The Impact of Uncontrollability Beliefs and Thought-related Distress on Ecological Momentary Interventions for Generalized Anxiety Disorder: A Moderated Mediation Model

Overview

Journal J Anxiety Disord

Publisher Elsevier

Specialty Psychiatry

Date 2019 Jul 31

PMID 31362145

Citations 5

Authors

Lucas S LaFreniere

Michelle G Newman

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

Treatment as a moderator and executive function as a mediator of the effect of a mindfulness ecological momentary intervention for generalized anxiety disorder.

Zainal N, Newman M Psychol Med. 2024; :1-14.

PMID: 39402796 PMC: 11536110. DOI: 10.1017/S0033291724001958.

Mechanisms of Change in Digital Health Interventions for Mental Disorders in Youth: Systematic Review.

Domhardt M, Engler S, Nowak H, Lutsch A, Baumel A, Baumeister H J Med Internet Res. 2021; 23(11):e29742.

PMID: 34842543 PMC: 8665396. DOI: 10.2196/29742.

Worry and Positive Episodes in the Daily Lives of Individuals With Generalized Anxiety Disorder: An Ecological Momentary Assessment Study.

Visla A, Zinbarg R, Hilpert P, Allemand M, Fluckiger C Front Psychol. 2021; 12:722881.

PMID: 34777100 PMC: 8579489. DOI: 10.3389/fpsyg.2021.722881.

Ecological momentary interventions for mental health: A scoping review.

Balaskas A, Schueller S, Cox A, Doherty G PLoS One. 2021; 16(3):e0248152.

PMID: 33705457 PMC: 7951936. DOI: 10.1371/journal.pone.0248152.

The 4Ds of Dealing With Distress - Distract, Dilute, Develop, and Discover: An Ultra-Brief Intervention for Occupational and Academic Stress.

Mansell W, Urmson R, Mansell L Front Psychol. 2021; 11:611156.

PMID: 33391129 PMC: 7772151. DOI: 10.3389/fpsyg.2020.611156.

References

Wells A . A cognitive model of generalized anxiety disorder. Behav Modif. 1999; 23(4):526-55. DOI: 10.1177/0145445599234002. View

Hoyer J, Becker E, Roth W . Characteristics of worry in GAD patients, social phobics, and controls. Depress Anxiety. 2001; 13(2):89-96. DOI: 10.1002/da.1021. View

Wetherell J, Le Roux H, Gatz M . DSM-IV criteria for generalized anxiety disorder in older adults: distinguishing the worried from the well. Psychol Aging. 2003; 18(3):622-7. DOI: 10.1037/0882-7974.18.3.622. View

Brown T, Antony M, Barlow D . Psychometric properties of the Penn State Worry Questionnaire in a clinical anxiety disorders sample. Behav Res Ther. 1992; 30(1):33-7. DOI: 10.1016/0005-7967(92)90093-v. View

Ruscio A, Borkovec T . Experience and appraisal of worry among high worriers with and without generalized anxiety disorder. Behav Res Ther. 2004; 42(12):1469-82. DOI: 10.1016/j.brat.2003.10.007. View

Wells A, King P . Metacognitive therapy for generalized anxiety disorder: an open trial. J Behav Ther Exp Psychiatry. 2005; 37(3):206-12. DOI: 10.1016/j.jbtep.2005.07.002. View

Bar-Haim Y, Lamy D, Pergamin L, Bakermans-Kranenburg M, van IJzendoorn M . Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study. Psychol Bull. 2007; 133(1):1-24. DOI: 10.1037/0033-2909.133.1.1. View

Rodebaugh T, Holaway R, Heimberg R . The factor structure and dimensional scoring of the generalized anxiety disorder questionnaire for DSM-IV. Assessment. 2008; 15(3):343-50. DOI: 10.1177/1073191107312547. View

Preacher K, Hayes A . Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008; 40(3):879-91. DOI: 10.3758/brm.40.3.879. View

10.

Andrews G, Hobbs M, Borkovec T, Beesdo K, Craske M, Heimberg R . Generalized worry disorder: a review of DSM-IV generalized anxiety disorder and options for DSM-V. Depress Anxiety. 2010; 27(2):134-47. DOI: 10.1002/da.20658. View

11.

Meyer T, Miller M, Metzger R, Borkovec T . Development and validation of the Penn State Worry Questionnaire. Behav Res Ther. 1990; 28(6):487-95. DOI: 10.1016/0005-7967(90)90135-6. View

12.

Andrews G, Hobbs M . The effect of the draft DSM-5 criteria for GAD on prevalence and severity. Aust N Z J Psychiatry. 2010; 44(9):784-90. DOI: 10.3109/00048671003781798. View

13.

Llera S, Newman M . Effects of worry on physiological and subjective reactivity to emotional stimuli in generalized anxiety disorder and nonanxious control participants. Emotion. 2010; 10(5):640-50. DOI: 10.1037/a0019351. View

14.

Newman M, Llera S . A novel theory of experiential avoidance in generalized anxiety disorder: a review and synthesis of research supporting a contrast avoidance model of worry. Clin Psychol Rev. 2011; 31(3):371-82. PMC: 3073849. DOI: 10.1016/j.cpr.2011.01.008. View

15.

van der Heiden C, Muris P, Van der Molen H . Randomized controlled trial on the effectiveness of metacognitive therapy and intolerance-of-uncertainty therapy for generalized anxiety disorder. Behav Res Ther. 2012; 50(2):100-9. DOI: 10.1016/j.brat.2011.12.005. View

16.

van der Heiden C . Metacognitions in generalized anxiety disorder: theoretical and practical perspectives. Expert Rev Neurother. 2013; 13(2):135-41. DOI: 10.1586/ern.12.161. View

17.

Hirsch C, Mathews A, Lequertier B, Perman G, Hayes S . Characteristics of worry in generalized anxiety disorder. J Behav Ther Exp Psychiatry. 2013; 44(4):388-95. PMC: 3743042. DOI: 10.1016/j.jbtep.2013.03.004. View

18.

Hallion L, Ruscio A . Should uncontrollable worry be removed from the definition of GAD? A test of incremental validity. J Abnorm Psychol. 2013; 122(2):369-75. DOI: 10.1037/a0031731. View

19.

Tempesta D, Mazza M, Serroni N, Moschetta F, Di Giannantonio M, Ferrara M . Neuropsychological functioning in young subjects with generalized anxiety disorder with and without pharmacotherapy. Prog Neuropsychopharmacol Biol Psychiatry. 2013; 45:236-41. DOI: 10.1016/j.pnpbp.2013.06.006. View

20.

Moore M, Anderson N, Barnes J, Haigh E, Fresco D . Using the GAD-Q-IV to identify generalized anxiety disorder in psychiatric treatment seeking and primary care medical samples. J Anxiety Disord. 2013; 28(1):25-30. DOI: 10.1016/j.janxdis.2013.10.009. View