Enhancing Social Connectedness in Anxiety and Depression Through Amplification of Positivity: Preliminary Treatment Outcomes and Process of Change

Abstract

Background

Anxiety and depressive disorders are often characterized by perceived social disconnection, yet evidence-based treatments produce only modest improvements in this domain. The well-established link between positive affect (PA) and social connectedness suggests that directly targeting PA in treatment may be valuable.

Method

A secondary analysis of a waitlist-controlled trial (N = 29) was conducted to evaluate treatment response and process of change in social connectedness within a 10-session positive activity intervention protocol—Amplification of Positivity (AMP)—designed to increase PA in individuals seeking treatment for anxiety or depression (ClinicalTrials.gov Identifier: NCT02330627). Perceived social connectedness and PA/negative affect (NA) were assessed throughout treatment. Time-lagged multilevel mediation models examined the process of change in affect and connectedness throughout treatment.

Results

The AMP group displayed significantly larger improvements in social connectedness from pre- to post-treatment compared to waitlist; improvements were maintained through 6-month follow-up. Within the AMP group, increases in PA and decreases in NA both uniquely predicted subsequent increases in connectedness throughout treatment. However, experiencing heightened NA throughout treatment attenuated the effect of changes in PA on connectedness. Improvements in connectedness predicted subsequent increases in PA, but not changes in NA.

Conclusions

These preliminary findings suggest that positive activity interventions may be valuable for enhancing social connectedness in individuals with clinically impairing anxiety or depression, possibly through both increasing positive emotions and decreasing negative emotions.

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Notes

  1. 1.

    Participants completed a functional magnetic resonance imaging (fMRI) scan at pre- and post-assessment (data presented elsewhere). Several of the eligibility criteria were implemented to ensure MRI safety and minimize confounding of the imaging findings (e.g., the upper age range was restricted due to changes in brain function that occur later in life).

  2. 2.

    We thank David Sheehan for giving us permission to use a preliminary version of the MINI for DSM-5 in this study.

  3. 3.

    We repeated the multilevel modeling analyses without including the four WL subjects who completed treatment following the WL period (i.e., AMP participants only). The pattern of findings and statistical significance was consistent with those reported in the main text for the full analysis sample.

  4. 4.

    All treatment completers (n = 15) finished at least one follow-up assessment (n = 14 at 3- and 6-month follow-up sessions). Missing data at a given follow-up assessment point were substituted using data from a participant’s last available assessment point (i.e., last observation carried forward). Note that the Greenhouse–Geisser corrected degrees of freedom were used given that Mauchly’s test of sphericity was significant, x2(5) = 18.86, p = 0.002.

  5. 5.

    We repeated the clinically significant change analysis using normative data from study 2 (M = 89.84, SD = 15.44) and study 3 (M = 91.90, SD = 14.83) reported in Lee et al. (2001). Results were identical to those reported in the main text using study 1 data.

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Funding

This research was supported by grants awarded to Charles T. Taylor from the University of California, San Diego, National Institute of Health Clinical and Translational Science Awards Program Grant UL1TR001442, and from the National Institute of Mental Health R61MH113769.

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Sarah Pearlstein and Sanskruti Kakaria declare no conflicts of interest. Charles T. Taylor declares that in the past 3 years he has been a paid consultant for Homewood Health, and receives payment for editorial work for UpToDate. Murray B. Stein declares that in the past 3 years he has been a paid consultant for Actelion, Aptinyx, Bionomics, Janssen, Neurocrine, Pfizer, and Resilience Therapeutics, and receives payment for editorial work for UpToDate and the journals Biological Psychiatry and Depression and Anxiety. Sonja Lyubomirsky declares that in the past 3 years she has been a paid lecturer for the Cleveland Clinic, Healthworld Ltd., and Metagenics, as well as a paid consultant for Biogen Idec.

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Taylor, C.T., Pearlstein, S.L., Kakaria, S. et al. Enhancing Social Connectedness in Anxiety and Depression Through Amplification of Positivity: Preliminary Treatment Outcomes and Process of Change. Cogn Ther Res 44, 788–800 (2020). https://doi.org/10.1007/s10608-020-10102-7

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Keywords

  • Anxiety
  • Depression
  • Positive activity intervention
  • Social connectedness
  • Affect
  • Randomized controlled trial