The Contrast Avoidance Model: Conclusion and Synthesis of New Research in the Special Issue

Abstract

In this special series, new research on the contrast avoidance model (CAM) was presented, including studies on the role of CAM in the maintenance of chronic worry, the incremental validity of CAM, CAM as a mediator of the association between generalized anxiety disorder (GAD) and other variables, CAM as transdiagnostic, and interpersonal behaviors as a means to avoid negative emotional contrasts (NECs). Furthermore, the role of perseverative thought in relation to positive emotional contrasts (PECs) was explored. Studies indicated that higher worry was positively and negatively reinforced, a factor that is likely to contribute to the maintenance of GAD. Further, research demonstrated that CAM contributed unique variance to understanding GAD above and beyond other variables associated with GAD, such as intolerance of uncertainty and negative problem orientation. Additional research revealed the transdiagnostic nature of contrast avoidance, as well as the association between contrast avoidance and problem-solving deficits. In addition, both worry and rumination increased the likelihood of PECs. Further, data suggested that anxious individuals may use interpersonal strategies to avoid NECs. Finally, savoring positive emotions was found to reduce contrast avoidance, providing a novel intervention strategy to address contrast avoidance in individuals with GAD.

The goal of this series was to examine several novel aspects of the contrast avoidance model (CAM). In this conclusion, we synthesize the findings from this series and how they fit into the larger literature on CAM. The papers in this series covered several important topics, including the maintenance of chronic worry, the incremental validity of CAM, CAM as a mediator of the association between GAD and other variables, CAM as transdiagnostic, and interpersonal relationships and CAM. Below, we focus on each of these topics individually.

CAM. and Maintenance of Chronic Worry

CAM proposes that worry is positively and negatively reinforced. More specifically, CAM proposes that worry increases the likelihood of experiencing reductions in negative affect and increases in positive emotion if a feared event does not occur or if a positive event occurs (Newman & Llera, 2011). Such decreased negative/increased positive emotion is labeled as a positive emotional contrast (PEC). Evidence suggests that worry is concurrently associated with increased negative emotion (Andrews & Borkovec, 1988; Borkovec & Hu, 1990; Borkovec et al., 1983; Dickson et al., 2012; Llera & Newman, 2010, 2014; Ottaviani et al., 2016; Skodzik et al., 2016; Stapinski et al., 2010). Additional evidence supports the notion that by increasing and sustaining negative emotion, worry enables avoidance of negative emotional contrasts (NECs; Jamil & Llera, 2021; Kim & Newman, 2019; Llera & Newman, 2010, 2014, 2017; Newman et al., 2019) and a few studies have also shown that high (vs. low) worry led to an increased likelihood of reduced negative emotion one hour later (Newman et al., 2019) and after a prior worrisome vs. positive event (Vîslă et al., 2021). However, few studies had examined the degree to which PECs also consisted of increased positive emotion rather than just reductions in negative affect.

In the current special issue, Newman et al. (2022) was the first study to examine positive and negative emotions separately and concurrently through ecological momentary assessment (EMA) in relation to CAM in a sample of individuals with generalized anxiety disorder (GAD). This study also examined these emotions before and after social interactions in relation to prior high vs. low worry. The goal was to determine whether naturalistic worry was negatively reinforced through a reduction in negative affect and positively reinforced through increases in positive emotion from before to after social interactions. Results indicated that higher worry was concurrently associated with both increased negative emotion and decreased positive emotion relative to lower worry. This showed that whereas worry did not enable avoidance of concurrent negative emotion it did suppress positive emotion. In addition, high worry before social interactions was associated with a moderate decrease in negative affect from before to after the social interaction and a moderate increase in positive affect. Lower worry before a social interaction was associated with a small increase in negative affect from before to after the social interaction and a small decrease in positive affect from before to after the social interaction. This supported the CAM notion that higher worry increases the likelihood of experiencing PECs and lower worry increased the likelihood of experiencing NECs from before to after a social interaction. Further, it indicated that whereas higher worry was positively and negatively reinforced, low worry was positively and negatively punished in those with GAD. These are factors that are likely to lead to the maintenance of GAD and to the perception that worry serves a positive role.

Similar to Newman et al. (2022), Kim and Newman (2023) examined the reinforcement of worry and its potential role in the maintenance of GAD. However, these authors extended this examination to major depressive disorder (MDD) and rumination in response to positive events in an experimental study. As previously described, worry leads to an increased likelihood of PECs in momentary assessment studies (Newman et al., 2019; Newman et al., 2022; Vîslă et al., 2021); however, no study had examined whether rumination also led to greater increased positive affect in response to a positive mood induction compared to relaxation. Further, although prior research (Kim & Newman, 2022) had demonstrated that worry led to greater avoidance of NECs of fear (as compared to sadness) and rumination led to greater avoidance of NECs of sadness (as compared to fear), no studies had examined whether there were similar reductions in these specific emotions (mostly a reduction of fear in those who worried and a reduction of sadness in those who ruminated) in response to positive events.

Thus, Kim and Newman (2023) examined the specificity of reductions in negative emotions and increased positive emotion in response to a positive film clip in a group of individuals with pure GAD symptoms, pure MDD, and a non-anxious and non-depressed healthy control group. Participants were randomly assigned to ruminate, worry, or engage in relaxation and then watched an enjoyable video. Across all groups, both worry and rumination inductions led to immediate increases in fear and sadness and decreased positive affect compared to resting baseline whereas relaxation had no immediate effect on fear or amusement but led to a decrease in sadness. Worry increased fear more than rumination and rumination increased sadness more than fear, across all groups, suggesting that there was specificity in the effect of worry on fear (relative to sadness) and rumination on sadness (relative to fear) but also that these repetitive cognitive processes generalized across those with GAD, MDD, and healthy controls.

When examining response to the positive video, prior worry and rumination (compared to relaxation) led to sharper decreases in negative emotion in all groups, supporting that they led to PECs regarding decreased negative emotion. Furthermore, it supports the idea that both worry and rumination were negatively reinforced regarding decreased fear and sadness. Also, the video led to greater decreased fear (vs. sadness) in those who had worried and greater decreased sadness (vs. fear) in those who had ruminated. This again supported the idea of specificity of emotion related to worry vs. rumination. Amusement was increased to the same degree after the positive mood inducing video regardless of whether people had previously engaged with worry, rumination, or relaxation. This suggested that all three inductions led to positive reinforcement. At the same time, those with GAD who worried experienced more amusement in response to the video than depressed individuals who worried. Thus, worry was both positively and negatively reinforced in those with GAD. However, rumination, although it was also positively reinforced in those with MDD and GAD, did not lead to greater positive reinforcement than prior relaxation.

Taken together, these studies suggest that it is equally important for therapies to address the experience of positive emotions and reductions in negative emotions in response to positive events in those with GAD or MDD. Individuals with GAD often report that they believe that worry has an adaptive purpose (Borkovec & Roemer, 1995; Davey et al., 1996; LaFreniere & Newman, 2019; Llera & Newman, 2020), which may lead to some reluctance for treatment to reduce perseverative cognition. Learning how to tolerate NECs may reduce the need to worry and modify these beliefs about the adaptive role that worry or rumination may play for those with GAD or MDD.

Incremental Validity of CAM

Although CAM is one of the more recent explanatory models of GAD, there are other models that may seem overlapping and highly related to it. Two such models are intolerance of uncertainty (IU) and negative problem orientation (NPO). IU represents a tendency to fear what is unknown (Carleton et al., 2007). The idea is that people with GAD are particularly uncomfortable with ambiguous information or unknown outcomes, which lead to distress (Freeston et al., 1994). IU proposes that worry is used as a means to try to resolve and reduce distress to this uncertainty via anticipating possible outcomes (Ladouceur et al., 2000). Although IU and CAM perceive worry as means to prepare for an outcome, what is distinct about the two models is that in CAM people worry to increase and sustain their negative emotion to avoid experiencing a sharp increase in negative emotion if the outcome is negative or they encounter a negative event. In other words, CAM argues that people prefer feeling bad in a sustained way as a means to protect themselves from a sharp increase in their negative emotions. In IU people worry to avoid the unknown by generating possible outcome scenarios.

NPO involves seeing problems as threatening, lacking confidence in one’s ability to solve problems, and having negative expectations for the outcome of problem-solving strategies (Davey et al., 1992; Dugas et al., 1998; Robichaud & Dugas, 2005). NPO is considered to be highly related to IU, such that it is perceiving threat related to uncertainty in the face of problems. Whereas CAM focuses on fear of sharp increases in negative emotion, NPO focuses on fear related to uncertainty of solving life problems. NPO and IU are moderately associated with worry and GAD, but like CAM have also been shown to be transdiagnostic constructs (Clarke et al., 2017; Gentes & Ruscio, 2011; McEvoy et al., 2019).

In the current special issue, Llera and Newman (2023a) examined the incremental validity of CAM in predicting GAD symptoms above and beyond IU and NPO. As such, Llera and Newman set out to examine the degree to which contrast avoidance contributed to the prediction of GAD symptoms above and beyond NPO and IU. In a large sample of undergraduates with varying levels of worry and GAD, contrast avoidance accounted for additional variance in predicting GAD symptoms when controlling for IU and NPO. Further, contrast avoidance was a stronger predictor of GAD symptoms (accounting for 39% of the variance) than IU (29% of the variance). In contrast, NPO was a larger predictor of GAD symptoms (44% of the variance) relative to contrast avoidance (32%). This important work demonstrates that CAM contributes unique variance to understanding GAD above and beyond IU and NPO. It further demonstrates the importance of clinicians and researchers considering the avoidance of NECs in their conceptualizations of GAD.

CAM as transdiagnostic

Avoidance of NECs may not be specific to GAD, but instead may be a transdiagnostic experience across numerous internalizing disorders. For example, numerous disorders involve repetitive cognitive processes, such as worrying in GAD and social anxiety disorder (SAD), post-event processing in SAD, as well as rumination in MDD. Although the focus of each repetitive process is slightly different, with worry focusing on anticipating future threat (Borkovec et al., 1983) and rumination focusing on past events (Nolen-Hoeksema et al., 2008), the two perseverative cognitive processes are highly correlated in clinical and nonclinical samples (Segerstrom et al., 2000; Szkodny & Newman, 2019). Further, studies have shown that those with GAD or MDD experience comparable levels of worry and rumination (McEvoy et al., 2013). Moreover, research has shown there are few differences between ruminative thoughts and worries in individuals who experience both types of repetitive thinking (Watkins et al., 2005). Thus, studies examining rumination and worry have found numerous similarities (for a review of repetitive negative cognitive processes, see Ehring & Watkins, 2008; Szkodny & Newman, 2019).

It is possible that these repetitive cognitive processes may all lead to maintenance of negative affect that could result in avoidance of NECs. Thus, it is possible that both worry and rumination serve a role in avoidance of NECs. For example, it was suggested that rumination in MDD may maintain helplessness and lead to avoidance of NECs when one attempts to impact a situation and is unsuccessful (Nolen-Hoeksema et al., 2008). Relatedly, studies of both depression (Bean et al., 2022; Feldman et al., 2008) and anxiety disorders (Eisner et al., 2009; Malivoire et al., 2022) have found that both rumination and worry were associated with dampening, a cognitive style wherein individuals used negative thoughts to reduce positive emotions and increase negative emotions (Wood et al., 2003). Dampening may serve as a means of avoiding NECs similar to worry. In fact, studies have shown that worry and rumination led to dampening via reduced positive emotion (Kim & Newman, 2023; Newman et al., 2022) and increased negative emotions (Jamil & Llera, 2021; Kim & Newman, 2022). Similarly, studies showed that dampening via worry and rumination led to avoidance of NECs when exposed to a negative emotion-inducing experimental induction (Jamil & Llera, 2021; Kim & Newman, 2022). Sensitivity to NECs has also been associated with GAD symptoms, MDD symptoms, and to rumination (Jamil & Llera, 2021; Javaherirenani et al., 2021; Kim & Newman, 2019; White et al., 2021). As such, it is important to further examine the degree to which contrast avoidance predicts symptoms of disorders with different types of repetitive negative cognitive processes.

In the current issue, Newman, Rackoff, Zhu, and Kim (2023) examined the accuracy of the Contrast Avoidance Questionnaire-General Emotion scale (CAQ-GE; Llera & Newman, 2017), in identifying possible GAD, MDD, and SAD. The CAQ-GE measures efforts toward contrast avoidance unrelated to the means used to achieve that contrast avoidance (i.e., general mood dampening). Contrast avoidance was significantly higher in those with probable GAD, MDD, and SAD than in those without any of these diagnoses with large effect sizes (Cohen’s d = 1.32, 1.48 and 1.53, respectively). Further, using ROC analyses, the CAGE-GE was highly accurate in predicting the presence of these disorders (AUC = was 0.81, 0.87, and 0.83, respectively), relative to healthy controls with a cutoff score of 48.5 being the most predictive of probable GAD and SAD and a cutoff of 50.5 being the most predictive of probable MDD. Therefore, the CAQ-GE had an excellent ability to detect these disorders.

Similarly, another study in this special issue (Baik & Newman, 2023) examined whether different repetitive cognitive processes, worry, and rumination, were associated with avoidance of NECs (increased negative and decreased positive affect) when exposed to real world negative events. The study used EMA to examine these cognitive processes across college students and a community-based sample who were diagnosed with GAD and/or MDD symptoms or were nonanxious and not depressed. This was the first naturalistic study to examine reactivity to negative events and that also tested ongoing sensitivity to NECs or the application of CAM to naturalistic rumination. Across all individuals, worry and rumination before negative events were associated with higher concurrent anxiety and sadness and lower happiness and less likelihood of experiencing NECs from before to after a negative event. These attenuated NECs from high (vs. low) worry were evident in smaller increases in negative affect from before to after a negative event and smaller reductions in positive affect from before to after a negative event. Those in the GAD/MDD sample (vs. controls) reported more frequent negative events and indicated that the negative events were more unpleasant than controls. They also reported higher rates of worry and rumination than controls, greater ongoing intentional focus on negative thinking to avoid NECs and greater ongoing susceptibility to NECs when feeling positive. Taken together, these studies suggest that contrast avoidance is transdiagnostic and that numerous repetitive cognitive processes may serve to maintain a negative affective state in order to avoid NECs. These results also extend other findings that suggest that those with GAD/MDD are uncomfortable with sustained positive affect because it leaves them vulnerable to NECs.

Contrast Avoidance as a Mediator

Two studies in this special issue examined whether contrast avoidance could be a mechanism by which GAD was associated with other variables. These variables included problem solving (Llera & Newman, 2023b), negative problem orientation, fear of emotional responding, and negative beliefs about control (Boi & Llera, 2023). These studies helped to explain that contrast avoidance may be maintaining mechanism for a number of other negative processes.

In terms of problem-solving, those with GAD often see worrying as enhancing problem solving and coping (Borkovec & Roemer, 1995; Davey et al., 1996). This is the case, despite evidence suggesting that worry is actually associated with problem solving deficits. Such deficits include slowed response during difficult cognitive tasks (Borkovec, 1985; LaFreniere & Newman, 2019; MacLeod & Donnellan, 1993; Stefanopoulou et al., 2014), fewer functional behaviors compared to control participants (Anderson et al., 2009), and poorer problem solving effectiveness (Pawluk et al., 2017). Worry is also associated with negative attitudes toward problem solving in clinical (Dugas et al., 1998; Fergus et al., 2015; Ladouceur et al., 1998) and subthreshold samples (Anderson et al., 2009; Robichaud & Dugas, 2005) and problem solving impairment, including expecting negative outcomes to problems, seeing solutions as negative (Szabó & Lovibond, 2002, 2006), less effective solutions and less likelihood of implementation of solutions (Llera & Newman, 2020). However, little of the extant literature had focused on the role that contrast avoidance may have played in problem solving deficits in worriers.

In one study in the current special issue (Llera & Newman, 2023b), researchers set out to do exactly that. Llera and Newman (2023b) examined whether contrast avoidance mediated the association between chronic worry and problem-solving ability in a sample of college students with varying levels of anxiety. Contrast avoidance predicted less confidence in the solutions that individuals generated in response to a problem that they were experiencing, less intention to carry out solutions, and higher state anxiety after choosing a solution. Furthermore, contrast avoidance mediated the relationship between worry and intention to implement solutions, suggesting that for people who were worriers, discomfort with NECs and attempts to maintain negative emotion to avoid NECs predicted less likelihood in implementing their solutions. It may be that implementing a solution to a problem could lead to an NEC if the solution did not work, therefore delaying implementation of a solution could serve as a means to avoid NECs. Contrast avoidance also partially mediated the association between worry and state anxiety after choosing a solution, suggesting that high worriers may feel anxious after choosing a solution due to their discomfort with NECs.

Related to other variables consistently associated with GAD, Boi and Llera (2023) explored whether contrast avoidance mediated the prospective relationship between fear of emotional responding, NPO, negative beliefs about control and GAD symptom levels. These authors examined these relationships across three weeks in individuals with varying levels of GAD symptoms. Fear of emotional responding, NPO, and low perceived control predicted contrast avoidance one week later. Further, contrast avoidance measured at week 2, prospectively mediated the association between these three variables measured at week 1 and GAD symptoms measured at week 3. This suggests that worry, which heightens and sustains negative emotion, may be a method of coping with the distress associated with emotional fluctuations, negative outcomes from problems, or concerns about negative outcomes. It also suggests that contrast avoidance may be a mechanism by which these cognitive processes predict and maintain GAD symptoms.

Thus, interventions may need to provide psychoeducation to individuals with GAD about their distress related to possible negative outcomes and emotional fluctuations, help individuals with GAD to learn to tolerate uncertainty, the possibility of negative outcomes, and shifts in their emotions, and replace worrying with an appropriate method of coping with distress. Given the key role that contrast avoidance played in problem solving deficits, interventions designed to help high worriers to learn how to tolerate NECs, may also indirectly lead to improvements in problem solving. Additionally, coupling interventions that increase tolerance of NECs with problem solving skills, such as breaking down problems into small and achievable goals and rewarding oneself when implementing a solution to a problem, may be optimal.

Contrast Avoidance and interpersonal relationships

Interpersonal relationships are the most common worry topics in GAD (Roemer et al., 1997). Additionally, interpersonal difficulties are associated with worry and GAD (Newman & Erickson, 2010) and have been demonstrated in subclinical (Eng & Heimberg, 2006) and clinical samples of individuals with GAD (Beesdo-Baum et al., 2012; Newman & Erickson, 2010; Przeworski et al., 2011; Salzer et al., 2008). Individuals with GAD endorse having interpersonal problems in relationships with friends and romantic partners (Hunt et al., 2002; Shin & Newman, 2019; Whisman & Collazos, 2023; Whisman et al., 2000; Zaider et al., 2010). Worry is also associated with lack of awareness of one’s impact on others (Erickson & Newman, 2007; Shin & Newman, 2019) and romantic partners (Erickson et al., 2016; Shin & Newman, 2019). Further, interpersonal problems in individuals with GAD before therapy predicted poorer response to some therapies (Crits-Christoph et al., 2005; Gómez Penedo et al., 2017; Newman et al., 2017). However, the role of CAM in interpersonal relationships has not yet been elucidated.

In addition to worry serving as a means to regulate emotion and avoid NECs via sustained distress, interpersonal behaviors may serve as a means to regulate affect (Horn & Maercker, 2016; Niven, 2017), including to prevent NECs. In this issue, Erickson et al. (2023) examined the degree to which interpersonal strategies may have been used specifically to prevent NECs. This was examined in two samples, a nonclinical sample of university students with varying levels of worry and a treatment seeking sample of individuals with various types of internalizing disorders (with the largest proportion of participants experiencing SAD or GAD). Results indicated that interpersonal contrast avoidance strategies predicted increased worry the following week and maintenance of worry over time. Further, in a treatment seeking sample with heterogenous anxiety and related disorders, interpersonal contrast avoidance strategies were associated with both worry and interpersonal problems. These results support and extend the contrast avoidance model of worry into the interpersonal realm and suggest that interpersonal strategies may be used by those with anxiety symptoms to attempt to avoid NECs; providing further support for the notion that GAD and interpersonal problems are intricately intertwined.

Treating Contrast Avoidance Via Focus on Positive Emotions

Many papers have proposed that contrast avoidance could be treated via exposure to NECs (e.g., Newman et al., 2019; Newman et al., 2013). However, LaFreniere and Newman (2023) took a different approach. These researchers harnessed the evidence suggesting that those with anxiety disorders are uncomfortable with sustained positive emotion and thus use perseverative thought and other processes to dampen positive affect (Eisner et al., 2009; Kim & Newman, 2019; Malivoire et al., 2022; Newman & Llera, 2011). Therefore, these researchers examined the impact of a savoring intervention, which entailed attending to and actively sustaining positive emotion (Bryant & Smith, 2015), on contrast avoidance in individuals diagnosed with GAD. GAD individuals were randomly assigned to either savoring positive emotions 8 times a day for 7 days or actively being aware of their feelings and thoughts and reporting on them across the same time period. Savoring reduced contrast avoidance whereas the active self-monitoring control did not. This suggests that focusing on positive emotions may help those with GAD to habituate to the experience of sustained positive emotion and vulnerability to NECs; therein, potentially reducing the need to worry to maintain a negative emotional state and avoid NECs. Moreover, increased savoring from pre to mid-trial mediated the relationship between treatment condition and reductions in contrast avoidance. Thus, the mechanism of change in reducing contrast avoidance was increased savoring.

Summary and Future Directions

The studies in the current special issue lend further support to the importance of CAM in understanding the relationship between perseverative thought and emotional disorders. Studies demonstrated that CAM was a stronger predictor of GAD symptoms than IU and that it accounted for additional variance in predicting GAD symptoms when controlling for IU and NPO (Llera & Newman, 2023b). Additionally, Newman et al. (2022) found that worry was positively and negatively reinforced through PECs, and low worry was positively and negatively punished via NECs, factors that are likely to lead to the maintenance of GAD and to the perception that worry serves a positive role. Similar to this study, worry was associated with enhanced PECs in both reduced negative emotion and increased positive emotion after a positive film clip (Kim & Newman, 2023). Similarly, rumination was also associated with reduced negative and increased positive emotion in response to a positive film clip. These studies suggest that it is essential to address the preference for strategies that sustain distress to increase the probability of brief moments of positive affect in order to effectively treat GAD and/or MDD. Future studies should continue to examine the role of negative and positive reinforcement in the maintenance of rumination and worry using EMA.

Studies also demonstrated that contrast avoidance played a role in problem solving deficits and other variables frequently associated with GAD (Boi & Llera, 2023; Llera & Newman, 2023a). More specifically, contrast avoidance predicted less confidence in solutions to problems, less intention to carry out solutions, and higher anxiety after choosing a solution and contrast avoidance mediated the relationship between worry and intention to implement solutions, suggesting that worriers delay implementation of solutions to avoid NECs (Llera & Newman, 2023a). Furthermore, Boi and Llera (2023) found that contrast avoidance mediated the association between fear of emotional responding, emotional control, NPO, and later GAD, suggesting that worry may be used to cope with NECs or concern about negative outcomes to problems. These studies further support the central role that distress related to NECs plays in GAD and support the importance of those with GAD learning to tolerate NECs during therapy. Future studies should examine the relationship between contrast avoidance and other constructs associated with GAD such as emotion regulation.

Erickson et al. (2023) extended CAM to interpersonal relationships by showing that interpersonal strategies were used to prevent the experience of NECs in a weekly diary study. In a clinical sample, they also showed that avoidance of NECs were related to interpersonal problems and worry. These findings suggested that CAM may be a factor contributing to the quality of interpersonal relationships in individuals with GAD. Future research should examine interpersonal contrast avoidance within an EMA framework.

Several studies in this series found support for the notion that contrast avoidance was transdiagnostic, with individuals with GAD, MDD, and SAD all exhibiting elevations in contrast avoidance (Newman et al., 2023). In addition, both worry and rumination before negative events was associated with reduced NECs (Baik & Newman, 2023). Furthermore, in those with MDD and/or GAD there was greater likelihood of ongoing endorsement of positive emotions leaving them vulnerable to NECs as well as the value of both worry and rumination in avoiding NECs (Baik & Newman, 2023). Also both worry and rumination enhanced the likelihood of PECs regardless of diagnostic status (i.e. GAD, MDD, or healthy controls; Kim & Newman, 2023). This suggests that CAM may be a transdiagnostic process that underlies numerous repetitive cognitive processes that are associated with internalizing disorders. Future studies should examine other repetitive negative cognitive processes such as obsessive thinking in obsessive compulsive disorders (OCD) and intrusive memories in post traumatic stress disorder (PTSD). However, it is possible that the negative repetitive thinking in these disorders may not play a role in avoidance of NECs in the same way that rumination and worry do. Studies have shown distinct differences between obsessive thinking, intrusive memories, worry, and rumination (Ehring & Watkins, 2008). On the other hand, there is evidence that numerous repetitive cognitive processes (worry, rumination, post-event processing, dampening, and repetitive thinking load on one latent factor and that this factor is similarly associated with measures of SAD, MDD, GAD, and OCD symptoms (Arditte et al., 2016). This could suggest that these negative cognitive processes are similar and may serve similar roles in maintaining negative affect in order to avoid NECs.

Finally, LaFreniere and Newman (2023) found that savoring, attending to positive emotions, led to reduced contrast avoidance relative to active self-monitoring. This novel intervention may provide a means to address contrast avoidance in individuals with GAD. Future studies should examine the long-term impact of this intervention in individuals with GAD on contrast avoidance as well as on GAD symptoms. Further, studies should examine whether existing interventions for GAD, such as cognitive-behavioral therapy and third wave interventions for GAD reduce contrast avoidance to a similar degree as savoring. In addition, interventions should focus on addressing the role that contrast avoidance may play in interpersonal relationships in those with GAD and on the links between contrast avoidance and problem-solving deficits. The CAM provides a promising avenue for understanding the processes that may lead to the development and maintenance of emotional disorders and for advancements in treatments for these disorders to address maladaptive strategies to avoid NECs and to increase the probability of PECs.

Highlights.

• The contrast avoidance model (CAM) is transdiagnostic.

• Worry is positively and negatively reinforced, likely maintaining GAD.

• CAM contributes unique variance to understanding GAD.

• CAM is associated with problem-solving deficits.

• Interpersonal strategies may be used to avoid negative emotional contrasts.

• Attending to positive emotions effectively reduces contrast avoidance.