The everyday emotional experiences of people with generalized anxiety disorder

It is innovative software that will transform daily diary studies

Elizabeth Pawluk

At a Glance

Study-Facts

  • Context: Doctoral Research Study
  • Number of participants: 70
  • Number of days per participants: 7
  • Number of prompst per Day: 8
  • Number of Items: 21

Study

For my doctoral dissertation, I am interested in examining the everyday emotional experiences of people with generalized anxiety disorder (GAD; American Psychiatric Association, 2013). GAD is characterized by excessive and uncontrollable worry and anxiety. In addition to the intense experience of anxiety, people with GAD also report concentration difficulties, sleep disturbances, muscle tension, and irritability. The psychological and physiological effects of GAD are significant; people with GAD report increased health problems, including elevated risk of cardiac disease, lost work productivity, and negative interpersonal relationships (Pieper et al., 2007). Compared to the other anxiety disorders, GAD is one of the most treatment-resistant disorders (Borkovec & Ruscio, 2001); yet, it has received less research attention (Dugas, 2000). Thus, there is a strong need to continue investigating the factors that maintain this chronic and pervasive disorder.

A growing body of research suggests that difficulties with emotion and emotion regulation have a significant role in the development and maintenance of GAD. To better understand this relationship, Mennin and colleagues (2005) proposed the emotion dysregulation model of GAD. Empirical tests of the model suggest that there two main factors that contribute to emotion dysfunction in people with GAD: (1) the experience of emotions at a heightened intensity and (2) engaging in maladaptive emotion regulation strategies when experiencing distress. Moreover, worry is argued to be one of the maladaptive coping strategies that people with GAD use in an attempt to attenuate or control their emotional experiences (Mennin et al., 2005).
To date, most of our knowledge on the generation and regulation of emotion in people with GAD is based on cross-sectional correlational studies and laboratory experiments; therefore, it is unknown the extent to which these findings generalize to their everyday emotional experiences. The present study has three primary aims: First, to examine the extent to which people with GAD differ from healthy people on their experience of negative emotions in daily life. For example, examining the extent to which people with GAD report greater intensity, increased variability, and longer duration of negative emotions compared to people without GAD. Second, to examine the extent to which engaging in worry affects the emotional experiences of people with GAD compared to healthy controls. Third, to investigate the extent to which people with GAD exhibit greater emotional reactivity following self-appraised negative and positive events in daily life.

Given that emotional experiences fluctuate over time, there are limitations to how accurate cross-sectional designs and once-daily diary assessments can be in providing a description of these dynamic experiences. Momentary examinations of people’s emotions via experience sampling methodology (ESM); however, can provide more nuanced details about people’s everyday emotional experiences and their patterns of reactivity to events in their daily life (Ebner-Priemer & Trull, 2009).

Hypotheses:

Based in theory and research, it is expected that in within the context of their daily life, people with GAD will report experiencing greater mean intensity of negative emotions relative to healthy control participants. In addition, based on the emotion dysregulation model, which posits that people with GAD have heightened emotional intensity and difficulty with engaging in adaptive emotion regulation strategies to manage their emotional experiences (Fresco et al., 2013; Mennin et al., 2005); it is hypothesized that people with GAD will exhibit greater variability and inertia of negative emotions relative to healthy controls.

The present study will also extend previous laboratory-based examinations of worry by examining the impact of worry on emotional experiences in daily life. Based on the findings from experiments that worry is generally associated with increased negative emotion, it is hypothesized that the experience of negative emotions in daily life will be preceded by higher levels of worry. In addition, it is hypothesized that the association between worry and an increase in negative emotion will be significantly more pronounced in people with GAD compared to healthy control participants.

Finally, ESM provides an ecologically valid method to clarify the extent to which people with GAD have heightened subjective reactivity to life events that they appraise to be negative or positive, relative to healthy controls. Based on the emotion dysregulation model of GAD, it is hypothesized that people with GAD will report heightened negative reactions to negative events relative to healthy controls.

Study Design:

Seventy participants (35 GAD; 35 healthy controls) will be recruited to participate in the study.

Day 1: Initial laboratory session. Participants will attend an introductory session. Participants will be provided with instructions for the use of a smartphone to use during the ESM protocol. The smartphone will be programmed with the MovisensXS e-diary program (MovisensXS, Version 0.4.2437); which records participants’ responses and response time. Following this training, participants will complete a practice trial. Participants will be provided with contact information for the experimenter and will be encouraged to contact the experimenter if any questions arise.

Days 2 to 8: Daily experience sampling. Starting on day 2, all participants will complete the computerized ESM protocol for 7 consecutive days. Each day, participants will be prompted with a beep 8 times during a 12-hour time period for a total of 56 experience-sampling events (Reis & Gable, 2000). Participants will select the time that they would like the sampling to start each day (e.g., 8am to 8pm; 10 am to 10pm). At each prompt, participants will be asked to record the following:

- Intensity of emotion: Participants will be asked to rate the intensity of their current experience of 12 distinct emotions (e.g., anxious, relaxed) on a 9-point scale from 0 (not at all) to 8 (extremely).

- Worry: Participants will rate the degree to which they engaged in worry since the last prompt from 0 (not at all) to 8 (very much so).

- Event: At each prompt, participants will be asked if a significant emotional event occurred between the current prompt and the previous prompt. If an event occurred, participants will be asked to provide a subjective rating of the event’s valence on a continuum from 1 (negative) to 100 (positive) (adapted from Thompson et al., 2012).

- In addition, for descriptive purposes, participants will be asked to:

(1) Give a brief written statement of what occurred in concrete terms (e.g., argument with friend).
(2) Rate the event on the level of importance, the level of stressfulness, and the extent to which they were expecting the event to occur on a 9-point scale (0 = not at all; 8 = very) (Bylsma et al., 2011).
(3) Indicate if the event involved another person (yes or no) and their relationship with the person, including friends, coworker/supervisor, significant other, parent/relative, children, clients/customer/student, stranger, and/or a pet (Bylsma et al., 2011; Myin-Germeys et al., 2003).

Day 9: Return to laboratory: Following Day 8, participants will return to the laboratory with their smartphone.

In sum, the present study represents an important contribution to the research on emotion dysregulation in GAD by studying people’s emotional experiences in their daily life. To the best of my knowledge this is the first study to examine the momentary emotional experiences of people with GAD compared to people with no psychopathology. Moreover, this study will add to existing literature by clarifying how emotions are influenced by worry and people’s reactivity to negative and positive events in daily life. Overall, the findings from the present study will advance the current theoretical understanding of the experience and regulation of emotions in people with GAD and may provide additional empirical support for targeting difficulties with emotion regulation and worry in the treatment of GAD.