examine differences in daily affect and cognitions in remitted depressed patients with a history of recurrent episodes (rMDD) and healthy controls, (b) analyze reciprocal prospective effects of momentary cognitions and affect, and (c) investigate effects of daily events on affect and cognitions in both groups. A sample of N = 102 participants underwent an ecological momentary assessment (EMA) phase of 5 consecutive days, where rMDD patients (n = 51) and healthy controls (n = 51) indicated their momentary rumination, positive thoughts, affect, and the occurrence of daily events 10 times per day. Via multilevel lag models, we found higher rumination to predict a decrease of positive affect (PA) in the rMDD group, but no effect of rumination on subsequent negative affect (NA) in either group. Higher positive thoughts predicted an increase in PA and a decrease in NA, similarly strong in both groups. Regarding daily events, rMDD patients reported a stronger increase in NA and rumination following negative daily events compared to controls, whereas an observed subsequent decrease of PA and positive thoughts was not moderated by group. Following positive daily events, rMDD patients showed a stronger increase in PA and positive thoughts and a stronger decrease in NA and rumination than controls. For interventions targeting relapse prevention, our results indicate the implementation of strategies fostering the responsiveness to positive events and the up-regulation of positive affect.

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.

PTSD Symptom Cluster Severity Predicts Momentary Emotion Dynamics During Couple Conversations

This study investigated the associations between momentary emotion dynamics and posttraumatic stress disorder (PTSD) symptoms. Using a sample of 61 couples (N = 122 individuals) in which all individuals were trauma exposed and at least one partner screened positive for PTSD, we examined the intra- and interpersonal regulation of vocally encoded emotional arousal (fundamental frequency [f0]) and how these momentary emotion regulatory patterns relate to specific PTSD symptoms during two couple conversations: one designed to elicit conflict and one to elicit intimacy. PTSD symptoms were assessed using a gold standard clinical interview. In both conversations, higher reexperiencing symptoms were associated with greater emotional inertia (i.e., more resistance to change in emotional state following deviation from one's emotional equilibrium), and higher avoidance symptoms were associated with less emotional inertia (i.e., quicker return to emotional equilibrium). In the intimacy conversations, individuals also responded to their partners' arousal. Furthermore, individuals whose partners exhibited higher emotional numbing symptoms exhibited more emotional inertia, suggesting that emotion regulation may be a function of both one's own and one's partner's PTSD symptoms. Attending to the interpersonal context of emotion dynamics during PTSD treatment may enhance outcomes.

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.

Challenging Parenting Behaviour and Anxiety Disorders in Emerging Adulthood

Challenging parenting behaviour (CPB) refers to parental encouragement of behaviours where children push their own limits through engaging them engage in safe risks, such as rough-and-tumble play (Bögels & Phares, 2008). Preliminary evidence suggests that CPB reduces the risk of child anxiety however, little is known about the relationship between CPB and specific forms of anxiety disorders and the factors that influence this relationship. The present study aims to examine current maternal and paternal CPB in relation to symptoms of generalised anxiety disorder (GAD) and social anxiety disorder (SAD) in emerging adulthood, and to identify whether intolerance of uncertainty (IU) and cognitive avoidance (CA) sequentially mediate this relationship. A sample of 190 UK-based adults (aged 18-25) completed a battery of online self-report measures. Greater maternal CPB, but not paternal CPB, was found to predict lower symptoms of SAD, but not GAD. IU and CA did not sequentially mediate the relationship between CPB and symptoms of GAD or SAD. This study suggests that CPB may be associated with certain forms of anxiety disorders such as SAD, but further investigation is needed to understand the mechanisms between CPB and anxiety in young people.

Depressive symptoms and persistent negative self-referent thinking among adolescents: A learning account

Learning theories of depression propose that negative thinking is acquired through subsequent rewarding experiences and is often resistant to change even when it becomes associated with punishment. We examined whether this persistency of negative thinking is related to current and future levels of depressive symptoms among adolescents. Persistency of negative self-referent thinking was assessed by means of a decision-making task, namely the emotional reversal learning task. This task offers participants the choice between thinking about negative and positive self-related aspects. Their choice for negative self-referent thinking is initially rewarded but is later punished. Therefore, participants were expected to efficiently switch between negative and positive self-referent thinking, and to internally update their reward expectancy for these thinking options. Results showed that persistency of negative self-referent thinking was related to concurrent levels of depressive symptoms, replicating earlier findings in adults. However, persistency of negative thinking was unrelated to future levels of depressive symptoms. These findings suggest that adolescents with depressive symptoms tend to hold on to the belief that negative self-referent thinking has beneficial consequences, even when it is no longer being rewarded. This tendency should be seen as a concurrent feature of depression, as the predictive value is still in question.

Impaired disengagement from worry: Dissociating the impacts of valence and internally-directed attention

Worry is a repetitive, negative thought process that is widely experienced as difficult to control. Despite the adverse effects of uncontrollable worry on academic and other role functioning, the mechanisms by which worry becomes uncontrollable remain poorly understood. Previous experimental work has historically emphasized valence (negative versus positive or neutral). However, contemporary cognitive neuroscience also distinguishes between internally-directed attention (e.g., to thoughts) and externally-directed attention (e.g., to perceptual stimuli). To date, no studies have experimentally examined potential dissociable contributions of valence versus attentional direction to impaired disengagement from worry. In a 2 (negative or neutral valence) x 2 (internal or external attention) between-subjects, experimental and prospective design (https://osf.io/vdyfn/), participants (N = 200) completed alternating blocks of a randomly-assigned attention manipulation and validated sustained attention task. Participants also rated trait worry and distress during the experimental session (T1) and a naturalistic stressor (the week before finals; T2). There was a main effect, such that internally-directed attention impaired sustained attention (increased commission errors). Worry (internal x negative) also impaired sustained attention (faster and less accurate responding) in planned group contrasts. Trait worry did not moderate these effects. Sustained attention at T1 did not predict distress or worry during the T2 stressor. These findings augment the literature on the attentional consequences of worry and replicate and extend previous findings of altered speed-accuracy tradeoffs following experimentally-induced worry. We also find evidence for impaired disengagement from internally-directed (versus externally-directed) attention, which may help to explain impaired disengagement from related forms of perseverative thought (e.g., rumination).

Effects of trauma-focused rumination among trauma-exposed individuals with and without posttraumatic stress disorder: An experiment

Rumination, or thinking repetitively about one's distress, is a risk factor for posttraumatic stress disorder (PTSD). Current theories suggest that rumination contributes to PTSD symptoms directly, by increasing negative reactions to trauma cues (i.e., symptom exacerbation), or represents a form of cognitive avoidance, if verbal ruminations are less distressing than trauma imagery. The goal of this study was to test the symptom exacerbation and cognitive avoidance accounts of trauma-focused rumination. We recruited 135 trauma-exposed participants (n = 60 diagnosed with PTSD) and randomly assigned them to ruminate about their trauma, distract themselves, or engage in trauma imagery. For individuals with and without PTSD, rumination led to larger increases in subjective distress (i.e., negative affect, fear, sadness, subjective arousal, valence) than distraction, η_p ² s = .04-.13, but there were no differences between rumination and imagery η_p ² s = .001-.02. We found no evidence that rumination or imagery elicited physiological arousal, ds = 0.01-0.19, but did find that distraction reduced general physiological arousal, as measured by heart rate, relative to baseline, d = 0.84, which may be due to increases in parasympathetic nervous system activity (i.e., respiratory sinus arrhythmia), d = 0.33. These findings offer no support for the avoidant function of rumination in PTSD. Instead, the findings were consistent with symptom exacerbation, indicating that rumination leads directly to emotional reactivity to trauma reminders and may be a fruitful target in PTSD intervention.

Negative School Gossip and Youth Adolescents' Mobile Phone Addiction: Mediating Roles of Anxiety and Experiential Avoidance

Being the target of negative school gossip, a form of relational aggression, has been shown to be associated with psychological and behavioral problems in youth adolescents. Based on the experience avoidance model, this study tested the association between negative school gossip and youth adolescents' mobile phone addiction, and the serial mediation roles of anxiety and experience avoidance in this relationship. Junior high school students (N = 837; ages 12-15; 50% girls) completed the Negative School Gossip Scale, Anxiety Scale, Acceptance and Action Questionnaire (AAQ-II), and Mobile Phone Addiction Scale in their classrooms. The results of regression-based analyses showed that after controlling for age and gender, (1) negative school gossip was significantly associated with mobile phone addiction; (2) anxiety and experience avoidance each significantly mediated this association; (3) anxiety and experience avoidance serially mediated this association. The results support the experience avoidance model and highlight emotional factors as an internal mechanism by which negative school gossip is associated with youth adolescents' mobile phone addiction. The results also have implications for preventing and reducing youth adolescents' mobile phone addiction.