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.

Does depression in multiple sclerosis mediate effects of cognitive functioning on quality of life?

PURPOSE: Patients with multiple sclerosis (MS) are at significant risk for decreased quality of life (QoL), in part due to factors such as cognitive impairment and depression. However, objective versus subjective assessments of cognitive functioning may differentially predict QoL, and it remains unknown whether they each impact QoL through levels of depression. The aims of the present study included (1) testing the effects of cognitive impairment on MS-related QoL via depression symptoms and (2) examining whether perceived and objective cognitive functioning differentially predict QoL through depression. METHODS: Patients formally diagnosed with MS (N = 128) participated in cognitive assessment (Brief International Cognitive Assessment for Multiple Sclerosis) and completed self-report measures of perceived cognitive functioning (perceived deficits questionnaire), depression (Hospital Anxiety and Depression Scale), and MS-related QoL (functional assessment of multiple sclerosis). RESULTS: Mediational hypotheses were tested by regression and structural equation modeling. As hypothesized, both perceived and objective cognitive functioning independently predicted lower QoL controlling for the effects of depression (p < 0.001). Consistent with hypotheses, depression mediated effects of both perceived (95% CI [0.31, 0.68]) and objective cognitive functioning (95% CI [0.09, 6.96]) on QoL when tested in separate models. However, when both predictors were modeled simultaneously, depression only mediated the effects of perceived (not objective) cognitive functioning (95% CI for standardized effect [0.10, 0.61]). CONCLUSIONS: This study, thus, suggests the need to conceptualize different pathways by which objective and subjective cognitive impairment may shape QoL in the lives of individuals with MS.

Gratitude is positively associated with quality of life in multiple sclerosis.

PURPOSE/OBJECTIVE: Individuals diagnosed with multiple sclerosis (MS) often experience decreased quality of life (QoL), in part attributable to fatigue, depression (Benedict et al., 2005), and cognitive dysfunction (Cutajar et al., 2000). Beyond these well-established predictors, the positive trait of gratitude-attentiveness to positive features in one's life-has predicted QoL in the context of other chronic illnesses. However, relatively little research has examined the relevance of gratitude as a contributor to QoL in MS. The purpose of the present study was (a) to test whether trait gratitude would predict QoL in MS, above and beyond known predictors (e.g., perceived and objectively assessed cognitive dysfunction, fatigue, and depression symptoms), and (b) to test whether gratitude would buffer (i.e., moderate) the effects of these predictors on QoL. Research Method/Design: This study employed a cross-sectional, single time-point design. Participants formally diagnosed with MS (N = 128) completed a short battery to assess cognitive function and self-report measures of depression, fatigue, perceived cognitive functioning, gratitude, and QoL. RESULTS: Consistent with hypotheses, gratitude uniquely predicted higher QoL beyond other predictors. In addition, gratitude buffered the effect of objective cognitive performance on QoL as expected, but did not interact with other predictors. CONCLUSIONS/IMPLICATIONS: These results suggest the need for further research into gratitude as a potential source of resilience for individuals with MS. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Prospective Investigation of the Contrast Avoidance Model of Generalized Anxiety and Worry.

The factors that maintain generalized anxiety disorder (GAD) symptoms and worry over time are not entirely clear. The Contrast Avoidance Model (CAM) postulates that individuals at risk for pathological worry and GAD symptoms uniquely fear emotional shifts from neutral or positive emotions into negative emotional states, and consequently use worry to maintain negative emotion in order to avoid shifts or blunt the effect of negative contrasts. This model has received support in laboratory experiments, but has not been investigated prospectively in the naturalistic context of daily life. The present study tested the CAM in a longitudinal experience sampling study with a subclinical sample. Participants selected to represent a broad range of symptoms (N = 92) completed baseline measures of GAD and depression symptoms, and eight weekly assessments of worry, experiences of negative emotional contrasts during their worst event of the week, and situation-specific negative emotion. Consistent with the CAM, GAD symptoms prospectively predicted higher endorsement of negative contrast experiences as worst events, independent of depression symptoms. Unsurprisingly, higher negative contrasts predicted higher negative emotion. However, both higher baseline GAD symptoms and weekly worry uniquely moderated (reduced) this relationship, providing consistent support for the idea that worry may blunt the emotional effects of contrasts. Depression symptoms did not have the same moderating effect. These findings support the CAM in an ecologically valid context.