Differential responses of positive affect, negative affect, and worry in CBT for generalized anxiety disorder: A person-specific analysis of symptom course during therapy

Abstract

Introduction: Research indicates that individuals with generalized anxiety disorder (GAD) may experience deficits in positive affect (PA), and tend to dampen or intentionally suppress PA. Despite the presence of PA-related pathology in GAD, little is known about change in PA during GAD treatment. Objective: This study examines changes in PA, negative affect (NA) and worry in seven participants during cognitive behavioral therapy (CBT) for GAD. Method: Intensive repeated measures (i.e., time series) data were subjected to person-specific regression analysis to delineate individual change trajectories. Results: Significant improvement in worry was observed in all but one participant. Fear and irritability - indices of NA - each improved in 5/7 participants while sadness improved in 4/7 participants (worsening in one). Of all symptom domains, PA had the poorest treatment response: PA improved in only 2/7 participants and actually significantly worsened in 5/7 individuals even as NA and worry improved during therapy. Conclusion: These findings indicate that treatment gains from traditional CBT for GAD may not generalize to improvements in PA regulation, or even emotional functioning more broadly. This evidence is a call to increase the focus on PA regulation in treatment for GAD; perhaps PA could be a missing piece in our understanding of ways to bolster GAD treatment outcomes.