1 - (SYM 130) Benefits of Savoring Practices for Generalized Anxiety Disorder: Outcomes and Mechanisms of the Skilljoy Intervention in a Randomized Controlled Trial

Research suggests those with generalized anxiety disorder (GAD) dismiss positive feelings with worry to prevent being caught off-guard (“kill-joy thinking”; Newman & Llera, 2011) and over-attend to threat relative to reward (Bar-Haim et al., 2007). Both positive and negative emotional dysfunction may be treated by savoring practices—attending to, amplifying, and extending positive emotions (Bryant, 2007). Savoring practices oppose kill-joy thinking, potentially reducing the use of worry to prevent emotional shifts. Thus, we designed an intervention for reducing worry by increasing positive emotion—SkillJoy (LaFreniere & Newman, 2023). The current study examines new benefits of this smartphone-delivered ecological momentary intervention (EMI). It also tests mediation of worry decreases by increased purposeful engagement with positive emotion (its theorized mechanism).

A two-group randomized controlled trial design compared SkillJoy with an active control. All 85 participants met full DSM-5 criteria for GAD by clinical interview. Participants were randomly assigned to either SkillJoy or a closely-related mindfulness control EMI. For 7 days, participants engaged in their EMI on their smartphones. Each EMI 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 engage in enjoyable activities; record positive experiences; note events that turned out better than expected; and look forward to positive events. The active control consisted of nearly identical prompts, but omitted savoring practices.

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 purposeful enjoyment using individuals’ worry slopes extracted from a multilevel model as outcome.

Average compliance was 92.63% of prompts. SkillJoy resulted in significantly greater reductions in worry and kill-joy thinking, as well as greater increases in positive emotions, savoring, prioritizing positive activities, and optimism than the control. For example, there was a greater reduction in worry from pre-to-post for SkillJoy users (t(83) = -7.55, p < .001, d = -1.66) and a greater increase in positive emotions (t(83) = 3.08 p = .007, d = 0.68). As hypothesized, decreases in worry pre- to post-trial were also significantly mediated by increases in purposeful enjoyment from pre- to mid-trial (95% bootstrap CI = [-2.58, -0.05]).