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

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Highlights

  • Tested contrast avoidance theory regarding negative and positive affect.

  • Used event-contingent momentary assessment of social interactions.

  • Worry led to concurrently high negative affect and low positive affect.

  • Worry before social interactions was positively and negatively reinforced.

  • Not worrying before social interactions was positively and negatively punished.

Abstract

Background

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

Objective

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

Method

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

Results

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

Conclusion

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

Section snippets

Participants

Participants were recruited from a psychology subject pool using the Generalized Anxiety Disorder Questionnaire-IV (GAD-Q-IV; Newman et al., 2002). They received course credit for their participation in the study. Inclusion criteria required meeting full diagnostic criteria for generalized anxiety disorder (GAD) on the GAD-Q-IV (Newman et al., 2002) and having the diagnosis confirmed using the Diagnostic Interview for Anxiety, Mood, and OCD and Related Neuropsychiatric Disorders (DIAMOND; Tolin

Results

Please see Table 2 for descriptive statistics. Table 3 presents results for negative affect. Associations reported herein are described as “small,” “medium,” or “large” corresponding to their Cohen’s d values. Pre-interaction worry was concurrently associated with higher negative affect with a large effect size, ß = 0.92, SE = 0.04, t(2045) = 21.89, p < .001, d = 0.97. On average, there was also a small and significant decrease in negative affect from pre-social interaction to post-social

Discussion

The present study examined the maintenance of pathological worry via reinforcement and punishment using ecologically valid methods of event-contingent EMA. In particular, we were interested in the effects of worry on concurrent and subsequent positive and negative affect. Results provide empirical support for several key tenets of CAM. First, higher worry prior to social interactions was associated with higher concurrent negative emotion and lower concurrent positive emotion. Thus, worry not

Funding

This research was supported in part by National Institute of Mental Health, United States Research Grant MH115128.

References (45)

  • S.J. Llera et al.

    Rethinking the role of worry in generalized anxiety disorder: Evidence supporting a model of emotional contrast avoidance

    Behavior Therapy

    (2014)
  • S.J. Llera et al.

    Development and validation of two measures of emotional contrast avoidance: The Contrast Avoidance Questionnaires

    Journal of Anxiety Disorders

    (2017)
  • S.J. Llera et al.

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

    Behaviour Research and Therapy

    (2020)
  • M.G. Newman et al.

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

    Clinical Psychology Review

    (2011)
  • M.G. Newman et al.

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

    Journal of Anxiety Disorders

    (2023)
  • M.G. Newman et al.

    Preliminary reliability and validity of the Generalized Anxiety Disorder Questionnaire-IV: A revised self-report diagnostic measure of generalized anxiety disorder

    Behavior Therapy

    (2002)
  • C. Nisita et al.

    Delimitation of generalized anxiety disorder: Clinical comparisons with panic and major depressive disorders

    Comprehensive Psychiatry

    (1990)
  • E.J. Pawluk et al.

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

    Journal of Anxiety Disorders

    (2021)
  • K.E. Shin et al.

    Self- and other-perceptions of interpersonal problems: Effects of generalized anxiety, social anxiety, and depression

    Journal of Anxiety Disorders

    (2019)
  • T. Skodzik et al.

    The effect of verbal and imagery-based worry versus distraction on the emotional response to a stressful in-vivo situation

    Journal of Behavior Therapy and Experimental Psychiatry

    (2016)
  • American Psychiatric Association

    Diagnostic and statistical manual of mental disorders

    (2013)
  • M.M. Bacon et al.

    A study of affective contrast

    American Journal of Psychology

    (1914)
  • Cited by (11)

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    Department of Psychology, Pennsylvania State University.

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    Department of Psychology, Long Island University, CW Post Campus.

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    Department of Psychiatry, Michigan Medicine, The University of Michigan. This research was supported in part by National Institute of Mental Health Research Grant MH-39172.

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