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.

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.

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).

Reducing contrast avoidance in GAD by savoring positive emotions: Outcome and mediation in a randomized controlled trial.

This secondary analysis of a randomized controlled trial (RCT) examined whether contrast avoidance (CA) in Generalized Anxiety Disorder (GAD) could be reduced through savoring-purposeful engagement with positive emotions. 85 participants were diagnosed with GAD by both questionnaire and clinical interview. They were then randomly assigned to one of two seven-day smartphone-delivered ecological momentary interventions (EMIs). The SkillJoy EMI facilitated in-the-moment practice of savoring positive emotions in participants' daily lives. The active self-monitoring control (ASM) was nearly identical to SkillJoy in ratings, activities, and language, yet omitted specific attention to positive emotion and savoring. CA was assessed by questionnaire at pre-trial and post-trial. Savoring was assessed by questionnaire at pre-trial and fifth-day mid-trial. Longitudinal linear mixed models and simple slope analyses examined CA change between and within conditions. Bias-corrected boot strapping path analysis examined mediation by savoring using individuals' CA slopes extracted from a multilevel model as outcome. Results showed that SkillJoy led to significant reductions in CA, whereas the ASM control did not. The relation between treatment condition and reduction in CA was mediated by increases in savoring from pre- to mid-trial. It may be possible for treatment to meaningfully reduce CA in GAD, specifically through savoring practices.

Parental support and monitoring influences on adolescent alcohol use: A peer selection mediation model.

Previous studies on parental support have consistently shown it predicts lower adolescent alcohol use. Yet findings regarding the influence of parental monitoring have been mixed. The current study aims to resolve this concern while examining peer selection as a mediator of both parenting factors. The current study used structural equation modeling and bootstrapping mediation analysis on data from 3,027 youth across three waves of the Adolescent Alcohol Prevention Trial to examine these factors. We tested a latent path model where the effect of parental support and monitoring in 7th grade on adolescent alcohol use in 9th grade was hypothesized to be mediated by best friends' alcohol use in 8th grade. Results: Higher parental support in seventh grade predicted lower adolescent alcohol use in 9th grade, mediated by lower best friends' use in eighth grade (ab = -0.025, CI = [-0.152, -0.003]). Yet parental monitoring in seventh grade did not predict alcohol use in 9th grade when parental support was included as a co-predictor in the model (ab = 0.018, CI = -0.135 - 0.025). There was also no significant mediation effect for the monitoring to youth drinking path. Adolescent's closeness with their parents may direct them to choose non-drinking friends, which leads to lower alcohol use in high school. Previously suggested effects of parental monitoring may be accounted for by support from parents.

Exposing Worry's Deceit: Percentage of Untrue Worries in Generalized Anxiety Disorder Treatment.

Theories of cognitive therapy have long proposed that those with generalized anxiety disorder (GAD) have inaccurate expectations. By challenging them with objective evidence, symptoms are thought to decrease. To test these premises, this study used ecological momentary assessment (EMA) during the Worry Outcome Journal (WOJ) treatment to determine the percentage of GAD worries that did not come true. We then analyzed the association between participants' untrue worry percentages and GAD symptom change across treatment. Twenty-nine participants with GAD recorded worries when prompted for 10 days, reviewed them online nightly, and tracked their worry outcomes across 30 days. These recordings were then coded by independent raters. Analyses applied bias-correct bootstrapping path analysis on slopes extracted from longitudinal linear mixed models. Primary results revealed that 91.4% of worry predictions did not come true. Higher percentages of untrue worries significantly predicted lower GAD symptoms after treatment, as well as a greater slope of symptom reduction from pre- to post-trial. Participants' average expected likelihoods of worries coming true were much greater than actual observed likelihoods. The most common percentage of untrue worries per person was 100%. Thus, worries in those with GAD were mostly inaccurate. Greater evidence of this inaccuracy predicted greater improvement in treatment. As theorized, disconfirming false expectations may significantly contribute to treatment's effect.

Probabilistic Learning by Positive and Negative Reinforcement in Generalized Anxiety Disorder.

This experiment examined learning tendencies in generalized anxiety disorder (GAD) using reinforcement feedback for probabilistic outcomes. One hundred sixty-six GAD and 105 non-GAD participants were randomized to a computerized probabilistic learning task that used either negative or positive reinforcement. Participants chose between stimuli with specific probabilities of reinforcement to learn which of each pair had the highest probability. Reinforced choices either removed an angry face (negative reinforcement) or made a happy face appear (positive reinforcement). Results showed that those with GAD learned the correct probabilistic choices at a slower rate over time and to a lesser degree than control participants regardless of reinforcement type. Estimations of the likelihood of receiving a good outcome posttask were also more inaccurate for those with GAD, especially when true likelihoods were high. Furthermore, compared with control participants, those with GAD reported lower perceived reinforcement sensitivity, higher behavioral inhibition sensitivity, and higher undesirable feelings toward probabilistic learning.

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

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

Relaxation-induced anxiety: Effects of peak and trajectories of change on treatment outcome for generalized anxiety disorder.

OBJECTIVE: Evidence is mixed regarding whether relaxation-induced anxiety (RIA) impedes relaxation training (RT) efficacy. Unlike past studies that averaged RIA across sessions, we examined peak RIA, change in RIA level across sessions, and timing of peak RIA with outcome. METHOD: This was a secondary analysis of Borkovec, Newman, Pincus, and Lytle [2002. A component analysis of cognitive-behavioral therapy for generalized anxiety disorder and the role of interpersonal problems. Journal of Consulting and Clinical Psychology, 70, 288-298. doi: 10.1037/0022-006X.70.2.288 ]. Forty-one GAD participants were assigned randomly to CBT (n = 22) or BT (n = 19). Both treatments contained RT and RIA ratings within 13/14 sessions. Analyses used generalized additive mixed models (GAMMs), which accounted for longitudinal nonindependence and examined nonlinear trajectories of change. RESULTS: All participants improved significantly regardless of RIA. "Change trajectory of RIA level did not predict outcome". Instead, lower peak RIA predicted fewer GAD symptoms at post-treatment and greater likelihood to continue to improve during follow-up. Also, timing of peak was important. Whereas lower peak early in therapy did not predict outcome, lower peak during the last third of treatment did. Peak RIA's effect was neither accounted for by baseline symptom severity, treatment condition, comorbidity, nor by preceding or concurrent anxiety symptom change. CONCLUSIONS: People with consistently low peak RIA and/or who fully habituate to RIA by the end of therapy respond optimally to relaxation-based treatments.

A BRIEF ECOLOGICAL MOMENTARY INTERVENTION FOR GENERALIZED ANXIETY DISORDER: A RANDOMIZED CONTROLLED TRIAL OF THE WORRY OUTCOME JOURNAL.

BACKGROUND: The efficacy of many cognitive behavioral component interventions has not been examined, with worry outcome monitoring among them. METHODS: To address this issue, 51 participants with clinical levels of generalized anxiety disorder were randomly assigned to a treatment or control condition for 10 days. The treatment condition consisted of a brief ecological momentary intervention termed the Worry Outcome Journal (WOJ). WOJ participants recorded worries and tracked their outcomes, rating worry distress, interference, and expected outcome probabilities. Thought log (TL) control participants completed a record of their everyday thoughts and rated associated distress. All participants made four entries on paper each day when randomly prompted by text message. They then entered their paper contents online each night. After 30 days they reviewed their contents electronically and completed follow-up measures. RESULTS: Primary results revealed significant reductions in worry for WOJ users compared to TL users at postintervention. A marginally significant difference was found at 20-day follow-up and treatment gains were maintained. Secondary analyses showed no harmful increases in worry beliefs for WOJ users, as well as preliminary evidence for decreases in beliefs about the uncontrollability of thoughts in both groups. CONCLUSION: The WOJ may be a viable therapist-independent treatment for reducing worry, even after only 10 days of use.

The taunting of parentally bereaved children: an exploratory study.

This exploratory study addresses the rarely mentioned, minimally investigated topic of peer taunting of parentally bereaved children. It suggests that social support cannot be adequately conceptualized or measured on an essentially one-dimensional scale from high to low support. The data are derived from lengthy semistructured transcribed research interviews of bereaved children. Using conservative criteria, 7 of the 35 children were found to have experienced direct, raw taunting about their loss. The varied forms of taunting experienced are described, as well as a range of victim reactions. Suggestions of foci for future research are presented.