Intentional Worrying to Avoid Negative Emotional Contrasts in GAD and MDD

According to results published in the Journal of Anxiety Disorders, in individuals with generalized anxiety disorder (GAD) and major depressive disorder (MDD) worry and rumination are associated with increased anxiety and sadness and decreased happiness, regardless of disorder severity. Additionally, the effects of higher worry and rumination, combined with pre- and post-event reduced negative affect, suggest that these worry habits may be reinforced by the not only the relief event, but also increased positive emotional contrasts (PECs).

Conducted by researchers at Pennsylvania State University, the study examines how these repetitive negative thinking patterns contribute to emotional regulation and whether they enhance positive emotional contrast in response to life events.

The researchers recruited 161 participants, including 76 individuals diagnosed with GAD and/or MDD and 85 healthy control individuals. Using ecological momentary assessment, researchers tracked participants’ emotional fluctuations over 8 days.

Using the Generalized Anxiety Disorder Questionnaire-IV, Beck’s Depression Inventory-II, participants rated their levels of worry, rumination, emotional states, and experiences of relief and positive events multiple times per day. The researchers also conducted the Diagnostic Interview for DSM-5 Anxiety, Mood, and Obsessive-Compulsive and Related Disorders to confirm eligibility.

Relief events were defined as situations where outcomes were better than anticipated, whereas positive events were those perceived as generally favorable.

Baseline measures indicated that individuals with GAD and MDD exhibited significantly higher levels of worry and rumination compared to healthy control individuals. Moreover, those with these conditions were more likely to intentionally engage in pessimistic thinking as a strategy to enhance feelings of relief or positive surprise when good events occurred (P<.001, d=.95 for GAD; d=.94 for MDD).

Higher levels of worry and rumination were also associated with increased decreases in anxiety and sadness, as well as greater increases in happiness following relief and positive events. This pattern was observed across all participants, regardless of the severity of their GAD or MDD symptoms, suggesting that worry and rumination may function as emotional regulation mechanisms. Additionally, individuals with greater symptom severity were more likely to report intentionally using these thought patterns to enhance PECs, reinforcing the cycle of negative thinking.

“…[T]he study suggests that individuals who engage in pathological worry and rumination, such as those with GAD and depression, intentionally worry and ruminate to increase the possibility of experiencing transient positive emotional state,” the study authors concluded. “However, these fleeting moments of positive emotional state come only at the cost of enduring perpetual state of negativity.”

Study limitations include the predominantly college-aged sample, which may limit generalizability to older populations, and reliance on self-reported measures, which are subject to recall bias.

This article originally appeared on Psychiatry Advisor