Why do individuals with generalized anxiety disorder and depression engage in worry and rumination? A momentary assessment study of positive contrast enhancement

Abstract

The contrast avoidance model suggests that individuals with generalized anxiety disorder (GAD) use worry to sustain negative emotionality and thus avoid a sharp increase in negative emotion. Maintenance of negative mood increases the probability of subsequent decreased negative and increased positive affect (positive emotional contrast; PEC) when worrisome outcomes are better than expected. However, occurrence of PECs via increased positive affect and its application to rumination are unclear. Using a momentary assessment design, we examined effects of worry/rumination on PECs associated with relief and positive events. Participants with GAD and/or major depressive disorder (MDD; N = 76), or without psychopathology (N = 85) rated the occurrence of relief and positive events, emotions, and repetitive thought 8x/day for 8 days. Higher vs. lower worry and rumination were associated with greater decreased anxiety and sadness, and greater increased happiness pre-to-post positive and relief events. Greater GAD and MDD symptoms predicted ongoing higher ratings on intentionally thinking pessimistically to be pleasantly surprised if something good happened. Results suggest that worry/rumination led to enhanced PECs via decreased negative and increased positive affect pre-to-post positive and relief events. Individuals with higher GAD and depression symptoms reported intentionally using worry/rumination to increase PECs in daily life.