Upregulating Positive Emotion in Generalized Anxiety Disorder: A Randomized Controlled Trial of the SkillJoy Ecological Momentary Intervention

Objective: This study sought to determine if upregulating positive emotion both reduces symptoms and increases well-being for those with generalized anxiety disorder (GAD). Method: Eighty-five participants were diagnosed with GAD by both questionnaire and clinical interview. They were then randomly assigned to one of two seven-day smartphone-delivered ecological momentary interventions (EMIs). SkillJoy, a savoring ecological momentary intervention, prompted participants to attend to positive aspects of the present moment, engage in and savor planned enjoyable activities, record and reflect on recent positive experiences, note events that turned out well, and look forward to positive events. The active self-monitoring control (ASM) mirrored SkillJoy’s activities and wording, yet omitted savoring. It included attending to current thoughts and feelings, planning everyday activities, remembering and recording daily events, and anticipating important events. Participants were assessed at pre and posttreatment with a 30th day follow-up. Linear mixed models and simple slope analyses with multiple imputation examined outcome change between and within conditions. Results: Pretrial to posttrial, SkillJoy (vs. ASM) led to significantly greater reductions in worry and increases in positive emotions and savoring. Depression symptoms significantly decreased for both EMIs. Pretrial to follow-up, SkillJoy (vs. ASM) users showed significantly greater increases in savoring. Both SkillJoy and ASM significantly decreased worry (d = −1.02 vs. −0.51) and depression (d = −1.09 vs. −0.63) pre-to-follow-up, yet SkillJoy had greater effect sizes. SkillJoy significantly increased positive emotions and savoring pre-to-follow-up, yet ASM did not. Conclusion: SkillJoy may strengthen positive emotions and skills for enhancing them, while also reducing worry.