4 - (IOP 37) Savoring Changes Novel Positive Mindset Targets of GAD Treatment: Optimism, Prioritizing Positivity, Kill-joy Thinking, and Worry Mediation

Those with Generalized Anxiety Disorder (GAD) tend to dismiss positive feelings with worry to prevent being caught off-guard (“kill-joy thinking”; Newman & Llera, 2011). They also over-attend to signals of threat relative to reward (Bar-Haim et al., 2007). These processes construe future events and emotions as potentially threatening. Yet problems in negative orientation toward the future may be treated by savoring practices—purposeful engagement with positive emotions and experiences (Smith & Bryant, 2017). Positive emotional attention may support a frame of mind opposed to worrying—one that foresees a relatively more optimistic, enjoyable future. Savoring directly counters kill-joy thinking. It also builds acceptance of being vulnerable to unexpected negative emotional changes (LaFreniere & Newman, 2023a). Thus, savoring practices may strengthen mindset factors countering GAD, such as optimism, prioritization of rewarding activities, and refraining from “kill-joy” thoughts. Furthermore, pairing the 1) high disseminability of smartphone intervention with 2) the self-reinforcing nature of reward-based treatment may increase accessibility for unreached, underserved, or high-stigma populations. Accordingly, we designed an ecological momentary intervention (EMI) to train and practice savoring skills in GAD—SkillJoy. In a previous study, SkillJoy was efficacious in reducing worry and depression (LaFreniere & Newman, 2023b). The current study examines new positive mindset benefits of this EMI, while also testing mediation of worry decreases by savoring.

A two-group randomized controlled trial design compared SkillJoy with a closely-related active treatment control (ClinicalTrials.gov: NCT05040061). All 85 participants met full DSM-5 criteria for GAD by clinical interview and criterion measure. Participants were randomly assigned to either SkillJoy or the active control EMI. For 7 days, participants engaged in their EMI on their smartphones. Both EMIs included 8 daily prompts to complete exercises at fixed and random times. SkillJoy prompted users to attend to positive aspects of the present moment; plan and savor enjoyable activities; savor reminiscing and anticipation; and record enjoyable events. The active control consisted of nearly identical prompts, but omitted positive emotional attention.

Analyses included longitudinal linear mixed models and multilevel simple slopes analysis with multiple imputation. Bias-corrected boot strapping path analysis also examined mediation by increases in savoring using individuals’ worry slopes extracted from a multilevel model as outcome.

SkillJoy resulted in significantly greater pre- to post-trial increases in optimism (t(83) = 3.07 p < .001, d = 0.67), positive emotions (t(83) = 3.48, p = .007, d = 0.68), and prioritizing positive emotion activities and goals (t(83) = 6.73, p < .001, d = 1.48) than the active control. Both groups significantly decreased in kill-joy thinking from pre- to post-trial (t(83) = -2.57, p < .001, d = -0.56), with a larger effect size for SkillJoy (d = -1.34) than controls (d = -0.79). Decreases in worry pre- to post-trial were also significantly mediated by increases in savoring from pre- to mid-trial (95% bootstrap CI = [-2.58, -0.05]).