Enhancing positive emotions in anxiety disorders: a preliminary evaluation of a CBT module targeting disturbances in positive emotion regulation

Research has shown that positive emotions are important to optimal health, functioning, and well-being, and contribute to resilience against psychological dysfunction. However, many clinical disorders, particularly anxiety and mood disorders, are associated with deficits in positive emotion that may contribute to symptoms and inhibit full recovery. Despite accumulating data identifying disturbances in positive emotion and positive emotion regulation in anxiety and depressive disorders, these deficits have received insufficient attention in treatment. The present study represents a preliminary evaluation of the feasibility and utility of a novel augmentation intervention for enhancing positive emotion in anxiety and depressive disorders. Nine patients with a range of principal anxiety disorders who had previously completed an initial course of cognitive-behavioral treatment at the Center for Anxiety and Related Disorders at Boston University (CARD) completed the study. The study utilized a single case experimental design, specifically a multiple baseline across participants design, with participants randomized to 2-, 4-, or 6-week baseline periods to control for the effect of time on outcome variables. Primary outcome variables were assessed weekly during the baseline and intervention phases to permit analysis of functional relationships between individual factors, specific treatment components, and therapeutic outcomes. Major assessments were conducted at baseline, pre-, post-treatment, and a 3-month follow-up. These included both self-report and independent evaluator-rated components. Results indicated that the intervention was effective in improving positive emotion regulation skills for 5 of the 9 of participants. The intervention was associated with significant improvements in anxiety and depressive symptoms, and preliminary effects sizes for pre- to follow-up changes in positive emotion regulation, symptoms, positive and negative emotion, functioning, quality of life, and well-being were moderate to large. Participants reported high acceptability and satisfaction with the study intervention. Qualitative feedback from participants highlighted several areas for improvement in the format and delivery of the intervention, such as increasing the number of sessions and providing a patient workbook, and these changes may increase the effectiveness of the intervention. Future research is needed to confirm the validity of these findings and evaluate the generalizability of these effects across patients and settings