Category: Adult Anxiety - GAD
Cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD) targets worry, the putative cardinal feature of GAD. It is often assumed that treating worry will result in generalized improvement of other domains not specifically targeted in psychotherapy. In addition to heightened negative affect (NA; Brown, Chorpita, & Barlow, 1998), GAD is associated with significant deficits in positive affect (PA; Bosley, Fernandez & Fisher). This may result from a maladaptive tendency of anxious individuals to use worry as an emotion regulation strategy, by upregulating NA and downregulating PA. Individuals often see this as protection against the possibility of a sudden shift from PA to NA (Newman & Llera, 2011); this “contrast avoidance” is consistent with other findings that GAD patients tend to dampen positive emotions (Eisner et al, 2009). Given the significant emotion-related pathology in GAD, it is crucial to understand whether improvements in worry during CBT actually generalize to downstream changes in NA and PA. To this end, this poster presents a person-specific analysis of time series data collected during a trial of CBT for GAD to examine the relative changes in PA, negative affect (NA) and worry in seven participants during a 60-day period. While receiving weekly CBT, participants filled out daily web based surveys to assess worry as well as PA and NA. These intensive repeated measures data were subjected to person-specific regression analysis in order to delineate individual change trajectories; results indicated that while worry improved in 6/7 participants and NA improved in 5/7 participants, PA improved in only 2/7 participants and actually worsened in 3/7 individuals during the course of treatment. These findings indicate that treatment gains from traditional CBT for GAD may not generalize to improvements in PA regulation (perhaps maladaptive emotion regulation processes like “contrast avoidance” persist through treatment for some individuals). Utilizing person-specific analysis reveals that increasing the focus on PA regulation may improve treatment outcomes and quality of life for certain GAD patients. Thus, shifting focus toward a personalized psychotherapy for GAD might result in improved outcomes over traditional psychotherapy, especially in light of the finding that a traditional CBT approach leaves other crucial features of psychopathology untreated in some individuals. To this end, ideas to improve PA regulation in GAD treatment will be presented.