The transdiagnostic use of worry and rumination to avoid negative emotional contrasts following negative events: A momentary assessment study

J Anxiety Disord. 2023 Apr:95:102679. doi: 10.1016/j.janxdis.2023.102679. Epub 2023 Feb 6.


The contrast avoidance model (CAM) suggests that individuals with generalized anxiety disorder (GAD) are sensitive to a sharp increase in negative and/or decrease in positive affect. They thus worry to increase negative emotion to avoid negative emotional contrasts (NECs). However, no prior naturalistic study has examined reactivity to negative events, or ongoing sensitivity to NECs, or the application of CAM to rumination. We used ecological momentary assessment to examine effects of worry and rumination on negative and positive emotion before and after negative events and intentional use of repetitive thinking to avoid NECs. Individuals with major depressive disorder (MDD) and/or GAD (N = 36) or without psychopathology (N = 27) received 8 prompts/day for 8 days and rated items on negative events, emotions, and repetitive thoughts. Regardless of group, higher worry/rumination before negative events was associated with less increased anxiety and sadness, and less decreased happiness from before to after the events. Participants with MDD/GAD (vs. controls) reported higher ratings on focusing on the negative to avoid NECs and greater vulnerability to NECs when feeling positive. Results support the transdiagnostic ecological validity for CAM extending to rumination and intentional engagement in repetitive thinking to avoid NECs among individuals with MDD/GAD.

Keywords: Contrast avoidance; Generalized anxiety disorder; Major depressive disorder; Rumination; Worry.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Anxiety / psychology
  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / psychology
  • Depressive Disorder, Major* / diagnosis
  • Depressive Disorder, Major* / psychology
  • Emotions
  • Humans
  • Longitudinal Studies