Abstract
The contrast avoidance model (CAM) proposes that individuals suffering from generalized anxiety disorder (GAD) fear abrupt shifts from a positive to a negative emotional state (negative emotional contrast). We posited that greater fear of uncontrollable emotional experiences and intolerance of uncertainty could have an indirect effect on the relationship between avoidance of negative emotional contrasts and GAD. As an exploratory objective, we investigated whether fear of a specific emotion (anger, anxiety, depression and positive emotion) is implicated in the mediation. A sample of 233 adults completed measures of the study variables. Avoidance of negative emotional contrast was significantly related to GAD symptom severity. General fear of emotions and intolerance of uncertainty each mediated the relationship between the tendency to avoid emotional contrast and GAD symptoms. However, when the mediation analysis was repeated with fear of specific emotions, none of the feared emotions was a significant mediator, and neither was intolerance of uncertainty. The results suggest that the relation between avoidance of emotional contrasts and GAD symptoms is explained by a greater fear of emotional reactions and intolerance of uncertainty. However, when fear of a specific emotion was taken into account, none of these emotional experiences seems to drive this relationship, which is consistent with the CAM that does not posit a fear of a specific emotion, but rather the fear of an unexpected negative emotional contrasts.
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The data that support the findings of this study are available from the corresponding author, [NK], upon reasonable request.
References
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Author.
Arditte Hall, K. A., Coleman, K., & Timpano, K. R. (2020). Associations between social anxiety and affective and empathic forecasts: A replication and extension in a Mechanical Turk sample. Behavior Therapy, 51, 365–374. https://doi.org/10.1016/j.beth.2019.06.004
Behar, E., DiMarco, I. D., Hekler, E. B., Mohlman, J., Staples, A. M. (2009). Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders, 23, 1011–1023. https://doi.org/10.1016/j.janxdis.2009.07.006
Borkovec, T. D., Alcaine, O. M., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. In: R. Heimberg, C. Turk, & D. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 77–108). Guilford Press.
Buhr, K., & Dugas, M. J. (2002). The Intolerance of Uncertainty Scale: Psychometric properties of the English version. Behaviour Research and Therapy, 40, 931–945. https://doi.org/10.1016/S0005-7967(01)00092-4
Buhr, K., & Dugas, M. J. (2009). The role of fear of anxiety and intolerance of uncertainty in worry: An experimental manipulation. Behaviour Research and Therapy, 47, 215–223. https://doi.org/10.1016/j.brat.2008.12.004
Buhr, K., & Dugas, M. J. (2012). Fear of emotions, experiential avoidance, and intolerance of uncertainty in worry and generalized anxiety disorder. International Journal of Cognitive Therapy, 5, 1–17. https://doi.org/10.1521/ijct.2012.5.1.1
Buhrmester, M., Kwang, T., & Gosling, S. D. (2011). Amazon’s Mechanical Turk a new source of inexpensive, yet high-quality, data? Perspectives on Psychological Science, 6, 3–5. https://doi.org/10.1037/14805-009
Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: A preliminary test of a conceptual model. Behaviour Research and Therapy, 36, 215–226. https://doi.org/10.1016/S0005-7967(97)00070-3
Freeston, M. H., Rhéaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17, 791–802. https://doi.org/10.1016/0191-8869(94)90048-5
Hayes, A. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Press.
Huang, J. L., Curran, P. G., Keeney, J., Poposki, E. M., & DeShon, R. P. (2012). Detecting and deterring insufficient effort responding to surveys. Journal of Business and Psychology, 27, 99–114. https://doi.org/10.1007/s10869-011-9231-8
Kaneko, M., Ozaki, Y., & Horike, K. (2018). Curiosity about a positive or negative event prolongs the duration of emotional experience. Cognition and Emotion, 32(3), 600–607. https://doi.org/10.1080/02699931.2017.1324766
Kennedy, R., Clifford, S., Burleigh, T., Waggoner, P. D., Jewell, R., & Winter, N. J. (2018). The shape of and solutions to the MTurk quality crisis. Political Science Research and Methods, 1–16. https://doi.org/10.1017/psrm.2020.6
Koerner, N., McEvoy, P., & Tallon, K. (2020). Cognitive-behavioral models of generalized anxiety disorder (GAD). In A. L. Gerlach & A. T. Gloster (Eds.), Generalized Anxiety Disorder and Worrying (pp. 117–150). John Wiley & Sons. https://doi.org/10.1002/9781119189909.ch7
Llera, S. J., & Newman, M. G. (2017). Development and validation of two measures of emotional contrast avoidance: The contrast avoidance questionnaires. Journal of Anxiety Disorders, 49, 114–127. https://doi.org/10.1016/j.janxdis.2017.04.008
Malivoire, B. L., Stewart, K. E., Tallon, K., Ovanessian, M. M., Pawluk, E. J., & Koerner, N. (2019). Negative urgency and generalized anxiety disorder symptom severity: The role of self-reported cognitive processes. Personality and Individual Differences, 145, 58–63. https://doi.org/10.1016/j.paid.2019.03.021
Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2002). Applying an emotion regulation framework to integrative approaches to generalized anxiety disorder. Clinical Psychology: Science and Practice, 9, 85–90. https://doi.org/10.1093/clipsy.9.1.85
Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2005). Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behaviour Research and Therapy, 43, 1281–1310. https://doi.org/10.1016/j.brat.2004.08.008
Meyers, E. A., Walker, A. C., Fugelsang, J. A., & Koehler, D. J. (2020). Reducing the number of non-naïve participants in Mechanical Turk samples. Methods in Psychology, 3, 100032. https://doi.org/10.1016/j.metip.2020.100032
Moore, M. T., Anderson, N. L., Barnes, J. M., Haigh, E. A. P., & Fresco, D. M. (2014). Using the GAD-Q-IV to identify generalized anxiety disorder in psychiatric treatment seeking and primary care medical samples. Journal of Anxiety Disorders, 28, 25–30. https://doi.org/10.1016/j.janxdis.2013.10.009
Newman, M. G., & Llera, S. J. (2011). A novel theory of experiential avoidance in generalized anxiety disorder: A review and synthesis of research supporting a Contrast Avoidance Model of worry. Clinical Psychology Review, 31, 371–382. https://doi.org/10.1016/j.cpr.2011.01.008
Newman, M. G., Zuellig, A. R., Kachin, K. E., Constantino, M. J., Przeworski, A., Erickson, T., & Cashman-McGrath, L. (2002). Preliminary reliability and validity of the Generalized Anxiety Disorder Questionnaire–IV: A revised self-report diagnostic measure of generalized anxiety disorder. Behavior Therapy, 33, 215–233. https://doi.org/10.1016/S0005-7894(02)80026-0
Newman, M. G., Llera, S. J., Erickson, T. M., Przeworski, A., & Castonguay, L. G. (2013). Worry and generalized anxiety disorder: a review and theoretical synthesis of evidence on nature, etiology, mechanisms, and treatment. Annual review of clinical psychology, 9, 275–297. https://doi.org/10.1146/annurev-clinpsy-050212-185544
Osmanağaoğlu, N., Creswell, C., & Dodd, H. F. (2018). Intolerance of uncertainty, anxiety, and worry in children and adolescents: A meta-analysis. Journal of Affective Disorders, 225, 80–90. https://doi.org/10.1016/j.jad.2017.07.035
Robichaud, M., Koerner, N., & Dugas, M. (2019). Cognitive-behavioral treatment for generalized anxiety disorder: From science to practice (2nd ed.). Routledge.
Roemer, L., Salters, K., Raffa, S., & Orsillo, S. M. (2005). Fear and avoidance of internal experiences in GAD: Preliminary tests of a conceptual model. Cognitive Therapy and Research, 29, 71–88. https://doi.org/10.1007/s10608-005-1650-2
Rogers, T. A., Gorday, J. Y., Bardeen, J. R., & Benfer, N. (2022). Examining the factor structure and incremental utility of the ontrast Avoidance Questionnaires via bifactor analysis. Journal of Personality Assessment. https://doi.org/10.1080/00223891.2022.2081921
Schadegg, M. J. (2018). Contrast avoidance model: Relationship to intolerance of uncertainty and fear of change. (Master’s Thesis). Retrieved from http://hdl.handle.net/11603/13139
Sexton, K. A., & Dugas, M. J. (2009). Defining distinct negative beliefs about uncertainty: Validating the factor structure of the Intolerance of Uncertainty Scale. Psychological Assessment, 21, 176–186. https://doi.org/10.1037/a0015827
Treanor, M., Erisman, S. M., Salter-Pedneault, K., Roemer, L., & Orsillo, S. M. (2011). Acceptance-based behavioral therapy for GAD: effects on outcomes from three theoretical models. Depression & Anxiety, 28, 127–136. https://doi.org/10.1002/da.20766
Turk, C. L., Heimberg, R. G., Luterek, J. A., Mennin, D. S., & Fresco, D. M. (2005). Emotion dysregulation in generalized anxiety disorder: A comparison with social anxiety disorder. Cognitive Therapy and Research, 29, 89?106. https://doi.org/10.1007/s10608-005-1651-1
White, E. J., Grant, D. M., Kraft, J. D., Taylor, D. L., Deros, D. E., Nagel, K. M., & Frosio, K. E. (2021). Psychometric properties and prospective predictive utility of the contrast avoidance questionnaires. European Journal of Psychological Assessment, 37(6), 460–472. https://doi.org/10.1027/1015-5759/a000630
Williams, K. E., Chambless, D. L., & Ahrens, A. (1997). Are emotions frightening? An extension of the fear of fear construct. Behaviour Research and Therapy, 35, 239–248. https://doi.org/10.1016/S0005-7967(96)00098-8
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This research was conducted with the support of funding from Toronto Metropolitan University awarded to Naomi Koerner.
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Marcotte-Beaumier, G., Malivoire, B.L. & Koerner, N. Exploring the relationship between contrast avoidance and generalized anxiety disorder symptoms: the mediating roles of fear of emotion and intolerance of uncertainty. Curr Psychol 42, 25185–25192 (2023). https://doi.org/10.1007/s12144-022-03572-3
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DOI: https://doi.org/10.1007/s12144-022-03572-3