Does Worrying Mean Caring Too Much? Interpersonal Prototypicality of Dimensional Worry Controlling for Social Anxiety and Depressive Symptoms

doi:10.1016/j.beth.2015.08.003

Behavior Therapy

Volume 47, Issue 1, January 2016, Pages 14-28

https://doi.org/10.1016/j.beth.2015.08.003 Get rights and content

Highlights

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We examined prototypical interpersonal features of worry, social anxiety, and depressive symptoms.
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Worry uniquely predicted self-reported high affiliation across self-report measures.
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Worry uniquely predicted low affiliation as rated by significant others.
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Social anxiety uniquely predicted self-reported and informant-rated submission.
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Unique effects of depressive symptoms varied by type of interpersonal measure.

Abstract

Worry, social anxiety, and depressive symptoms are dimensions that have each been linked to heterogeneous problems in interpersonal functioning. However, the relationships between these symptoms and interpersonal difficulties remain unclear given that most studies have examined diagnostic categories, not accounted for symptoms’ shared variability due to general distress, and investigated only interpersonal problems (neglecting interpersonal traits, interpersonal goals, social behavior in daily life, and reports of significant others). To address these issues, students (Study 1; N = 282) endorsed symptoms and interpersonal circumplex measures of traits and problems, as well as event-contingent social behaviors during one week of naturalistic daily interactions (N = 184; 7,036 records). Additionally, depressed and anxious patients (N = 47) reported symptoms and interpersonal goals in a dyadic relationship, and significant others rated patients’ interpersonal goals and impact (Study 2). We derived hypotheses about prototypical interpersonal features from theories about the functions of particular symptoms and social behaviors. As expected, worry was uniquely associated with prototypically affiliative tendencies across all self-report measures in both samples, but predicted impacting significant others in unaffiliative ways. As also hypothesized, social anxiety was uniquely and prototypically associated with low dominance across measures, and general distress was associated with cold-submissive tendencies. Findings for depressive symptoms provided less consistent evidence for unique prototypical interpersonal features. Overall, results suggest the importance of multimethod assessment and accounting for general distress in interpersonal models of worry, social anxiety, and depressive symptoms.

Section snippets

The Interpersonal Circumplex As a Dimensional Organizing Framework

The interpersonal circumplex (IPC) provides an overarching conceptual framework for examining interpersonal tendencies associated with symptom dimensions. The IPC dimensionally assesses the full range of social behavior via two underlying dimensions of dominance vs. submissiveness and affiliativeness vs. coldness (Gurtman, 2009; see Figure 1, panel A). Most IPC measures contain eight scales reflecting blends of these dimensions on the circle, permitting estimation of specific interpersonal

Study 1

Study 1 tested the interpersonal specificity of the symptom dimensions of worry, social anxiety, and depression in a non-clinical sample with a wide range of symptom severity.

Study 2

The purpose of Study 2 was to complement Study 1 by testing for interpersonal prototypicality of symptoms in a clinically distressed sample with a range of anxiety and depressive symptoms, using an IPC measure of interpersonal impact perceived by significant others. We also tested whether the findings of specificity for worry would extend to a measure of prototypically affiliative-submissive social goals (compassionate goals; at 320°, R² = .94).

Summary of Findings

Our primary goal was to clarify the specific and nonspecific relationships between worry, social anxiety, depressive symptoms, and interpersonal tendencies. A robust effect emerged for worry. As hypothesized, after controlling for other symptoms, worry predicted higher self-reported affiliation of interpersonal traits, problems, and daily social behavior in naturalistic interactions, and self-reported compassionate goals in a dyadic relationship, suggesting notable convergence. SSM results

Conflict of Interest Statement

The authors declare that there are no conflicts of interest.

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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.
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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.
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Citation Excerpt :
Moreover, we found that positive relations with others mediated the link between more severe T1 GAD symptoms predicting higher T3 MDD symptom severity. This aligns with past literature supporting a connection between anxiety and dysfunctional behavioral tendencies in social relationships (Erickson et al., 2016; Shin and Newman, 2019). Maladaptive interpersonal styles associated with anxiety (e.g., avoidant, intrusive, nonassertive) may cause relationship stress and negative social experiences (Eng and Heimberg, 2006; McEvoy et al., 2013; Przeworski et al., 2011; Salzer et al., 2008).
Major depressive disorder (MDD) and generalized anxiety disorder (GAD) co-occur at high rates, often preceding and predicting one another over long durations. Interpersonal theories propose that relationships with others may contribute to the longitudinal connections between MDD and GAD. Therefore, the current study examined the mediational effect of positive relations with others in these connections over 18 years.
Community-dwelling adults (n = 3294) participated in data collection at three time-points (Time 1 [T1], Time 2 [T2], and Time 3 [T3]) spaced about nine years apart. MDD and GAD symptoms were assessed using the Composite International Diagnostic Interview–Short Form. Positive relations was measured with the Psychological Well-Being Scale–Positive Relations with Others subscale. Structural equation mediation modeling was used for data analysis.
Results indicated that lower T2 positive relations significantly mediated the relationship between higher T1 MDD severity predicting more severe T3 GAD symptoms (d = 0.375) and explained 10.7% of the variance. T2 positive relations also had a significant mediational effect in the association between T1 GAD symptoms positively predicting T3 MDD severity (d = 0.360), accounting for 12.2% of the variance of this connection. These mediational effects were significant after adjusting for age, gender, education, and T1 symptoms (d = 0.277–0.677).
Supporting interpersonal theories, lack of positive relations with others mediated the bidirectional connections between MDD and GAD symptoms across 18 years. Future research should continue to explore the influence of positive relations on mental health and whether treatments that enhance interpersonal functioning could improve treatment for depression and anxiety.
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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.
To determine if reinforcement of worry occurs naturalistically via contrasts in both negative and positive emotion.
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.
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.
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.
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Does Worrying Mean Caring Too Much? Interpersonal Prototypicality of Dimensional Worry Controlling for Social Anxiety and Depressive Symptoms

Highlights

Abstract

Section snippets

The Interpersonal Circumplex As a Dimensional Organizing Framework

Study 1

Study 2

Summary of Findings

Conflict of Interest Statement

Clinical Psychology Review

Journal of Behavior Therapy and Experimental Psychiatry

Behaviour Research and Therapy

Behaviour Research and Therapy

Journal of Anxiety Disorders

Behavior Therapy

Behavior Therapy

Journal of Anxiety Disorders

Behavior Therapy

Psychiatric Clinics of North America

Journal of Anxiety Disorders

Journal of Affective Disorders

Personality and Individual Differences

Behavior Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Clinical Psychology Review

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Anxiety team clinic diagnosis reliability data

An interpersonal analysis of social anxiety and depression

Cognitive Therapy and Research

Construction of circumplex scales for the Inventory of Interpersonal Problems

Journal of Personality Assessment

Diagnostic and statistical manual of mental disorders

A proposal for a dimensional classification system based on the shared features of the DSM-IV anxiety and mood disorders: Implications for assessment and treatment

Psychological Assessment

Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal

Journal of Abnormal Psychology

Interpersonal subtypes in social phobia: Diagnostic and treatment implications

Journal of Personality Assessment

Interpersonal pathoplasticity in the course of major depression

Journal of Consulting and Clinical Psychology

Entrapment and defeat perceptions in depressive symptomatology: Through an evolutionary approach

Psychiatry

Expanding stress generation theory: Test of a transdiagnostic model

Journal of Abnormal Psychology

Creating and undermining social support in communal relationships: The role of compassionate and self-image goals

Journal of Personality and Social Psychology

Toward the future of psychiatric diagnosis: The seven pillars of RDoC

BMC Medicine

Heterogeneity of interpersonal problems among depressed young adults: Associations with substance abuse and pathological personality traits

Journal of Personality Assessment

Even the downhearted may be uplifted: Moral elevation in the daily life of clinically depressed and anxious adults

Journal of Social and Clinical Psychology

Predicting unpredictability: Do measures of interpersonal rigidity/flexibility and distress predict intraindividual variability in social perceptions and behavior?

Journal of Personality and Social Psychology

A hybrid model of social phobia: An analysis of social anxiety and related symptoms of anxiety

Journal of Clinical Psychology

Evaluating the interpersonalness of personality scales

Personality and Social Psychology Bulletin

Exploring personality with the interpersonal circumplex

Social and Personality Psychology Compass

Circular measurement redux: The analysis and interpretation of interpersonal circle profiles

Clinical Psychology: Science and Practice