(PS9-A25) Contrast Avoidance Reduction in GAD from Savoring Positive Emotions: Randomized Controlled Trial Results

Studies have not yet examined whether clinical intervention can reduce contrast avoidance specifically. Research suggests those with GAD dismiss positive emotions with worry to prevent unexpected shifts toward negative emotion (Newman & Llera, 2011). This aspect of contrast avoidance is known as “kill-joy thinking.” Kill-joy thinking may be treated by upregulating positive affect through savoring—attending to, amplifying, and extending positive emotions (Bryant, 2007). Continued engagement with positive emotions is incompatible with the dismissal of positive emotion. Furthermore, extending the duration of positive affect may indirectly allow for exposure to negative shifts. It may also lead them to tolerate simply being vulnerable to potential future shifts, whether or not they occur. Habituation to emotional contrasts should reduce contrast avoidance motivation and, in turn, the need for worrying. Accordingly, we designed an intervention for reducing contrast avoidance by increasing engagement with and extension of positive emotion—SkillJoy. The current study tested whether or not this smartphone-based ecological momentary intervention (EMI) would reduce contrast avoidance in a GAD sample.

A two-group randomized controlled trial compared SkillJoy with an active EMI control. The current sample included 85 participants who met DSM-5 criteria for GAD by clinical interview. Participants were randomly assigned to either SkillJoy or an active treatment control EMI. Participants took the Penn State Worry Questionnaire and the Contrast Avoidance Questionnaire at baseline and 8^th day post-trial. For 7 days, they used their EMI on their smartphones. Each EMI included 9 brief daily prompts to complete exercises at fixed and random times. SkillJoy prompted users to attend to positive aspects of the present moment and recent memories, anticipate positive future events, and to plan, engage in, and actively savor enjoyable activities. The active control consisted of nearly identical planning, present-moment awareness, and self-monitoring prompts, but omitted savoring practices. Analyses included longitudinal linear mixed models and multilevel simple slopes analysis with multiple imputation. We examined differences in change trajectories of contrast avoidance from pre- to post-trial between and within conditions.

Simple slopes analyses showed that SkillJoy users had a significant reduction in contrast avoidance (t(83) = -2.92, p = .004, d = -0.64), yet active control users did not change (t(83) = -0.54, p = .590, d = -0.12). In linear mixed models, there was a marginally significant interaction between condition and time trend predicting reduction in contrast avoidance with a large effect size: SkillJoy resulted in greater reductions in contrast avoidance than the active control (t(83) = -7.12, p = .083, d = -1.56). Preliminary analyses showed greater reductions in contrast avoidance in the first half of treatment predicted greater decreases in worry to post-trial (B = .47, t(64) = 4.28, p </em>< .001, d = 1.07). These results suggest contrast avoidance may respond to targeted intervention, possibly contributing to savoring’s ameliorative effect on worry. Additional, complete analyses and results will be available by ABCT 2022.