Anxiety
How do worry and good moments shape anxiety in people with GAD?
Open access · cc by · source: Europe PMC
In people with generalised anxiety disorder, anxiety rose less when a worry episode followed another worry than when it followed a good moment, fitting the idea that worry is used to avoid sudden emotional drops.
Study at a glance
- Design
- Other — Observational ecological momentary assessment: participants self-reported each worry or positive episode on a smartphone for 7 days; time-lagged multilevel models.
- N
- N=49 · 49 adults with GAD contributing 514 episodes (331 worry, 183 positive); 55 started, 6 lost to technical problems, unreturned phones or non-compliance.
- Population
- Adults with a structured-interview GAD diagnosis about to start CBT in a University of Zurich trial
- Outcome
- Momentary anxiety (0-100 scale) and perceived controllability (1-9 SAM item) in each episode, and change in anxiety between consecutive episodes
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Key findings
Worry episodes came with much higher anxiety (62.68 versus 22.73 on a 0-100 scale) and lower controllability than positive episodes. The type of the previous episode did not predict the level of anxiety in the next one, but it did predict change: the rise in anxiety entering a worry episode was smaller if the prior episode was also worry, and the drop in anxiety entering a positive episode was larger if the prior episode was worry. Unexpectedly, a preceding worry episode predicted feeling more in control during the next worry episode.
Methodology
Forty-nine adults diagnosed with generalised anxiety disorder, waiting to start therapy, carried a smartphone for a week and logged every worry episode and every positive episode as it happened. For each episode they rated how anxious they felt and how much in control they felt. Multilevel models tested whether the type and intensity of the previous episode predicted anxiety, controllability and the change in anxiety in the next one.
Limitations
The design is observational, so it cannot show that worry is used on purpose to avoid emotional contrasts; the pattern is only consistent with that model. Participants chose when to report, so episodes may be missed or selectively logged, anxiety and control were each measured with a single item, and positive emotions were not measured. The authors note that reported worry could have included rumination, the sample was a small group of treatment-seeking Swiss patients with no comparison group, and they call the controllability finding preliminary.
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