Positive/Negative Affect Transdiagnostic Method in Anxiety/Depression Symptoms

Reducing internalizing symptoms by decreasing negative affect vs increasing positive affect may be most successful with a transdiagnostic affective treatment approach, according to study findings published in Depression and Anxiety.

Researchers sought to investigate within-person reciprocal effects of symptoms (depression and anxiety) and negative and positive affect (NA, PA, respectively), including between-person associations with affect inertia. They aimed to investigate lagged bidirectional relations between daily NA and PA, and symptoms of depression and anxiety. They hypothesized daily NA would predict next-day symptoms of depression and anxiety, and daily PA would predict next-day depression only.

They conducted a self-report longitudinal study that included 776 individuals (53% women) at a partial hospital program in the Northeastern US who were receiving current treatment for psychological disorders from September 2017 to April 2019 and who completed up to 14 days of daily assessments of affect and symptoms. Patients were being treated for anxiety, mood, personality, and psychotic disorders. Average treatment length was 13.9±3.7 days, range 1 to 43 days.

Study participants were 90.1% White non-Hispanic and 62.4% were never married. More than 90% had at least some college, 60.2% were living with family, and almost 50% were unemployed.

The International Positive and Negative Affect Schedule Short Form was used to assess the daily NA (hostile, ashamed, upset, nervous, afraid) and PA (inspired, attentive, determined, active) of participants. Daily anxiety symptoms of participants were assessed with the 7-item self-report GAD scale. Severity of depression symptoms of participants was assessed with the self-report 9-item Patient Health Questionnaire.

Researchers found within-person modeling indicated differential cross-lagged affect-symptom effects. Their paths for NA and symptoms of depression and anxiety were significantly bidirectional, with effect sizes comparable in both directions. Patients were observed for PA and symptoms. Significance was only found for PA and depression with PA negatively predicting subsequent-day depression symptoms. However, depression symptoms did not predict subsequent-day PA.

Researchers noted NA-symptom relations were bidirectional, and PA-symptom relations were 1-directional (PA to depression) and significant only for depression.

Study limitations include the preponderance of White non-Hispanic individuals presenting to an intensive treatment program leading to a lack of generalizability, reliance on self-reported data introducing bias, and possible confounding due to lack of information concerning consistency of effects through various daily time periods and whether there’s a change over time of affect-symptom dynamics.

Researchers concluded “Our within‐person results reveal affect–symptom dynamics where NA and symptoms of anxiety and depression were mutually reinforced across daily life, whereas PA specifically and unidirectionally predicted subsequent‐day depression but not anxiety.” They wrote “Our results also underscore the importance of NA in the maintenance of anxiety symptoms, and PA in the maintenance of depression as particularly attractive targets for treatment.” They believe individuals with resistance to NA change can be more effectively treated by targeting NA rather than PA.