Network analyses of ecological momentary emotion and avoidance assessments before and after cognitive behavioral therapy for anxiety disorders

Laura E Meine; Miriam Müller-Bardorff; Dominique Recher; Christina Paersch; Ava Schulz; Tobias Spiller; Isaac Galatzer-Levy; Tobias Kowatsch; Aaron J Fisher; Birgit Kleim

doi:10.1016/j.janxdis.2024.102914

Network analyses of ecological momentary emotion and avoidance assessments before and after cognitive behavioral therapy for anxiety disorders

J Anxiety Disord. 2024 Aug:106:102914. doi: 10.1016/j.janxdis.2024.102914. Epub 2024 Aug 13.

Authors

Affiliations

¹ Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Zurich, Switzerland. Electronic address: [email protected].
² Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Zurich, Switzerland.
³ Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Zurich, Switzerland; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
⁴ Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Zurich, Switzerland; Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland.
⁵ Psychiatry, New York University School of Medicine, New York, NY, United States.
⁶ Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland; School of Medicine, University of St. Gallen, St. Gallen, Switzerland; Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland.
⁷ Department of Psychology, University of California at Berkeley, Berkeley, CA, United States.
⁸ Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Zurich, Switzerland. Electronic address: [email protected].

PMID: 39153405
DOI: 10.1016/j.janxdis.2024.102914

Abstract

Negative emotions and associated avoidance behaviors are core symptoms of anxiety. Current treatments aim to resolve dysfunctional coupling between them. However, precise interactions between emotions and avoidance in patients' everyday lives and changes from pre- to post-treatment remain unclear. We analyzed data from a randomized controlled trial where patients with anxiety disorders underwent 16 sessions of cognitive behavioral therapy (CBT). Fifty-six patients (68 % female, age: M = 33.31, SD = 12.45) completed ecological momentary assessments five times a day on 14 consecutive days before and after treatment, rating negative emotions and avoidance behaviors experienced within the past 30 min. We computed multilevel vector autoregressive models to investigate contemporaneous and time-lagged associations between anxiety, depression, anger, and avoidance behaviors within patients, separately at pre- and post-treatment. We examined pre-post changes in network density and avoidance centrality, and related these metrics to changes in symptom severity. Network density significantly decreased from pre- to post-treatment, indicating that after therapy, mutual interactions between negative emotions and avoidance were attenuated. Specifically, contemporaneous associations between anxiety and avoidance observed before CBT were no longer significant at post-treatment. Effects of negative emotions on avoidance assessed at a later time point (avoidance instrength) decreased, but not significantly. Reduction in avoidance instrength positively correlated with reduction in depressive symptom severity, meaning that as patients improved, they were less likely to avoid situations after experiencing negative emotions. Our results elucidate mechanisms of successful CBT observed in patients' daily lives and may help improve and personalize CBT to increase its effectiveness.

Keywords: Anxiety disorders; Avoidance; Cognitive behavioral therapy; Ecological momentary assessment; Negative emotions; Network analysis.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Anxiety Disorders* / psychology
Anxiety Disorders* / therapy
Avoidance Learning*
Cognitive Behavioral Therapy* / methods
Depression / psychology
Depression / therapy
Ecological Momentary Assessment*
Emotions* / physiology
Female
Humans
Male
Middle Aged
Treatment Outcome
Young Adult